Elective delayed sternal closure portends better outcomes in congenital heart surgery: a retrospective observational study

Abstract

Introduction Delayed sternal closure is used in paediatric cardiac surgery as a management strategy for patients with unstable hemodynamics or postoperative bleeding routinely. We hypothesise that planned postponement of sternal closure leads to better outcomes than emergent reopening in the intensive care unit (ICU) in patients exhibiting some hemodynamic indication for the same. Methods We retrospectively analysed the outcomes of delayed sternal closure 220/2111 (10.42%) out of which 14 sternums were opened in the ICU after shifting the patients. Results A total of 220/2111 (10.42%) sternums were left open postoperatively, out of which 14 were opened after shifting to the ICU. Total mortality of the delayed sternal closure was 33/220, i.e. 15%. The patients whose sternums were left open from the theatre had a mortality of 23/206, i.e. 11.16%, whereas those patients whose sternums were opened in the ICU had a mortality of 10/14, i.e. 71.42%. Conclusion In doubtful postoperatively hemodynamic, the choice of leaving the sternum open electively has better outcomes, rather than opening the sternum as a terminal bail out procedure.

Celsior® vs. St Thomas® cardioplegia: analysis of myocardial protection and clinical safety in neonates

“…There is an almost twofold decrease of DSC incidence in the Celsior® group compared to the St Thomas group. Patients with a delayed sternal closure have an associated morbidity and surgical wound infection ( 16 ) and a mortality rate that is 3 times higher than patients who have a closed chest ( 17 ).…”

Deferring sternal closure after complex congenital heart surgery—to do or not to do is the question!

“…In this issue of IJTC, Kundan et al [10] have analyzed their experience with deferred sternal closure over a 5-year period that covered 2111 operated patients. They conclude that in patients with doubtful post-operative hemodynamics, the choice of leaving the sternum open has better outcomes than opening the sternum, in the intensive care unit (ICU), as a bail out procedure.…”