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Ann Thorac Surg 2005;80:678-684
© 2005 The Society of Thoracic Surgeons

Original article: Cardiovascular

"Early" Delayed Sternal Closure Following Pediatric Cardiac Surgery

Shelley Riphagen, FCP a , * , Marilyn McDougall, FCP a , Shane M. Tibby, MRCP a , Nelson Alphonso, FRCS b , David Anderson, FRCS b , Conal Austin, FRCS b , Andrew Durward, FCP a , Ian A. Murdoch, FRCP a

a Department of Pediatric Intensive Care, Guy’s Hospital, London, United Kingdom
b Department of Cardiothoracic Surgery, Guy’s Hospital, London, United Kingdom

Accepted for publication February 9, 2005.

* Address reprint requests to Dr Riphagen, Pediatric Intensive Care Unit, Guy’s Hospital, Saint Thomas Street, London SE1 9RT, United Kingdom (Email: shelley.riphagen{at}gstt.sthames.nhs.uk).

BACKGROUND: Delayed sternal closure is commonly used following pediatric cardiopulmonary bypass surgery for many reasons including support of the failing myocardium. We hypothesized that, as a result of improvements in perioperative care, sternal closure could be achieved at an earlier postoperative time than the 3 to 5 days typically reported in the literature.

METHODS: Retrospective chart review of all bypass surgery (n = 585) performed in a single center over a 3-year period (2000–2002).

RESULTS: We identified 66 children (11.3%), median age 5 days old, who underwent delayed sternal closure. In 60 of these patients, sternal closure was achieved at a median (interquartile) postoperative time of 21 hours (18 to 40 hours). The most common indication was inadequate hemostasis, although early sternal closure was also achieved in the subgroup with poor myocardial function as the primary indication at a median of 36 hours (21 to 44 hours). There was no noticeable hemodynamic, respiratory or metabolic compromise following sternal closure, although patients with poor myocardial function tended to have a lower mean blood pressure than those with inadequate hemostasis (ANOVA, p = 0.02). The overall mortality was 19.7% (13 of 66), with a median duration of ventilation and intensive care stay among survivors of 3.8 days (2.4 to 6.3 days) and 4.8 days (3.7 to 7.9 days), respectively.

CONCLUSIONS: Delayed sternal closure is possible at an earlier stage than previously reported.




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