Indications and Risks of Delayed Sternal Closure After Open Heart Surgery in Neonates and Early Infants

2012 ◽  
Vol 3 (2) ◽  
pp. 229-235 ◽  
Author(s):  
Ersin Erek ◽  
Yusuf Kenan Yalcinbas ◽  
Yasemin Turkekul ◽  
Arda Saygili ◽  
Ayse Ulukol ◽  
...  
Keyword(s):  
Heart Surgery ◽  
Univariate Analysis ◽  
Open Heart Surgery ◽  
Morbidity Rate ◽  
Wound Complications ◽  
Skin Closure ◽  
Sternal Closure ◽  
Delayed Sternal Closure ◽  
Patch Closure ◽  
Mechanical Ventilation Time

Background: Delayed sternal closure (DSC) has been an essential part of neonatal and infant heart surgery. Here, we report our single institution experience of DSC for eight years. Methods: The successive 188 patients were analyzed retrospectively. Sternum was closed at the end of the operation in 97 (51.6%) patients (primary sternal closure [PSC] group). Sternum was left open in 91 (48.4%) patients. Among them, 45 (23.9%) had only skin closure (DSCs group) and 46 (24.4%) had membrane patch closure (DSC membrane [DSCm] group). Median age was higher in PSC group (90 days) than DSCs (11 days) and DSCm groups (9.5 days). Results: Mortality was 1%, 11.1%, and 28.2% in PSC, DSCs, and DSCm groups, respectively ( P < .05). Univariate analysis recognized the neonatal age (odds ratio [OR] = 4.2), preoperative critical condition (OR = 5.3), cardiopulmonary bypass time >180 minutes (OR = 4), and cross clamp time >99 minutes (OR = 3.9) as risk factors for mortality. Total morbidity rate was higher in DSCm group (73.9%) than DSCs group (51.1%) and PSC group (23.7%; P < .001). Mechanical ventilation time, intensive care unit stay, and hospital stay were longer in DSCs and DSCm groups than PSC group ( P < .001). The incidence of hospital infection was also higher in DSCs (43.5%) and DSCm (33.3%) groups than PSC group (20.6%; P < .05). But there was no difference in the incidence of sternal wound complications, including both deep and superficial (4.1%, 8.8%, and 4.4%, respectively). Conclusion: Although the risk of sternal wound complications is not different, patients who necessitate DSC (using both skin and membrane closure techniques) have more complicated postoperative course than patients with PSC.

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

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.

scholarly journals Clinical Evaluation of Delayed Sternal Closure following Open Heart Surgery in Neonates and Infants.

1992 ◽  
Vol 21 (2) ◽  
pp. 149-154
Author(s):  
Masanao IMAI ◽  
Masahiro YAMAGUCHI ◽  
Hidetaka OHASHI ◽  
Yoshihiro OSHIMA ◽  
Naoki YOSHIMURA ◽  
...  
Keyword(s):  
Clinical Evaluation ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Sternal Closure ◽  
Delayed Sternal Closure ◽  
Neonates And Infants

scholarly journals Risk factors for delayed sternal closure after open-heart surgery in children under one year of age

2018 ◽  
Vol 10 (3-4) ◽  
pp. 288
Author(s):  
Stéphanie Delange ◽  
Jean-Benoît Thambo ◽  
Zakaria Jalal ◽  
Jean-Baptiste Mouton ◽  
Xavier Iriart ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Sternal Closure ◽  
Delayed Sternal Closure ◽  
One Year

A simple method of sternal traction to relieve compression of the heart after open heart surgery

1994 ◽  
Vol 4 (1) ◽  
pp. 82-83 ◽  
Author(s):  
Osamu Matsuki ◽  
Toshikatsu Yagihara ◽  
Yasunaru Kawashima
Keyword(s):  
Heart Surgery ◽  
Simple Technique ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Risk Of Infection ◽  
Simple Method ◽  
Sternal Closure ◽  
Delayed Sternal Closure

AbstractA simple technique is described with which to relieve postoperative compression of the heart. Although delayed sternal closure has conventionally been used to deal with postoperative compression, this maneuver always exposes the patient to the risk of infection. We have recently employed a simple method of sternal traction when there are signs of compression on temporary sternal closure. One or two couples of sutures in the sternum are used supported by bags of saline. This simple and effective method is applicable to patients, but especially to infants and neonates, without worrying about overindications.

scholarly journals OUTCOMES AND SAFETY OF STERNAL CLOSURE USING NON-ABSORBABLE POLYESTER BRAIDED SUTURE: SINGLE TERTIARY CARE CENTER EXPERIENCE OF 5 YEARS.

