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Delayed sternal closure following open-heart operation
Insights
Delayed sternal closure offers hemodynamic stability and easier access to the heart in complex cardiac surgery cases. This technique improves outcomes for select patients, with a low infection rate.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Critical Care Medicine
Background:
- Delayed sternal closure is a surgical technique used in specific cardiovascular surgery scenarios.
- Indications include cardiac tamponade, poor lung compliance, hemodynamic instability, and the need for mediastinal support devices.
Purpose of the Study:
- To evaluate the outcomes and benefits of delayed sternal closure in patients undergoing open-heart procedures.
- To assess the safety and efficacy of this approach in managing complex postoperative conditions.
Main Methods:
- A retrospective review of 29 patients who underwent delayed sternal closure between June 1976 and December 1980.
- The procedure involved initial skin closure followed by delayed sternal approximation within 1-4 days.
Main Results:
- Delayed sternal closure provided significant hemodynamic stability and facilitated rapid access to the heart.
- The technique allowed for uncomplicated removal of intra-aortic balloon pumps.
- Long-term survival was observed in 19 of 29 patients, with only one minor superficial wound infection.
Conclusions:
- Judicious use of delayed sternal closure offers advantages in managing selected, high-risk cardiac surgery patients.
- The procedure enhances surgical flexibility and patient management without significantly increasing complication rates.
Abstract:
Between June, 1976, and December, 1980, 29 patients underwent delayed sternal closure at the Newark Beth Israel Medical Center. The indications were enlarged heart with tamponade when the mediastinum was closed, poor lung compliance, hemodynamic instability due to intractable arrhythmias or coagulopathy, and presence of a mediastinal assist device. Following an open-heart procedure, the retrosternal space may no longer accommodate the heart and approximation of the sternum will produce hypotension and elevation of right and left end-diastolic pressures. In such instances, only the skin is closed and between one to four days later, the wound is closed in a routine manner. There are several advantages of the procedure: hemodynamic stability; quick access to the heart for massage or evacuation of clots; and possibility of removing an intraaortic balloon in the ascending aorta without leaving a large Dacron tube. Of the 29 patients treated, 19 were long-term survivors and only 1 patient had a minor superficial wound infection. Although it is not recommended that this procedure be utilized routinely or indiscriminately, its judicious use will add flexibility in the management of selected and difficult cases.