Outcomes of Primary versus Secondary Delayed Sternal Closure in Pediatric Cardiac Surgery.

Published on Mar 1, 2021in The Annals of Thoracic Surgery3.639
· DOI :10.1016/J.ATHORACSUR.2021.02.029
Mohamed Farouk Elsisy3
Estimated H-index: 3
Joseph A. Dearani95
Estimated H-index: 95
+ 3 AuthorsElizabeth H. Stephens25
Estimated H-index: 25
Abstract Background Delayed sternal closure (DSC) is a management strategy for hemodynamic instability and severe coagulopathy after complex congenital heart surgery. We hypothesized that DSC results in better outcomes than perioperative sternal reopening. Methods We reviewed patients 2days (81 patients), and secondary DSC (45 patients) were analyzed. Results Median age was 120 days (range 3-6553) and median DSC duration was 2 days (range 1-60). The primary DSC >2 days group was the youngest group, and the distribution of procedures was different between groups. Indications for DSC were hemodynamic instability in 152 patients (67.9%) and severe coagulopathy in 33 patients (14.7%), with no difference between groups (p=0.141). Extracorporeal membrane oxygenation use was higher in the PDSC>2 days group than the other groups (47.5% vs 7.1%, p 2 days, p 2 days (44±6, p=0.01). Survival was better in PDSC regardless of duration than SDSC. Conclusions PDSC demonstrated better outcomes than SDSC. Sternal reopening can be life-saving, but when anticipated, PDSC can yield better outcomes.
#1Ghassan Shaath (National Guard Health Affairs)H-Index: 6
#2Abdulraouf Jijeh (National Guard Health Affairs)H-Index: 6
Last. Mohamed S. Kabbani (National Guard Health Affairs)H-Index: 12
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#1S. Ram Kumar (SC: University of Southern California)H-Index: 27
#2Nigel Scott (SC: University of Southern California)H-Index: 1
Last. Vaughn A. Starnes (SC: University of Southern California)H-Index: 55
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Background Delayed sternal closure (DSC) is often employed to optimize hemodynamics following pediatric cardiac surgery. Prior reports have suggested that DSC may be associated with increased morbidity. We sought to analyze the impact of a liberal policy of DSC on surgical outcomes at our center. Methods We retrospectively evaluated the clinical course of 1,000 consecutive patients between July 2005 and June 2015 whose sternum was electively left open following pediatric cardiac surgery. Data ar...
6 CitationsSource
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 ...
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#2Christoph P. Hornik (Durham University)H-Index: 28
Last. Marshall L. Jacobs (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 72
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Background Delayed sternal closure (DSC) is commonly used to optimize hemodynamic stability after neonatal and infant heart surgery. We hypothesized that duration of sternum left open (SLO) was associated with rate of infection complications, and that location of sternal closure may mitigate infection risk. Methods Infants (age ≤365 days) undergoing index operations with cardiopulmonary bypass and DSC at STS Congenital Heart Surgery Database centers (from 2007 to 2013) with adequate data quality...
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#1A.D.J. Ten Harkel (EUR: Erasmus University Rotterdam)H-Index: 5
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#1Shelley Riphagen (Guy's Hospital)H-Index: 2
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Background Delayed sternal closure is commonly used following pediatric cardiopulmonary bypass surgery for many reasons including support of the failing myocardium. We hypothesized that, as a result of improvements in perioperative care, sternal closure could be achieved at an earlier postoperative time than the 3 to 5 days typically reported in the literature. Methods Retrospective chart review of all bypass surgery (n = 585) performed in a single center over a 3-year period (2000–2002). Result...
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