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CC BY-NC-ND 4.0 · Journal of Cardiac Critical Care TSS 2020; 4(02): 096-103
DOI: 10.1055/s-0040-1721229
Original Article

Outcomes of Delayed Sternal Closure in Paediatric Cardiac Surgical Patients–A Prospective Single Centre Study

Prateek Vaswani
1  Department of Cardiothoracic and Vascular Surgery, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
,
Manoj Kumar Sahu
2  Intensive Care for CTVS, CT Centre, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
,
Challatil Bipin
2  Intensive Care for CTVS, CT Centre, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
,
Sarvesh Pal Singh
2  Intensive Care for CTVS, CT Centre, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
,
Palleti Rajashekar
1  Department of Cardiothoracic and Vascular Surgery, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
,
Velayoudam Devagourou
1  Department of Cardiothoracic and Vascular Surgery, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
,
Sachin Talwar
1  Department of Cardiothoracic and Vascular Surgery, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
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Abstract

Background Delayed sternal closure (DSC) is being increasingly used as an interim support to help the dysfunctional heart in the road to recovery after complex pediatric cardiac surgeries. The purpose of this study was to assess the conduct of DSC at a tertiary care center.

Methods Between 2018 and 2019, 185 consecutive pediatric patients (below 12 years of age) underwent cardiac surgery at a tertiary care center. The incidence and causes of DSC were noted. The various pre, intra and postoperative factors till discharge or demise were noted and analyzed.

Results In this study, DSC was done in 63 patients (34.05%) with a median age and weight of 29 days (18–100 days) and 4 kg (2–12.3 kg), respectively. Transposition of great arteries (TGA) (41.27%) constituted the majority, followed by total anomalous pulmonary venous connection (TAPVC) (26.98%). Myocardial edema (49.21%) was the most common indication for DSC. Mean duration of open chest was 40.75 ± 18.58 hours. All-cause mortality was 19.05% (12/63). On multivariate analysis by logistic regression, the independent predictors of mortality were needed for preoperative mechanical ventilation (OR 42.82, 95% CI = 4.52–406.03, p < 0.001) and development of postoperative sepsis (OR 20.07, 95% CI = 2.12–189.80, p = 0.002).

Conclusions DSC is a safe and effective technique in the management of complex pediatric cardiac surgeries. It provides assistance to the severely dysfunctional myocardium soon after the surgery and helps in stabilization of hemodynamics with avoidance of postoperative mediastinal compression. Early sternal closure should be considered on the basis of cardiovascular function and/or resolution of primary indication for DSC.

Keywords

delayed sternal closure - open chest management - pediatric cardiac surgeries - cardiopulmonary bypass - ECMO


Publication History

Publication Date:
06 November 2020 (online)

© 2020. Official Publication of The Simulation Society (TSS), accredited by International Society of Cardiovascular Ultrasound ISCU. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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