Delayed Sternal Closure after Cardiac Operations

Abstract

In 1,459 open heart operations performed between July 1995 and March 2000, sternal closure was delayed in 30 patients (2%) because of hemodynamic instability limiting primary sternal closure in 12 and uncontrollable bleeding in 18. Two patients died in the immediate postoperative period while the chest was open, due to persistent low cardiac output secondary to myocardial failure. The sternum was closed in 28 patients at an average of 22 ± 0.3 hours (range, 8 to 48 hours) postoperatively. Two patients died in the late postoperative period prior to hospital discharge after sternal closure. Nonfatal wound infections occurred in 8 patients. The 26 survivors (86.7%) were discharged and followed up for a mean of 11.2 months. This study demonstrates that delayed sternal closure is an effective method of dealing with unstable hemodynamics and uncontrollable hemorrhage.

In-Hospital Outcomes of Delayed Sternal Closure after Open Cardiac Surgery

“…Prolonged open sternotomy with subsequent DSC has been described as useful in the treatment of server myocardial dysfunction, uncontrollable hemorrhage, and intractable arrhythmia 7,15‐17 . These effects are magnified in the presence of poor ventricular compliance secondary to ischemia, reperfusion, and myocardial edema 18 . Restriction of diastolic filling is the main point at which there is disproportion in the cardiac to mediastinal relationship, leading to compression or tamponade 19 .…”

Graft compression by drain tube

“…[1] These effects are amplified by poor ventricular compliance due to myocardial edema and ischemia-reperfusion injury. [2] Furnary et al . have shown that opening sternum raises systemic blood pressure by 18% and cardiac index by 59% and thereby beneficial in improving low cardiac output.…”

Comparison of Thoracotomy with Median Sternotomy Approach for Intra Cardiac Operations

“…Primary sternal closure carries a mortality of 8.7%, superficial sternal infection in 13.3%, mediastinitis 1.2% and sternal dehiscence in 3.7% 21 . Deep sternal wound infection increases morbidity and mortality 22 , in cardiac surgery choosing a proper approach for a given procedure is a must, because even with minimally invasive cardiac procedures serious wound infections can occur 23 .…”