Routine Primary Sternal Closure After the Norwood Procedure.

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.