Indications and Risks of Delayed Sternal Closure After Open Heart Surgery in Neonates and Early Infants

Abstract

Background: Delayed sternal closure (DSC) has been an essential part of neonatal and infant heart surgery. Here, we report our single institution experience of DSC for eight years. Methods: The successive 188 patients were analyzed retrospectively. Sternum was closed at the end of the operation in 97 (51.6%) patients (primary sternal closure [PSC] group). Sternum was left open in 91 (48.4%) patients. Among them, 45 (23.9%) had only skin closure (DSCs group) and 46 (24.4%) had membrane patch closure (DSC membrane [DSCm] group). Median age was higher in PSC group (90 days) than DSCs (11 days) and DSCm groups (9.5 days). Results: Mortality was 1%, 11.1%, and 28.2% in PSC, DSCs, and DSCm groups, respectively ( P < .05). Univariate analysis recognized the neonatal age (odds ratio [OR] = 4.2), preoperative critical condition (OR = 5.3), cardiopulmonary bypass time >180 minutes (OR = 4), and cross clamp time >99 minutes (OR = 3.9) as risk factors for mortality. Total morbidity rate was higher in DSCm group (73.9%) than DSCs group (51.1%) and PSC group (23.7%; P < .001). Mechanical ventilation time, intensive care unit stay, and hospital stay were longer in DSCs and DSCm groups than PSC group ( P < .001). The incidence of hospital infection was also higher in DSCs (43.5%) and DSCm (33.3%) groups than PSC group (20.6%; P < .05). But there was no difference in the incidence of sternal wound complications, including both deep and superficial (4.1%, 8.8%, and 4.4%, respectively). Conclusion: Although the risk of sternal wound complications is not different, patients who necessitate DSC (using both skin and membrane closure techniques) have more complicated postoperative course than patients with PSC.

Multicenter Validation of the Vasoactive-Ventilation-Renal Score as a Predictor of Prolonged Mechanical Ventilation After Neonatal Cardiac Surgery*

“…Moreover, peak VVR score greater than or equal to 35 within the first 12 hours of admission remained independently associated with prolonged duration of mechanical ventilation in a model that included several additional variables frequently associated with an extended postoperative course: prematurity, preoperative mechanical ventilation, delayed sternal closure, use of inhaled nitric oxide, and the occurrence of postoperative arrhythmias (20)(21)(22)(23)(24)(25)(26).…”

Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest in children after cardiac surgery

“…We use this strategy very liberally. In our recent study, we performed delayed chest closure in 48.4% of the neonates and early infants after cardiac surgery (23). …”

A Systematic Review of Antibiotic Prophylaxis for Delayed Sternal Closure in Children

“…Postoperative infections were defined by each author. Most studies 3,6 -9,17 -24 used the National Health Safety Network/Centers for Disease Control and Prevention (NHSN/CDC) guidelines, 25 and one study 26 referenced the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS CHSD) definitions. 11 Studies using the NHSN/CDC definitions referenced the 1988 guidelines, 2008 guidelines, or did not specify which guidelines were used.…”