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

  • Ahmed Abdelrahman Elassal Department of Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
  • Osama Saber Eldib Department of Cardiothoracic Surgery, Faculty of Medicine, Zagazig University, Egypt
  • Ahmed Mohamed Dohain Department of Pediatrics, Cairo University, Cardiology Division, Egypt
  • Gaser Abdelmohsen Abdelmohsen Department of Pediatrics, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
  • Ahmed Hassan Abdalla Alahrar Teaching Hospital, Zagazig, Egypt
  • Osman Osama Al-Radi Department of Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
Keywords: Delayed - closure- congenital

Abstract

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.

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Published
2019-08-27
How to Cite
Elassal, A., Eldib, O., Dohain, A., Abdelmohsen, G., Abdalla, A., & Al-Radi, O. (2019). Delayed Sternal Closure in Congenital Heart Surgery: A Risk-Benefit Analysis. The Heart Surgery Forum, 22(5), E325-E330. https://doi.org/10.1532/hsf.2471
Section
Articles