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Delayed sternal closure following cardiac operation
Scandinavian Journal of Thoracic and Cardiovascular Surgery
|January 1, 1982
Summary
Delayed sternal closure after cardiopulmonary bypass surgery is a valuable technique for managing cardiac distension and bleeding. This approach improved survival in selected adult patients, offering crucial flexibility in complex cardiac surgeries.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Anesthesia
Background:
- Delayed sternal closure is a surgical technique used in specific cardiac surgery cases.
- Indications include cardiac distension, especially of the right ventricle, and persistent bleeding.
- This approach aims to manage complications arising during or after cardiopulmonary bypass.
Observation:
- Five adult cases with delayed sternal closure following cardiopulmonary bypass are reported.
- Reasons for delay were cardiac distension and intractable bleeding.
- Three infant cases with severe congenital heart disease also underwent open sternum procedures for similar reasons.
Findings:
- Four out of five adult patients survived after delayed sternal closure.
- One adult patient died 23 days postoperatively due to myocardial failure.
- All three infants with severe congenital heart disease died within hours of the operation from cardiac insufficiency.
Implications:
- Delayed sternal closure is a useful maneuver that adds flexibility to the management of complex cardiac surgical cases.
- Judicious application of this technique can improve outcomes in carefully selected patients.
- The findings highlight the critical balance between managing surgical complications and the risks associated with delayed sternal closure, particularly in neonates.