2020 ◽  
pp. 1-3
Author(s):  
Manpal Loona ◽  
Rahul Bhushan ◽  
Vaibhav chugh ◽  
Narender S. Jhajhria ◽  
Vijay Grover ◽  
...  
Keyword(s):  
Heart Surgery ◽  
Care Center ◽  
Tertiary Care ◽  
Open Heart Surgery ◽  
Median Sternotomy ◽  
Wound Complications ◽  
Sternal Dehiscence ◽  
Sternal Closure ◽  
Surgical Suture ◽  
Poly Ethylene

Introduction: Median sternotomy is done as regular practice in cardiac surgery, which can lead to morbidity and mortality after sternal closure. Inappropriate sternal closure can lead to sternal dehiscence, sternal wound infection and mediastinitis. Aim: Efficacy and outcomes of sternal closure in adults weighing 2.5 kgs to 50 kgs using non-absorbable polyester braided suture. Methods: Total of 1091 patients underwent standard median sternotomy, weighing between 2.5 kgs to 50 kgs had sternal closure using non absorbable, braided, sterile, surgical suture composed of Poly ethylene terephthalate [polyester]. A retrospective analysis was done to review outcomes and complications related to this sternal closure technique. Results: Nineteen patients developed superficial surgical site infection and sternal sinus were seen in eight patients, whereas one patient had sternal dehiscence during immediate post-operative period. No sternal sutures were broken during the sternal closure and no case of mediastinitis was seen. Follow-up analyses of patients were done for 6 months after open heart surgery. Conclusion: Sternal closure using non-absorbable polyester braided suture is a safe and effective method with very less chances of post sternal wound complications in patients weighing between 2.5 kgs to 50 kgs.

A Clinical Study of Isolated Aortic Valve Replacement: A Univariate Analysis of Risk Factors

1993 ◽  
Vol 1 (3) ◽  
pp. 137-142 ◽  
Author(s):  
Kim Wook Sung ◽  
Lee Jeong Ryul ◽  
Kim Ki Bong ◽  
Sung Sook Whan ◽  
Ahn Hyuk ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Heart Surgery ◽  
Nyha Class ◽  
Univariate Analysis ◽  
Survival Rates ◽  
Open Heart Surgery ◽  
Class Iii ◽  
Preoperative Serum

Between 1979 and 1990, 190 patients underwent isolated aortic valve replacement at Seoul National University Hospital in Korea. There were 11 (5.8%) in-hospital deaths. Univariate analysis identified advanced age (p = 0.026), preoperative serum GOT or GPT greater than 40IU/1 (p < 0.001, p = 0.003), NYHA Class III or IV (p = 0.029), preoperative mean pulmonary arterial pressure greater than 19 mmHg (p = 0.019), reoperation for aortic valve replacement (p = 0.035), second or third open heart surgery (p < 0.001), and use of mechanical valve (p = 0.008) as variables associated with increased in-hospital risk. Follow-up documented survival rates of 98.1% and 96.4% and event-free survival rates of 95.7% and 81.6% at 3 and 7 postoperative years, respectively. NYHA Class III or IV (p = 0.009), preoperative serum total bilirubin level greater than 1.2 mg/dl (p = 0.009), reoperation for aortic valve replacement (p = 0.03), second or third open heart surgery (p = 0.002), and use of mechanical valve were associated with decreased late survival and event-free survival.

Multicenter Quality Improvement Project to Prevent Sternal Wound Infections in Pediatric Cardiac Surgery Patients

2017 ◽  
Vol 8 (4) ◽  
pp. 453-459 ◽  
Author(s):  
Cathy Woodward ◽  
Richard Taylor ◽  
Minnette Son ◽  
Roozbeh Taeed ◽  
Marshall L. Jacobs ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Quality Improvement ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Wound Infections ◽  
Improvement Project ◽  
Sternal Closure ◽  
Increased Risk ◽  
Delayed Sternal Closure ◽  
Sternal Wound Infections

Background: Children undergoing cardiac surgery are at risk for sternal wound infections (SWIs) leading to increased morbidity and mortality. Single-center quality improvement (QI) initiatives have demonstrated decreased infection rates utilizing a bundled approach. This multicenter project was designed to assess the efficacy of a protocolized approach to decrease SWI. Methods: Pediatric cardiac programs joined a collaborative effort to prevent SWI. Programs implemented the protocol, collected compliance data, and provided data points from local clinical registries using Society of Thoracic Surgery Congenital Heart Surgery Database harvest-compliant software or from other registries. Results: Nine programs prospectively collected compliance data on 4,198 children. Days between infections were extended from 68.2 days (range: 25-82) to 130 days (range: 43-412). Protocol compliance increased from 76.7% (first quarter) to 91.3% (final quarter). Ninety (1.9%) children developed an SWI preprotocol and 64 (1.5%) postprotocol, P = .18. The 657 (15%) delayed sternal closure patients had a 5% infection rate with 18 (5.7%) in year 1 and 14 (4.3%) in year 2 P = .43. Delayed sternal closure patients demonstrated a trend toward increased risk for SWI of 1.046 for each day the sternum remained open, P = .067. Children who received appropriately timed preop antibiotics developed less infections than those who did not, 1.9% versus 4.1%, P = .007. Conclusion: A multicenter QI project to reduce pediatric SWIs demonstrated an extension of days between infections and a decrease in SWIs. Patients who received preop antibiotics on time had lower SWI rates than those who did not.

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