Delayed Sternal Closure after Neonatal Cardiac Operations_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

PANYan-jun , ZHANGHai-bo , WANGShun-min , ZHENGJing-hao , CHOULi-sheng , LUYa-nan

Department of Pediatric Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, Medical School of Shanghai Jiaotong University, Shanghai 200127, P. R. China;

Corresponding author：

Keywords：

Neonate; Congenital heart defect; Surgery; Delayed sternal closure

DOI：

10.7507/1007-4848.20150143

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the clinical effect of delayed sternal closure (DSC) after neonatal cardiac operations. Methods We retrospectively analyzed the clinical data of 347 neonates who underwent cardiac operations through midterm sternotomy in Shanghai Children's Medical Center between January 2008 and December 2012. There were 273 male and 74 female patients with mean age of 14.8±8.4 days and mean weight at 3.4±0.5 kg. We analyzed the influencing factors of delayed sternal closure and the relationship between delayed sternal closure and mortality. A total of 127 patients had DSC (36.6%). Ninety-two patients were of primary DSC because of hemodynamic instability in the operation room, and 35 were of the secondary DSC because that the sternum was reopened in intensive care unit during the early postoperative period. The diagnosis of complex congenital heart defects had a high risk of DSC. The incidence of DSC for great artery (TGA), corctation of aorta (CoA), interruption of aortic arch (IAA), total anormalous pulmonary vein drainage (TAPVD), Taussig-Bing malformation, hypoplastic left heart syndrome (HLHS) was 43.2%, 83.3%, 62.5%, 15.6%, 71.4%, and 66.7% respectively. The DSC patients had longer duration of CPB time (141.4±51.7 min versus 108.5±51.9 min) and clamping time (79.3±29.2 min versus 65.4±25.5 min). In 113 patients the sternums were closed 1-11 days after the initial operation. Sixteen patients died ultimately including 2 deaths after the closure of sternum with a mortality of 12.6%. Surgical site infection occurred in 5 patients including 2 severe patients with surgical intervention. Conclusion DSC has been an essential part of neonatal heart surgery. It provides an opportunity for the recovery of cardiac function.

Citation： PANYan-jun, ZHANGHai-bo, WANGShun-min, ZHENGJing-hao, CHOULi-sheng, LUYa-nan. Delayed Sternal Closure after Neonatal Cardiac Operations. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(6): 560-563. doi: 10.7507/1007-4848.20150143 Copy

