Delayed Sternal Closure Following Complex Cardiac Surgery in Neonates

Area of Science:

• Pediatric Cardiac Surgery
• Neonatal Critical Care
• Surgical Outcomes Research

Background:

• Delayed sternal closure (DSC) is a strategy used in neonates following complex congenital cardiac surgery to manage hemodynamic and respiratory instability.
• It is particularly relevant for neonates with prolonged cardiopulmonary bypass (CPB), extended aortic cross-clamp times, or deep hypothermic circulatory arrest, who are prone to myocardial edema or bleeding.

Purpose of the Study:

• To evaluate the morbidity and mortality associated with DSC in neonates undergoing complex cardiac surgery.
• Specifically, to assess rates of superficial and deep sternal wound infections and the need for surgical debridement.

Main Methods:

• A retrospective review was conducted on neonates who underwent DSC after cardiac surgery between 2015 and 2021 at a single institution.
• Data collected included patient demographics, surgical variables, intensive care unit (ICU) and hospital length of stay, and mortality outcomes.

Main Results:

• The study included 187 neonates, with a mean age of 12.8 days and weight of 3.3 kg.
• Sternal wound complications were low: 1.07% required debridement, and 10.2% had superficial infections.
• Thirty-day mortality was 4.8%. Extracorporeal membrane oxygenation (ECMO) was significantly associated with 30-day mortality, while higher Risk Adjustment for Congenital Heart Surgery (RACHS-1) scores were linked to sternal wound infections.

Conclusions:

• Delayed sternal closure is a safe and effective therapeutic option for neonates experiencing instability after complex cardiac surgery.
• The procedure is indicated when sternal approximation is not tolerated due to myocardial edema, hemodynamic compromise, or coagulopathy.
• Higher RACHS-1 scores are identified as an independent risk factor for sternal wound infections in this population.