TY - JOUR AU - Elassal, Ahmed Abdelrahman AU - Eldib, Osama Saber AU - Dohain, Ahmed Mohamed AU - Abdelmohsen, Gaser Abdelmohsen AU - Abdalla, Ahmed Hassan AU - Al-Radi, Osman Osama PY - 2019/08/27 Y2 - 2024/03/29 TI - Delayed Sternal Closure in Congenital Heart Surgery: A Risk-Benefit Analysis JF - The Heart Surgery Forum JA - HSF VL - 22 IS - 5 SE - DO - 10.1532/hsf.2471 UR - https://journal.hsforum.com/index.php/HSF/article/view/2471 SP - E325-E330 AB - <p class="p1"><span class="s1"><strong>Background:</strong> Delayed sternal closure commonly is used after pediatric cardiac surgery. Its benefits include relieving cardiac compression and stabilizing postoperative critically ill patients.</span></p><p class="p1"><span class="s2"><strong>Methods:</strong> 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.</span></p><p class="p1"><span class="s2"><strong>Results:</strong> 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 <br> </span>(<em>P</em> = .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 (<em>P</em> = .036). Bypass time, clamping time, and nonsurgical bleeding did not significantly affect SCT. The mortality rate was 15.2% (N = 11).</p><p class="p1"><span class="s1"><strong>Conclusion:</strong> Delayed sternal closure is a simple and effective technique that could prevent postoperative cardiac compression in hemodynamic instability states after pediatric cardiac operations. </span></p> ER -