Open chest and delayed sternal closure after cardiac surgery

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Critical Care Medicine

Background:

• Open chest (OC) with delayed sternal closure (DSC) is a recognized technique for managing severe cardiac dysfunction post-surgery.
• Its application is particularly noted in cases of hemodynamic compromise, intractable bleeding, or persistent arrhythmias.

Purpose of the Study:

• To evaluate the efficacy and safety of open chest with delayed sternal closure in adult cardiac surgery.
• To assess the impact of DSC on patient survival, sternal wound complications, and long-term outcomes.

Main Methods:

• A retrospective analysis of 142 patients undergoing prolonged open chest procedures (4.2% of 3373 adult cardiac operations) between 1987 and 1993.
• Indications included hemodynamic compromise (121), bleeding (9), and arrhythmias (12). DSC was performed in 123 patients.
• Comparison of outcomes based on indications for OC and use of intraaortic balloon pump support.

Main Results:

• Of 123 patients undergoing DSC, 78.9% survived and were discharged.
• Mortality rates varied by indication: low cardiac output (38.6%), bleeding (33.3%), arrhythmias (27.3%), and hemodynamic collapse (0%).
• DSC without intraaortic balloon pump support showed significantly lower mortality (16.0% vs. 46.3%). Sternal morbidity rates were comparable to primary closure.

Conclusions:

• Open chest with delayed sternal closure is a valuable adjunct for managing postoperative cardiac dysfunction, hemorrhage, and arrhythmias.
• The procedure can be performed without increasing sternal morbidity.
• Long-term follow-up indicates encouraging survival rates and functional improvement (NYHA class).