Outcomes of delayed chest closure after congenital heart surgery in neonates
https://doi.org/10.4081/pmc.2024.328
Accepted: 8 February 2024
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We present the outcomes of delayed chest closure in neonates who underwent congenital heart surgery under cardiopulmonary bypass. Eighty-one consecutive neonatal patients (age ≤ 28 days) with congenital heart diseases who underwent heart operations and after surgery, chest remained open in the intensive care unit until DCC. Correction of transposition of the great arteries pathology was the most common surgical procedure (48.1% of patients). Median sternal closure time from surgery was 3 (2-4) days. Median age of neonates was 9 (5-12) days. In addition, in 4 cases (4.9%) there was secretion from the surgical site after DCC and after taking cultures, in 2 (2.4%) of the cases a pathogen was identified. Multivariable linear regression analysis (adjusted to gender and CPB) showed that only the age-predicted the sternum closure time (β=-0.09, 95%CI: - 0.16 to -0.02, p=0.02). In-hospital mortality was 6 (7.4%) patients. Although the DCC in neonates who underwent CHD surgical correction was related to a high mortality rate, only the age of neonates predicted the sternum closure time in the ICU.
Gangahar DM, McGough EC, Synhorst D. Secondary sternal closure: a method of preventing cardiac compression. Ann Thorac Surg 1981;31:281-2. DOI: https://doi.org/10.1016/S0003-4975(10)60944-7
Tabbutt S, Duncan BW, McLaughlin D, et al. Delayed sternal closure after cardiac operations in a pediatric population. J Thorac Cardiovasc Surg 1997;113:886-93. DOI: https://doi.org/10.1016/S0022-5223(97)70261-7
McElhinney DB, Reddy VM, Parry AJ, et al. Management and outcomes of delayed sternal closure after cardiac surgery in neonates and infants. Crit Care Med 2000;28:1180-4. DOI: https://doi.org/10.1097/00003246-200004000-00044
Jogi P, Werner O. Hemodynamic effects of sternum closure after open-heart surgery in infants and children. Scand J Thorac Cardiovasc Surg 1985;19:217 20. DOI: https://doi.org/10.3109/14017438509102722
Kumar SR, Scott N, Wells WJ, Starnes VA. Liberal use of delayed sternal closure in children is not associated with increased morbidity. Ann Thorac Surg 2018;106:581-6. DOI: https://doi.org/10.1016/j.athoracsur.2018.03.053
Das S, Rubio A, Simsic JM, et al. Bloodstream infections increased after delayed sternal closure: cause or coincidence. Ann Thorac Surg 2011;91:793-7. DOI: https://doi.org/10.1016/j.athoracsur.2010.09.055
Johnson JN, Jaggers J, Li S, et al. Center variation and outcomes associated with delayed sternal closure after stage 1 palliation for hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 2010;139:1205-10. DOI: https://doi.org/10.1016/j.jtcvs.2009.11.029
Shin HJ, Jhang WK, Park JJ, Yun TJ. Impact of delayed sternal closure on postoperative infection or wound dehiscence in patients with congenital heart disease. Ann Thorac Surg 2011;92:705-9. DOI: https://doi.org/10.1016/j.athoracsur.2011.03.040
Adler AL, Smith J, Permut LC, et al. Significance of positive mediastinal cultures in pediatric cardiovascular surgical procedure patients undergoing delayed sternal closure. Ann Thorac Surg 2014;98:685-90. DOI: https://doi.org/10.1016/j.athoracsur.2014.03.038
Özker E, Saritaş B, Vuran C, et al. Delayed sternal closure after pediatric cardiac operations; single center experience: a retrospective study. J Cardiothorac Surg 2012;7:102. DOI: https://doi.org/10.1186/1749-8090-7-102
Harder EE, Gaies MG, Yu S, et al. Risk factors for surgical site infection in pediatric cardiac surgery patients undergoing delayed sternal closure. J Thorac Cardiovasc Surg 2013;146:326-12. DOI: https://doi.org/10.1016/j.jtcvs.2012.09.062
Woodward CS, Son M, Calhoon J, et al. Sternal wound infections in pediatric congenital cardiac surgery: a survey of incidence and preventative practice. Ann Thorac Surg 2011;91:799-804. DOI: https://doi.org/10.1016/j.athoracsur.2010.10.030
Gielchinsky I, Parsonnet V, Krishnan B, et al. Delayed sternal closure following open-heart operation. Ann Thorac Surg 1981;32:273–7. DOI: https://doi.org/10.1016/S0003-4975(10)61050-8
Anderson CA, Filsoufi F, Aklog L, et al. Liberal use of delayed sternal closure for postcardiotomy hemodynamic instability. Ann Thorac Surg 2002;73:1484-8. DOI: https://doi.org/10.1016/S0003-4975(01)03601-3
Boeken U, Assmann A, Mehdiani A, et al. Open chest management after cardiac operations: outcome and timing of delayed sternal closure. Eur J Cardiothorac Surg 2011;40:1146-50. DOI: https://doi.org/10.1016/j.ejcts.2011.02.047
Erek E, Yalcinbas YK, Turkekul Y, et al. Indications and risks of delayed sternal closure after open heart surgery in neonates and early infants. World J Pediatr Congenital Heart Surg 2012;3:229-35. DOI: https://doi.org/10.1177/2150135111432771
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