Liberal use of delayed sternal closure for postcardiotomy hemodynamic instability

2002 ◽  
Vol 73 (5) ◽  
pp. 1484-1488 ◽  
Author(s):  
Curtis A Anderson ◽  
Farzan Filsoufi ◽  
Lishan Aklog ◽  
Robert S Farivar ◽  
John G Byrne ◽  
...  
Keyword(s):  
Hemodynamic Instability ◽  
Sternal Closure ◽  
Delayed Sternal Closure

scholarly journals Delayed Sternal Closure in Congenital Heart Surgery: A Risk-Benefit Analysis

2019 ◽  
Vol 22 (5) ◽  
pp. E325-E330 ◽  
Author(s):  
Ahmed Abdelrahman Elassal ◽  
Osama Saber Eldib ◽  
Ahmed Mohamed Dohain ◽  
Gaser Abdelmohsen Abdelmohsen ◽  
Ahmed Hassan Abdalla ◽  
...  
Keyword(s):  
Congenital Heart ◽  
Significant Risk ◽  
Hemodynamic Instability ◽  
Deep Sternal Wound Infection ◽  
Transposition Of Great Arteries ◽  
Sternal Closure ◽  
Icu Stay ◽  
Cardiac Compression ◽  
Delayed Sternal Closure ◽  
The Mean

Background: Delayed sternal closure commonly is used after pediatric cardiac surgery. Its benefits include relieving cardiac compression and stabilizing postoperative critically ill patients. Methods: We retrospectively reviewed the records of 72 patients, who had undergone delayed sternal closure, among 1,254 patients operated for congenital heart diseases. Indications of delayed sternal closure, perioperative hemodynamic and metabolic status, postoperative infection, and mortality were reported. Results: Transposition of great arteries was the most common preoperative cardiac pathology (26.3%). Bleeding and hemodynamic instability were the most frequent indications for delayed sternal closure, representing 38.8% and 34.7%, respectively. The mean duration of open chest was 3.45 days ± 1.46 days. The mean duration of ICU stay was 20.95 days ± 20.06 days. Two patients had deep sternal wound infection. Sepsis was found in 39 patients (54.1%), and the most common causative organism was coagulase negative (30.5%). ICU stay was a significant risk factor for sepsis (P = .003); duration of open sternum, period of mechanical ventilation (MV), and total hospital stay were not statistically significant risk factors. Sternal closure time (SCT) was affected by period of hemodynamic instability (P = .036). Bypass time, clamping time, and nonsurgical bleeding did not significantly affect SCT. The mortality rate was 15.2% (N = 11). Conclusion: Delayed sternal closure is a simple and effective technique that could prevent postoperative cardiac compression in hemodynamic instability states after pediatric cardiac operations.

Preliminary Experience with a New Device for Delayed Sternal Closure Strategy in Cardiac Surgery

2012 ◽  
Vol 35 (6) ◽  
pp. 471-476
Author(s):  
Francesco Santini ◽  
Francesco Onorati ◽  
Mariassunta Telesca ◽  
Giuseppe Faggian ◽  
Alessandro Mazzucco
Keyword(s):  
Steel Wire ◽  
Multiorgan Failure ◽  
Hemodynamic Instability ◽  
Elastic Membrane ◽  
Myocardial Recovery ◽  
New Device ◽  
Sternal Closure ◽  
Number Of Patients ◽  
Delayed Sternal Closure ◽  
Infective Complications

Purpose: Open chest management with delayed sternal closure (DSC) is a valuable strategy in the management of patients with postcardiotomy hemodynamic instability or severe coagulopathy The conventional extemporized material available for off-label sternal stenting however may limit its efficacy We evaluated outcomes of patients with refractory severe postcardiotomy cardiogenic shock (SPCCS) treated with DSC using a novel temporary sternal spreader (NTSS) which allows myocardial recovery by progressive controlled approximation of the sternal edges. Methods: Seven patients (4 male, mean age 66.5 ± 5 years) with refractory SPCCS showing acute hemodynamic instability at sternal closure, were implanted with the NTSS, consisting of stainless-steel branches linked to 2 diverging plates of polyether-ether ketone, whose progressive opening/closing mechanism can be controlled from outside the chest with a rotating steel wire. The sternal wound was closed by an elastic membrane to achieve a sterile field. Swan-Ganz monitoring was employed, and clinical outcomes evaluated. Results: The device was successfully implanted in all patients without device-related complications or failures. Progressive approximation of sternal edges, titrated on cardiac index values, was successfully completed allowing subsequent uneventful sternal closure in all. Mean time from SPCCS to sternal closure was 70 ± 21 hours. No patient developed infective complications or late hemodynamic instability after device removal and sternal closure. One patient (14%) died of multiorgan failure on postoperative day 9. Conclusions: Despite the limited number of patients enrolled, the NTSS proved safe and effective in allowing complete myocardial recovery after SPCCS, avoiding hemodynamic instability related to abrupt sternal closure, with no occurrence of infective complications.

