Delayed Sternal Closure after Cardiac Surgery

Fanning, William J.; Vasko, John S.; Kilman, James W.

doi:10.1016/s0003-4975(10)62034-6

Cited by 59 publications

(35 citation statements)

References 12 publications

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“…The high proportion of high-risk patients (redos, urgent or emergent operations, and poor preoperative left ventricular function) in our patient population may well explain the relatively high incidence of OC and DSC in this analysis. The indications for OC management in our patients are similar to those reported previously [6,10,11]. Our survival rates after OC treatment and DSC are comparable to results described by other authors [7,10,11].…”

Section: Discussionsupporting

confidence: 91%

“…The indications for OC management in our patients are similar to those reported previously [6,10,11]. Our survival rates after OC treatment and DSC are comparable to results described by other authors [7,10,11]. Patients who required OC treatment had a higher incidence of emergency or urgent operations (22.9%) and re-operative surgery (31.7%) compared with the controls.…”

Section: Discussionsupporting

confidence: 90%

“…The incidence (3.5%) of OC after cardiac operations at our institution is slightly higher than earlier reported [4,10,11]. The high proportion of high-risk patients (redos, urgent or emergent operations, and poor preoperative left ventricular function) in our patient population may well explain the relatively high incidence of OC and DSC in this analysis.…”

Section: Discussioncontrasting

confidence: 52%

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Open chest management after cardiac operations: outcome and timing of delayed sternal closure

Boeken

Assmann

Mehdiani

et al. 2011

European Journal of Cardio-Thoracic Surgery

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 90%

Section: Discussioncontrasting

confidence: 52%

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Open chest management after cardiac operations: outcome and timing of delayed sternal closure

Boeken

Assmann

Mehdiani

et al. 2011

European Journal of Cardio-Thoracic Surgery

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“…2,3) Here, we report a successful surgical case of acute aortic dissection with delayed sternal closure 4) in a patient with RP who had been taking oral corticosteroids. not close the sternum and decided to use delayed sternal closure.…”

Section: Introductionmentioning

confidence: 94%

Emergency Repair of Acute Aortic Dissection in a Patient with Relapsing Polychondritis

Iida

Orime

Umeda

et al. 2013

Ann Thorac Cardiovasc Surg

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Relapsing polychondritis (RP) is a rare, inflammatory, multiorgan disorder affecting cartilaginous structure and other connective tissue. Cardiovascular complications occur in 10%-52% of patients. We report a case of emergency surgery for an acute aortic dissection in a patient with RP. A 45-year-old female who had been taking corticosteroids (10 mg/day) for 2 years for RP presented at another hospital with dyspnea and severe chest and back pain. Acute aortic dissection was diagnosed, and we performed emergency replacement of the ascending aorta. We could not control the bleeding from suture holes of the native aorta because the vessel was so fragile. Thus, we performed a delayed sternal closure. The day after surgery, bleeding had decreased, and we could close the chest wall. Infection was well controlled, and the patient suffered minimal additional complications. She was discharged to home by herself 29 days after surgery and returned to normal life.Keywords: acute aortic dissection, relapsing polychondritis, emergency operation, delayed sternal closure Case ReportA 45-year-old female presented at the emergency department of another hospital with dyspnea and severe chest and back pain at work. She was diagnosed with acute aortic dissection (Stanford type A) and was transferred to our hospital for emergency surgery. She had a history of RP treated with corticosteroids (10 mg/day) for the previous 2 years. Computed tomography (CT) on admission showed acute aortic dissection (Stanford type A). The dissection started at the right coronary artery and continued to the infrarenal abdominal aorta (Fig. 1). No other medical history was available at the time of admission. We performed emergency surgery. Through a median sternotomy, the dissected, ascending aorta was reconstructed by end-to-end anastomosis with a vascular graft (Triplex Ⓡ 28 mm, Terumo Corporation, Tokyo, Japan) using the less invasive quick replacement (LIQR) technique. 5) Stump plasty was performed with a felt strip sandwiched in the distal and proximal ends. Withdrawal from extracorporeal circulation was uneventful, but bleeding from the needle holes in the native aorta was uncontrollable. As a result of bleeding problem, we could

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“…Although the incidence of mediastinal infection with DSC has been reported between 1 and 4%, no significant increase in the rate of mediastinitis has been observed when compared to non-open chest managed procedures [8]. Despite these reports, concerns over mediastinal infection especially in the setting of exposed aortic graft remains concerning.…”

Section: Introductionmentioning

confidence: 99%