Delayed sternal closure: a life-saving measure in neonatal open heart surgery; could it be predictable?

Abstract

Many of the factors thought to be associated with the need for delaying the sternal closure had no statistical significance as risk factors. On the other hand, the diagnosis of IAA or TAPVD, an age less than 7 days, aortic clamping more than 98 min, CPB time more than 185 min and a post-bypass central venous saturation less than 51% were statistically significant risk factors that could be used in predicting the need for delaying the sternal closure.

Delayed Sternal Closure in Cardiac Surgery

“…Patients were maintained on prophylactic IV antibiotic therapy. The decision and timing of sternal closure was at the discretion of the attending surgeon, influenced by improvements in hemodynamics, edema, and cardiac function [8][9][10][11][12].…”

Nursing Considerations for Children Undergoing Delayed Sternal Closure After Surgery for Congenital Heart Disease

“…9 Gangahar et al 11 Shore et al 7 Bjork et al 12 Jogi and Werner 13 Kay et al 14 Odim et al 15 Ziemer et al 6 Elami et al 16 Hakimi et al 17 Alexi-Meskishvili et al 18 Iyer et al 19 Tabbutt et al 20 McElheinney et al 21 McElheinney et al 5 Amato 22 Walker et al 23 Main et al 24 Samir et al 25 Riphagen et al 10 lifted off of the heart with some form of traction or splinted from touching the heart ( Figure 2) by using surgical tools such as rib spreaders, stents, 16,23 or struts. 20 The splinting device is placed between the sternal edges before the sterile dressing is applied.…”

Delayed sternal closure after total artificial heart implantation

“…[2][3][4][5][6] Fortunately, most of the published experience with this strategy, including patients undergoing ventricular assist device implantation, 7 describes successful outcomes with the use of DSC. Surprisingly, low rates of mediastinitis or device colonization, presumably due to meticulous attention to sterility, antibiotic prophylaxis, and expedient wound closure, have been the norm rather than the exception in these published series.…”