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Routine Primary Sternal Closure After the Norwood Procedure.

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World Journal for Pediatric & Congenital Heart Surgery
|September 9, 2025
PubMed
Summary
This summary is machine-generated.

Primary sternal closure (PSC) after the Norwood procedure is safe and effective, leading to better survival rates and shorter hospital stays compared to delayed sternal closure (DSC). DSC is not an independent risk factor for mortality or infection.

Keywords:
Norwoodhypoplastic left heart syndromeneonatesternum

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Area of Science:

  • Pediatric Cardiac Surgery
  • Congenital Heart Disease
  • Neonatal Intensive Care

Background:

  • Delayed sternal closure (DSC) is often used after the Norwood procedure to aid myocardial recovery.
  • This institution primarily uses primary sternal closure (PSC) unless high-risk factors are present.

Purpose of the Study:

  • To analyze the outcomes of primary sternal closure (PSC) versus delayed sternal closure (DSC) following the Norwood procedure.
  • To determine if DSC is an independent risk factor for mortality or infectious complications.

Main Methods:

  • Retrospective review of 116 neonates undergoing the Norwood procedure (2017-2022).
  • Patients were divided into PSC (n=80) and DSC (n=36) groups.
  • Comparison of baseline demographics, clinical characteristics, perioperative details, operative survival, and infectious complications.

Main Results:

  • PSC patients had lower preoperative inotrope use, fewer bypass runs, and less need for mechanical circulatory support.
  • Hospital survival was higher (91.3% vs 66.7%) and length of stay was shorter (29 vs 78 days) in the PSC group.
  • 5.2% of PSC patients required sternal reopening; DSC was not an independent risk factor for mortality (OR 1.42) or infection (OR 2.22).

Conclusions:

  • Primary sternal closure is a viable option for most neonates after the Norwood procedure, associated with favorable outcomes.
  • Delayed sternal closure may benefit selected high-risk patients.
  • The choice between PSC and DSC should be individualized based on patient-specific risk factors.