1.	Hakimi M, Walters HL 3rd, Pinsky WW, et al. Delayed sternal closure after neonatal cardiac operations. J Thorac Cardiovasc Surg, 1994, 107(3): 925-933.
2.	Horvath R, Shore S, Schultz SE, et al. Cerebral and somatic oxygen saturation decrease after delayed sternal closure in children after cardiac surgery. J Thorac Cardiovasc Surg, 2010, 139(4): 894-900.
3.	Main E, Elliott MJ, Schindler M, et al. Effect of delayed sternal closure after cardiac surgery on respiratory function in ventilated infants. Crit Care Med, 2001, 29(9): 1798-1802.
4.	Amato J. Review of the rationale for delayed sternal closure. Crit Care Med, 2000, 28(4): 1249-1251.
5.	Shalabi RI, Amin M, Ayed AK, et al. Delayed sternal closure is a life saving decision. Ann Thorac Cardiovasc Surg, 2002, 8(4): 220-223.
6.	Riphagen S, McDougall M, Tibby SM, et al. “Early” delayed sternal closure following pediatric cardiac surgery. Ann Thorac Surg, 2005, 80(2): 678-684.
7.	Anderson CA, Filsoufi F, Aklog L, et al. Liberal use of delayed sternal closure for postcardiotomy hemodynamic instability. Ann Thorac Surg, 2002, 73(5): 1484-1488.
8.	Tabbutt S, Duncan BW, McLaughlin D, et al. Delayed sternal closure after cardiac operations in a pediatric population. J Thorac Cardiovasc Surg, 1997, 113(5): 886-893.
9.	张玉龙, 李仲智, 李晓峰, 等. 延迟关胸在小儿心脏外科应用的经验. 中国体外循环杂志, 2007, 5(1): 20-22.
10.	张惠锋, 贾兵, 陈张根, 等.3个月内复杂先天性心脏病患儿术后延迟关胸的因素分析. 中华小儿外科杂志, 2008, 29(2): 78-81.
11.	丁晋阳, 莫绪明, 顾海涛, 等. 延迟关胸技术在婴儿复杂危重先心病手术中的应用. 临床小儿外科杂志, 2011, 10(2): 98-100.
12.	McElhinney DB, Reddy VM, Parry AJ, et al. Management and outcomes of delayed sternal closure after cardiac surgery in neonates and infants. Crit Care Med, 2000, 28(4): 1180-1184.
13.	Iyer RS, Jacobs JP, de Leval MR, et al. Outcomes after delayed sternal closure in pediatric heart operations: a 10-year experience. Ann Thorac Surg, 1997, 63(2): 489-491.
14.	Vojtovic P, Reich O, Selko M, et al. Haemodynamic changes due to delayed sternal closure in newborns after surgery for congenital cardiac malformations. Cardiol Young, 2009, 19(6): 573-579.
15.	Kubitz JC, Annecke T, Kemming GI, et al. The influence of positive end-expiratory pressure on stroke volume variation and central blood volume during open and closed chest conditions. Eur J Cardiothorac Surg, 2006, 30(1): 90-95.
16.	柳立平, 何萍萍, 孔英, 等. 先天性心脏病延迟关胸患儿胸骨缝合术前后呼吸功能的变化. 临床小儿外科杂志, 2011, 10(6): 407-410.
17.	Samir K, Riberi A, Ghez O, et al. Delayed sternal closure: a life-saving measure in neonatal open heart surgery; could it be predictable? Eur J Cardiothorac Surg, 2002, 21(5): 787-793.
18.	Alexi-Meskishvili V, Weng Y, Uhlemann F, et al. Prolonged open sternotomy after pediatric open heart operation: experience with 113 patients. Ann Thorac Surg, 1995, 59(2): 379-383.
19.	Walters HL 3rd, Ionan CE, Thomas RL, et al. Single-stage versus 2-stage repair of coarctation of the aorta with ventricular septal defect. J Thorac Cardiovasc Surg, 2008, 135(4): 754-761.
20.	Sarris GE, Chatzis AC, Giannopoulos NM, et al. The arterial switch operation in Europe for transposition of the great arteries: a multi-institutional study from the European Congenital Heart Surgeons Association. J Thorac Cardiovasc Surg, 2006, 132(3): 633-639.
21.	Shin HJ, Jhang WK, Park JJ, et al. Impact of delayed sternal closure on postoperative infection or wound dehiscence in patients with congenital heart disease. Ann Thorac Surg, 2011, 92(2): 705-709.
22.	Stulak JM, Romans T, Cowger J, et al. Delayed sternal closure does not increase late infection risk in patients undergoing left ventri-cular assist device implantation. J Heart Lung Transplant, 2012, 31 (10): 1115-1119.

