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
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Abstract
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.
References0
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#2Abdulraouf Jijeh (National Guard Health Affairs)H-Index: 6
Last. Mohamed S. Kabbani (National Guard Health Affairs)H-Index: 12
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OBJECTIVES: Capillary leak syndrome can be severe in children after open-heart surgery which may hinder sternum closure and described as mediastinal tamponade. Reopening the sternum postoperatively may help maintaining hemodynamics and respiratory function. We looked for predictors that indicate the need for reopening the sternum. DESIGN: A retrospective cohort study. SETTING: A single cardiac center experience from 2009 to end of 2015. PATIENTS: All children who required emergent reopening the ...
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#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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#2Bulent Saritas (Başkent University)H-Index: 4
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Background: Delayed sternal closure (DSC) after cardiac surgery is a therapeutic option in the treatment of the severely impaired heart in pediatric cardiac surgery. The results with the technique of DSC over a 4-year period are examined with regard to mortality and morbidity. Methods: We retrospectively reviewed records of 38 patients who had undergone DSC among 1100 congenital cardiac operations. Indication of DSC, time to sternal closure, pre and post closure cardiopulmonary and metabolic sta...
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Background Mediastinitis results in significant morbidity in pediatric cardiac patients. It is not clear whether delayed sternal closure is a risk factor for these infections. Management of mediastinitis remains controversial. Methods Cases of mediastinitis at the Stollery Children's Hospital from January 1, 1991, to June 30, 2004, were reviewed. Results There were 29 cases of mediastinitis in 2,675 open cardiac procedures for an overall incidence of 1.1%. Infection was diagnosed 5 to 27 days af...
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The objective of this study was to evaluate the different causes of extubation failure and the consequent mortality rates in a pediatric population after cardiac surgery. We studied 184 consecutive patients with a median age of 9 months (range, 0–165). In 158 patients, extubation was successful (group A). Nine patients were reintubated for upper airway obstruction and finally extubated successfully (group B). Seventeen patients were reintubated for cardiorespiratory failure, finally leading to d...
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#2Marilyn McDougall (Guy's Hospital)H-Index: 1
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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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