Delayed sternal closure after total artificial heart implantation

Early and late outcomes with prolonged open chest management after cardiac surgery

“…OCM in a contemporary cohort of patients at our institution was required in 5% of patients undergoing cardiac surgery, resulting in a survival rate of 84%, which is similar to other reports in the literature. 3,5,7,13 In this study, a longer duration of OCM was significantly associated with an increased likelihood of 30-day mortality. This finding was noted previously by Anderson and colleagues 2 in a study of 87 patients undergoing OCM.…”

Delayed sternal closure after assist device implantation: Not all bleeding stops

“…We demonstrated that, similar to the experience with DSC in left ventricular assist device recipients, 7,8 this strategy for the management of refractory bleeding is effective because it breaks the cycle of pericardial tamponade and low-output events of the artificial ventricles and contributes to a decrease in major perioperative complications. As in the case of patients with LVADs, concerns regarding infection proved to be unfounded.…”

“…[9][10][11][12][13][14] Given the comparatively low incidence of infections in patients with a left ventricular assist device and a TAH in whom DSC was used, DSC would seem to be a logical strategy in cases of refractory hemorrhage. However, the practical utility of the analysis by Spiliopoulos and colleagues 8 is somewhat handicapped by its broadly defined indication for the use of DSC, namely, ''persistent nonsurgical bleeding despite intensive haemostatic therapy.'' Because multiple factors contributing to coagulopathic bleeding are in play with assist device implantation (eg, congestive hepatopathy, hypothermia, heparinization, artificial blood surfaces, extracorporeal circulation, massive transfusion), this definition is not specific enough to apply DSC in a consistent, data-driven manner.…”

“…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. Spiliopoulos and colleagues 8 have taken this precedent further by reporting the successful use of DSC for the management of intractable bleeding in patients implanted with the SynCardia total artificial heart (TAH) (SynCardia Systems Inc, Tucson, Ariz) system. The investigators observed a lower incidence of prolonged mechanical ventilation and acute renal failure with DSC compared with primary sternal closure (PSC), as well as shorter hospitalizations with no significant differences in overall mortality at 90 days.…”

Perioperative Care of the Patient With the Total Artificial Heart

“…42,45,54,55 Bleeding resulting in repeat surgery mostly occurs within the first postoperative month with the highest incidence reported during the first week. 59 There does not appear to be an increased risk for infection associated with delayed sternal closure in the device population. 56 If intraoperative hemostasis is inadequate, the chest may be left open for delayed sternal closure to decrease risk of tamponade.…”