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Delayed sternal closure after neonatal cardiac operations
M Hakimi1, H L Walters, W W Pinsky
1Department of Cardiovascular Surgery, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit 48201.
The Journal of Thoracic and Cardiovascular Surgery
|March 1, 1994
Summary
Primary elective open sternum with delayed closure effectively manages neonatal mediastinal compression post-cardiac surgery. This approach showed similar mortality to primary sternal closure, despite treating sicker infants.
Area of Science:
- Cardiovascular Surgery
- Neonatal Medicine
- Thoracic Surgery
Background:
- Neonatal cardiac surgery often necessitates sternal closure.
- Complications such as mediastinal compression can arise.
- Surgical techniques aim to optimize outcomes in critically ill neonates.
Purpose of the Study:
- To compare primary elective open sternum with delayed sternal closure versus primary sternal closure in neonates undergoing cardiac operations.
- To evaluate the efficacy and safety of these two sternal closure methods.
Main Methods:
- Retrospective analysis of 89 neonates undergoing cardiac operations.
- Comparison between primary elective open sternum/delayed sternal closure and primary sternal closure groups.
- Selective use of open sternum based on intraoperative hemodynamic or respiratory status.
Main Results:
- No significant difference in overall mortality between the two groups (20% vs. 14.7%).
- Shorter mechanical ventilation and hospital stay durations in the primary sternal closure group (p=0.0005 and p=0.004, respectively).
- 20.6% of primary sternal closure patients required delayed sternal reopening for low cardiac output, compared to one superficial wound infection in the delayed closure group.
Conclusions:
- Primary elective open sternum with delayed sternal closure is an effective strategy for managing neonatal mediastinal compression post-cardiac surgery.
- This approach demonstrates low morbidity and comparable mortality to primary sternal closure, even in critically ill neonates.
- Delayed sternal closure avoids the need for reoperation in a significant proportion of neonates who might otherwise require it for low cardiac output.