The treatment of low cardiac output syndrome following cardiopulmonary bypass using delayed sternal closure

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Critical Care Medicine

Background:

• Low cardiac output syndrome (LCOS) is a serious complication following coronary artery bypass grafting (CABG).
• Mechanical circulatory support devices like intra-aortic balloon pumps (IABP) or ventricular assist devices (VAD) are often used for LCOS but carry significant risks.
• Delayed sternal closure (DSC) is an alternative management strategy for specific patient populations.

Purpose of the Study:

• To evaluate the efficacy of delayed sternal closure (DSC) in resolving low cardiac output syndrome (LCOS) post-coronary artery bypass grafting (CABG).
• To determine if DSC can obviate the need for intra-aortic balloon pump (IABP) or ventricular assist device (VAD) in patients with contraindications to these devices.

Main Methods:

• Retrospective review of 3014 patients undergoing CABG.
• Identification of 60 patients with contraindications to IABP/VAD who required DSC for LCOS.
• Analysis of LCOS resolution rates, need for circulatory support, morbidity, and mortality associated with DSC.

Main Results:

• Delayed sternal closure (DSC) successfully resolved LCOS in 75% of indicated patients (45/60), averaging 1.6 days.
• Fifteen percent (15/60) of patients still required IABP or VAD after DSC.
• Postoperative morbidity (36.7%) and operative mortality (47%) were noted, but not directly attributed to DSC. Sternal wound infection rate was low (1.7%).

Conclusions:

• Delayed sternal closure (DSC) is a safe and effective method for managing low cardiac output syndrome (LCOS) after CABG in select patients.
• DSC can successfully avoid the need for mechanical circulatory support devices in a majority of cases.
• This approach potentially reduces the morbidity, mortality, and costs associated with IABP or VAD use.