Early and Mid-Term Outcomes of Delayed Sternum Closure Strategy in Adult Cardiac Surgery: A Single-Center Experience

Sameh Alagha; Ferit  Çiçekçioğlu; Hasan  Ekim; Ökkeş Hakan Miniksar

doi:10.1532/hsf.5461

Authors

Sameh Alagha Cardiovascular Surgery Department, Yozgat Bozok University School of Medicine, 66100 Yozgat, Turkey https://orcid.org/0000-0002-7892-5471
Ferit Çiçekçioğlu Cardiovascular Surgery Department, Yozgat Bozok University School of Medicine, 66100 Yozgat, Turkey https://orcid.org/0000-0002-4809-0100
Hasan Ekim Cardiovascular Surgery Department, Yozgat Bozok University School of Medicine, 66100 Yozgat, Turkey https://orcid.org/0000-0002-7245-3872
Ökkeş Hakan Miniksar Anesthesiology and Reanimation Department, Yozgat Bozok University School of Medicine, 66100 Yozgat, Turkey https://orcid.org/0000-0001-5645-7729

DOI:

https://doi.org/10.1532/hsf.5461

Keywords:

delayed sternum closure, open sternum, cardiac surgery, cardiopulmonary bypass, hemodynamics

Abstract

Background: Delayed sternum closure is a crucial strategy in the management of hemodynamic instability after weaning from cardiopulmonary bypass. This study aimed to evaluate our outcomes with this technique in light of the literature. Methods: We retrospectively reviewed the data of all the patients who developed postcardiotomy hemodynamic compromise and intraaotic balloon pump was inserted between November 2014 to January 2022. Patients were divided into two groups: primary sternal closure group, and delayed sternum closure group. Patients' demographic data, hemodynamic parameters, and postoperative morbidities were recorded. Results: Delayed sternum closure was performed in 16 patients with an incidence of 3.6%. The most common indication was hemodynamic instability in 14 patients (82%), followed by arrhythmia in 2 patients (12%) and diffuse bleeding in 1 patient (6%). The mean time to sternum closure was 21 (±7) hours. Three patients died (19%), p > 0.999. The median follow-up period was 25 months. Survival analysis revealed that the survival rate was 92%, p = 0.921. Deep sternal infection was observed in one patient with (6%), p > 0.999. multivariate logistic regression analysis revealed that end-diastolic diameter [odds ratio (OR) 4.5, 95% CI (1.19–17), p = 0.027], right ventricle diameter [OR 3.9, 95% CI (1.3–10.7), p = 0.012] and aortic clamp time [OR 1.16, 95% CI (1.02–1.12), p = 0.008] were independent risk factors for delayed sternum closure. Conclusions: Elective delayed sternal closure is a safe and effective method for treating postcardiotomy hemodynamic instability. It can be performed with a low incidence of mortality and sternal infections.

Author Biographies

Ferit Çiçekçioğlu, Cardiovascular Surgery Department, Yozgat Bozok University School of Medicine, 66100 Yozgat, Turkey

Hasan Ekim, Cardiovascular Surgery Department, Yozgat Bozok University School of Medicine, 66100 Yozgat, Turkey

Ökkeş Hakan Miniksar, Anesthesiology and Reanimation Department, Yozgat Bozok University School of Medicine, 66100 Yozgat, Turkey

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