scholarly journals Outcomes of Delayed Sternal Closure in Pediatric Heart Surgery: Single-Center Experience

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Daniel Hurtado-Sierra ◽  
Juan Calderón-Colmenero ◽  
Pedro Curi-Curi ◽  
Jorge Cervantes-Salazar ◽  
Juan Pablo Sandoval ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Therapeutic Option ◽  
Hemodynamic Instability ◽  
Control Group ◽  
Single Center ◽  
Sternal Closure ◽  
Pediatric Heart Surgery ◽  
Single Center Experience ◽  
Delayed Sternal Closure

Background. Delayed sternal closure (DSC) after cardiac surgery is a therapeutic option in the treatment of the severely impaired heart in pediatric cardiac surgery. Methods. A single-center retrospective review of all bypass surgeries performed over a 10-year period (2003–2012). Results. Of a total of 2325 patients registered in our database, the DSC group included 259 cases (11%), and the remaining 2066 cases (89%) constituted the control group (PSC). RACHS-1 risk was higher for the DSC group (74% had a score of 3 or 4) than for the PSC group (82% had a score of 2 or 3). The most frequent diagnosis for the DSC group was transposition of the great arteries (28%). We found out that hemodynamic instability was the main indication observed in patients aged ≤ 8 years (63%), while bleeding was the principal indication for patients aged ≥ 8 years (94%) (p≤0.001). The average time between surgery and sternal closure was 2.3±1.4 days. Overall mortality rates were higher for patients of the DSC group (22%) than for the PSC group (8.7%) (OR: 0.4 (95% CI: 0.4 to 0.5), p<0.05). There were six patients with DSC who developed mediastinitis (2.3%). The risk of mediastinitis was significantly higher when DSC was performed 4 days after the primary surgery. Conclusions. DSC is an important management strategy for congenital cardiac surgery in infants and children. The prolonged sternal closure time is associated with an increased rate of postoperative mediastinitis.

Management of open chest and delayed sternal closure with the vacuum assisted closure system

2008 ◽  
Vol 56 (S 1) ◽  
Author(s):  
T Fleck ◽  
P Mares ◽  
R Moidl ◽  
F Waldenberger ◽  
W Mohl ◽  
...  
Keyword(s):  
Closure System ◽  
Vacuum Assisted Closure ◽  
Sternal Closure ◽  
Open Chest ◽  
Delayed Sternal Closure

Delayed sternal closure: an effective procedure for life-saving in open-heart surgery

2010 ◽  
Vol 10 (2) ◽  
pp. 163-167 ◽  
Author(s):  
Haydar Yasa ◽  
Banu Bahriye Lafci ◽  
Levent Yilik ◽  
Mehmet Bademci ◽  
Aykut Sahin ◽  
...  
Keyword(s):  
Heart Surgery ◽  
Open Heart Surgery ◽  
Effective Procedure ◽  
Open Heart ◽  
Sternal Closure ◽  
Life Saving ◽  
Delayed Sternal Closure

Physiologic effects of delayed sternal closure following stage 1 palliation

2018 ◽  
Vol 28 (12) ◽  
pp. 1393-1403 ◽  
Author(s):  
Kimberly I. Mills ◽  
Sarah J. van den Bosch ◽  
Kimberlee Gauvreau ◽  
Catherine K. Allan ◽  
Ravi R. Thiagarajan ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Circulatory Arrest ◽  
Unit Length ◽  
Aortic Cross Clamp Time ◽  
Technical Performance ◽  
Sternal Closure ◽  
Ventilatory Parameters ◽  
Delayed Sternal Closure ◽  
Patients At Risk ◽  
Stage 1

