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Delayed sternal closure after cardiac operations in a pediatric population
S Tabbutt1, B W Duncan, D McLaughlin
1Department of Medicine, Harvard Medical School, Children's Hospital, Boston, Mass 02115, USA.
Summary
Delayed sternal closure in pediatric cardiac surgery is often necessary for patient stability. This approach, while associated with a 19% mortality rate, demonstrates low morbidity in a pediatric population.
Area of Science:
- Pediatric Cardiac Surgery
- Thoracic Surgery
- Critical Care Medicine
Background:
- Delayed sternal closure is a technique used in complex pediatric cardiac operations.
- Indications include myocardial distention, chest wall edema, or to prevent postoperative compromise.
Purpose of the Study:
- To assess the morbidity and mortality rates associated with delayed sternal closure.
- To evaluate the outcomes of delayed sternal closure in pediatric cardiac surgery patients.
Main Methods:
- Retrospective review of hospital records.
- Inclusion of patients who underwent delayed sternal closure after cardiac operations.
- Data collected from January 1992 to December 1995 at Children's Hospital, Boston.
Main Results:
- 178 patients underwent delayed sternal closure with a 19% overall mortality rate.
- Hypoplastic left heart syndrome was the most common diagnosis (29%).
- Successful closure was achieved in 89% of patients; significant hemodynamic and respiratory changes occurred during closure.
Conclusions:
- Delayed sternal closure is often necessary due to intraoperative conditions like edema or bleeding.
- It can be electively used to improve postoperative hemodynamic and respiratory stability.
- The study supports a low morbidity associated with this procedure in pediatric patients.