1. Hakimi M, Walters HL 3rd, Pinsky WW, et al. Delayed sternal closure after neonatal cardiac operations. J Thorac Cardiovasc Surg, 1994, 107(3): 925-933.
2. Horvath R, Shore S, Schultz SE, et al. Cerebral and somatic oxygen saturation decrease after delayed sternal closure in children after cardiac surgery. J Thorac Cardiovasc Surg, 2010, 139(4): 894-900.
3. Main E, Elliott MJ, Schindler M, et al. Effect of delayed sternal closure after cardiac surgery on respiratory function in ventilated infants. Crit Care Med, 2001, 29(9): 1798-1802.
4. Amato J. Review of the rationale for delayed sternal closure. Crit Care Med, 2000, 28(4): 1249-1251.
5. Shalabi RI, Amin M, Ayed AK, et al. Delayed sternal closure is a life saving decision. Ann Thorac Cardiovasc Surg, 2002, 8(4): 220-223.
6. Riphagen S, McDougall M, Tibby SM, et al. “Early” delayed sternal closure following pediatric cardiac surgery. Ann Thorac Surg, 2005, 80(2): 678-684.
7. Anderson CA, Filsoufi F, Aklog L, et al. Liberal use of delayed sternal closure for postcardiotomy hemodynamic instability. Ann Thorac Surg, 2002, 73(5): 1484-1488.
8. Tabbutt S, Duncan BW, McLaughlin D, et al. Delayed sternal closure after cardiac operations in a pediatric population. J Thorac Cardiovasc Surg, 1997, 113(5): 886-893.
9. 张玉龙, 李仲智, 李晓峰, 等. 延迟关胸在小儿心脏外科应用的经验. 中国体外循环杂志, 2007, 5(1): 20-22.
10. 张惠锋, 贾兵, 陈张根, 等.3个月内复杂先天性心脏病患儿术后延迟关胸的因素分析. 中华小儿外科杂志, 2008, 29(2): 78-81.
11. 丁晋阳, 莫绪明, 顾海涛, 等. 延迟关胸技术在婴儿复杂危重先心病手术中的应用. 临床小儿外科杂志, 2011, 10(2): 98-100.
12. McElhinney DB, Reddy VM, Parry AJ, et al. Management and outcomes of delayed sternal closure after cardiac surgery in neonates and infants. Crit Care Med, 2000, 28(4): 1180-1184.
13. Iyer RS, Jacobs JP, de Leval MR, et al. Outcomes after delayed sternal closure in pediatric heart operations: a 10-year experience. Ann Thorac Surg, 1997, 63(2): 489-491.
14. Vojtovic P, Reich O, Selko M, et al. Haemodynamic changes due to delayed sternal closure in newborns after surgery for congenital cardiac malformations. Cardiol Young, 2009, 19(6): 573-579.
15. Kubitz JC, Annecke T, Kemming GI, et al. The influence of positive end-expiratory pressure on stroke volume variation and central blood volume during open and closed chest conditions. Eur J Cardiothorac Surg, 2006, 30(1): 90-95.
16. 柳立平, 何萍萍, 孔英, 等. 先天性心脏病延迟关胸患儿胸骨缝合术前后呼吸功能的变化. 临床小儿外科杂志, 2011, 10(6): 407-410.
17. Samir K, Riberi A, Ghez O, et al. Delayed sternal closure: a life-saving measure in neonatal open heart surgery; could it be predictable? Eur J Cardiothorac Surg, 2002, 21(5): 787-793.
18. Alexi-Meskishvili V, Weng Y, Uhlemann F, et al. Prolonged open sternotomy after pediatric open heart operation: experience with 113 patients. Ann Thorac Surg, 1995, 59(2): 379-383.
19. Walters HL 3rd, Ionan CE, Thomas RL, et al. Single-stage versus 2-stage repair of coarctation of the aorta with ventricular septal defect. J Thorac Cardiovasc Surg, 2008, 135(4): 754-761.
20. Sarris GE, Chatzis AC, Giannopoulos NM, et al. The arterial switch operation in Europe for transposition of the great arteries: a multi-institutional study from the European Congenital Heart Surgeons Association. J Thorac Cardiovasc Surg, 2006, 132(3): 633-639.
21. Shin HJ, Jhang WK, Park JJ, et al. Impact of delayed sternal closure on postoperative infection or wound dehiscence in patients with congenital heart disease. Ann Thorac Surg, 2011, 92(2): 705-709.
22. Stulak JM, Romans T, Cowger J, et al. Delayed sternal closure does not increase late infection risk in patients undergoing left ventri-cular assist device implantation. J Heart Lung Transplant, 2012, 31 (10): 1115-1119.

Previous Article
Therapy Effect of Modified B-T Shunt for Complex Congenital Heart Disease
Next Article
Completely Video-assisted Thoracopic Surgery for Pulmonary Aspergilloma: A Case Control Study

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Delayed Sternal Closure after Neonatal Cardiac Operations

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content