AbstractBackgroundFollowing stage 1 palliation, delayed sternal closure may be used as a technique to enhance thoracic compliance but may also prolong the length of stay and increase the risk of infection.MethodsWe reviewed all neonates undergoing stage 1 palliation at our institution between 2010 and 2017 to describe the effects of delayed sternal closure.ResultsDuring the study period, 193 patients underwent stage 1 palliation, of whom 12 died before an attempt at sternal closure. Among the 25 patients who underwent primary sternal closure, 4 (16%) had sternal reopening within 24 hours. Among the 156 infants who underwent delayed sternal closure at 4 [3,6] days post-operatively, 11 (7.1%) had one or more failed attempts at sternal closure. Patients undergoing primary sternal closure had a shorter duration of mechanical ventilation and intensive care unit length of stay. Patients who failed delayed sternal closure had a longer aortic cross-clamp time (123±42 versus 99±35 minutes, p=0.029) and circulatory arrest time (39±28 versus 19±17 minutes, p=0.0009) than those who did not fail. Failure of delayed sternal closure was also closely associated with Technical Performance Score: 1.3% of patients with a score of 1 failed sternal closure compared with 18.9% of patients with a score of 3 (p=0.0028). Among the haemodynamic and ventilatory parameters studied, only superior caval vein saturation following sternal closure was different between patients who did and did not fail sternal closure (30±7 versus 42±10%, p=0.002). All patients who failed sternal closure did so within 24 hours owing to hypoxaemia, hypercarbia, or haemodynamic impairment.ConclusionWhen performed according to our current clinical practice, sternal closure causes transient and mild changes in haemodynamic and ventilatory parameters. Monitoring of SvO2following sternal closure may permit early identification of patients at risk for failure.

Early Versus Late Sternal Closure in Infants—Perioperative Associations and Outcomes

2021 ◽  
Vol 12 (5) ◽  
pp. 589-596
Author(s):  
Ahmed Asfari ◽  
Matthew G. Clark ◽  
Kristal M. Hock ◽  
Jordan L. Huskey ◽  
A. K. M. F. Rahman ◽  
...  
Keyword(s):  
Median Time ◽  
Heart Surgery ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Retrospective Chart Review ◽  
Future Research ◽  
Sternal Closure ◽  
Delayed Sternal Closure ◽  
Laboratory Variables ◽  
Neonates And Infants

Background: Delayed sternal closure (DSC) has been used for patients who develop bleeding, chest wall edema, and malignant arrhythmia following cardiopulmonary bypass. Multiple factors can influence the timing of when to perform DSC. We aimed to describe our DSC experience in neonates and infants by comparing outcomes between patients undergoing early (<48 hours) versus late DSC (> 48 hours). We explored the associations between specific clinical and laboratory variables and the timing of DSC. Methods: Retrospective chart review of neonates and infants (<one-year-old) with DSC after heart surgery from December 2012 to December 2018. Patients requiring extracorporeal membrane oxygenation were excluded. Results: A total of 121 patients were included in the analysis, 34% (n = 41) met late DSC criteria. The overall cohort had a 75% survival rate and a median time for open sternum of 42.5 hours (Q1:23-Q3:65). The median time for open sternum in the early and late DSC groups was 24 hours (Q1:21-Q3:43) and 93 hours (Q1:65-Q3:141), respectively ( P < .01). There was no statistical difference in mortality rate between groups. Patients with late DSC endured longer intensive care unit stays (median 24.3 days [Q1:13-Q3:35.3] vs 36.8 [Q1:23.9, 73.6]; P< .01) and a two-fold longer hospital stay compared to the early DSC group (multivariable analysis: relative risk = 2, 95% CI: 1.5-2.7; P < .01). Univariate analysis revealed patients with late DSC had higher median lactates both intraoperatively (7.6 [Q1:5.9-Q3:10.7] vs 9.3 [Q1:7.5-Q3:12.1]; P < .01) and 24 hours postoperatively (6.5 [Q1:4.3-Q3:10.3] vs 8.7 [Q1:5.7-Q3:14.70]; P = .03). A higher vasoactive inotrope score at 36 hours was associated with late DSC (odds ratio = 1.1, 95% CI: 1.01-1.2; P = .02). Conclusions: Future research that explores additional clinical and laboratory variables that can help guide DSC decision-making and timing is needed.

Pericardial Bridge for Delayed Sternal Closure

2021 ◽  
pp. 53-54
Author(s):  
John A. Elefteriades ◽  
Bulat A. Ziganshin
Keyword(s):  
Sternal Closure ◽  
Delayed Sternal Closure
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