Risk Factors for Delayed Sternal Closure in Operation for the Neonates with Congenital Heart Disease_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YANGSheng-chun ,  CHENXin-xin , CUIHu-jun , CUIYan-qin , XIAYuan-sheng , MALi , LIJian-bin , ZOUMing-hui , CHENWei-dan , LIWei

Heart Center, Guangzhou Women and Children's Hospital, Guangzhou 510623, P. R. China;

Corresponding author：

CHENXin-xin, Email: zingerchen@163.com

Keywords：

Congenital heart disease; Risk factor; Cardiac surgical procedures; Delayed sternal closure

DOI：

10.7507/1007-4848.20150206

Video：

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Objective To analyze the risk factors for delayed sternal closure (DSC) in the operation for the neonates with congenital heart defects. Methods We retrospectively analyzed the case notes of the 203 neonates with congenital heart defect in our hospital between January 2010 and June 2014. There were 152 males and 51 females at age of 0-28 (17.68±8.62) days. The relative factors were analyzed by univariate and multivariate logistic regression. Results These factors significantly correlated with DSC in univariate analysis:age at operation, premature, low weight (weight≤2.5 kg) at operation/weight at operation, RACHS-1, mechanical ventilation before operation, continuous use of intravenous cardiovascular drugs before operation, CPB time, aortic clamping time, total circulatory arrest with profound hypothermia. The results of logistic regression analysis showed that weight at operation/low weight, pre-operative mechanical ventilation, total circulatory arrest with profound hypothermia were independent risk factors for DSC. Conclusion Weight at operation/low weight, pre-operative mechanical ventilation, and total circulatory arrest with profound hypothermia are the independent risk factors for DSC in the operation for the neonates with congenital heart defects.

Citation： YANGSheng-chun, CHENXin-xin, CUIHu-jun, CUIYan-qin, XIAYuan-sheng, MALi, LIJian-bin, ZOUMing-hui, CHENWei-dan, LIWei. Risk Factors for Delayed Sternal Closure in Operation for the Neonates with Congenital Heart Disease. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(9): 821-825. doi: 10.7507/1007-4848.20150206 Copy

1.	郑景浩, 刘玉洁. 新生儿危重先天性心脏病急症治疗进展. 中华临床医师杂志(电子版), 2013, 7(13):5719-5720.
2.	杨盛春, 陈欣欣, 崔虎军, 等. 24例低体重危重先天性心脏病患儿的外科治疗. 中华胸心血管外科杂志, 2012, 28(11):680-682.
3.	李星, 岑坚正, 陈寄梅, 等. 新生儿危重先天性心脏病的手术治疗. 中华小儿外科杂志, 2013, 34(3):169-171.
4.	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.
5.	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.
6.	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.
7.	潘燕军, 王顺民, 张海, 等. 延迟关胸在先天性心脏病手术后的应用体会. 中华胸心血管外科杂志, 2014, 30(8):449-451.
8.	张玉龙, 李仲智, 李晓, 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.
9.	Jenkins KJ, Gauvreau K, Newburger JW, et al.Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg, 2002, 123(1):110-118.
10.	Padley JR, Cole AD, Pye VE, et al. Five-year analysis of operative mortality and neonatal outcomes in congenital heart diseases. Heart Lung Circ, 2011, 20(7):460-467.
11.	Cheng HH, Almodovar MC, Laussen PC, et al. Outcomes and risk factors for mortality in premature neonates with critical congenital heart disease.Pediatr Cardiol, 2011, 32(8):1139-1146.
12.	Riahi M, Tomatis LA, Schlosser RJ, et al. Cardiac compression due to closure of the median sternotomy in open-heart surgery. Chest, 1975, 67(1):113-114.
13.	Misawa Y. What can be an indicator of delayed sternal closure after cardiac surgery? Eur J Cardiothorac Surg, 2002, 22(3):493-494.
14.	Boeken, Assmann U, Mehdiani A, et al. Open chest management after cardiac operations:outcome and timing of delayed sternal closure. Eur J Cardiothorac Surg, 2011, 40(5):1146-1150.
15.	Misawa Y. Indication for delayed sternal closure. J Thorac Cardiovasc Surg,1997, 114(5):874.
16.	Furnary AP, Magovern JA, Simpson KA, et al. Prolonged open sternotomy and delayed sternal closure after cardiac operations. Ann Thorac Surg, 1992, 54(2):233-239.
17.	Allpress AL, Rosenthal GL, Goodrich KM, et al. Risk factors for surgical site infections after pediatric cardiovascular surgery. Pediatr Infect Dis J, 2004, 23(3):231-234.
18.	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.
19.	Woodward CS, Son M, Calhoon J, et al. Sternal wound infections in pediatric congenital cardiac surgery:a survey of incidence and preventative practice. Ann Thorac Surg, 2011, 91(3):799-804.
20.	Mehta PA, Cunningham CK, Colella CB, et al. Risk factors for sternal wound and other infections in pediatric cardiac surgery patients. Pediatr Infect Dis J, 2000, 19(10):1000-1004.

1. 郑景浩, 刘玉洁. 新生儿危重先天性心脏病急症治疗进展. 中华临床医师杂志(电子版), 2013, 7(13):5719-5720.
2. 杨盛春, 陈欣欣, 崔虎军, 等. 24例低体重危重先天性心脏病患儿的外科治疗. 中华胸心血管外科杂志, 2012, 28(11):680-682.
3. 李星, 岑坚正, 陈寄梅, 等. 新生儿危重先天性心脏病的手术治疗. 中华小儿外科杂志, 2013, 34(3):169-171.
4. 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.
5. 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.
6. 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.
7. 潘燕军, 王顺民, 张海, 等. 延迟关胸在先天性心脏病手术后的应用体会. 中华胸心血管外科杂志, 2014, 30(8):449-451.
8. 张玉龙, 李仲智, 李晓, 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.
9. Jenkins KJ, Gauvreau K, Newburger JW, et al.Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg, 2002, 123(1):110-118.
10. Padley JR, Cole AD, Pye VE, et al. Five-year analysis of operative mortality and neonatal outcomes in congenital heart diseases. Heart Lung Circ, 2011, 20(7):460-467.
11. Cheng HH, Almodovar MC, Laussen PC, et al. Outcomes and risk factors for mortality in premature neonates with critical congenital heart disease.Pediatr Cardiol, 2011, 32(8):1139-1146.
12. Riahi M, Tomatis LA, Schlosser RJ, et al. Cardiac compression due to closure of the median sternotomy in open-heart surgery. Chest, 1975, 67(1):113-114.
13. Misawa Y. What can be an indicator of delayed sternal closure after cardiac surgery? Eur J Cardiothorac Surg, 2002, 22(3):493-494.
14. Boeken, Assmann U, Mehdiani A, et al. Open chest management after cardiac operations:outcome and timing of delayed sternal closure. Eur J Cardiothorac Surg, 2011, 40(5):1146-1150.
15. Misawa Y. Indication for delayed sternal closure. J Thorac Cardiovasc Surg,1997, 114(5):874.
16. Furnary AP, Magovern JA, Simpson KA, et al. Prolonged open sternotomy and delayed sternal closure after cardiac operations. Ann Thorac Surg, 1992, 54(2):233-239.
17. Allpress AL, Rosenthal GL, Goodrich KM, et al. Risk factors for surgical site infections after pediatric cardiovascular surgery. Pediatr Infect Dis J, 2004, 23(3):231-234.
18. 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.
19. Woodward CS, Son M, Calhoon J, et al. Sternal wound infections in pediatric congenital cardiac surgery:a survey of incidence and preventative practice. Ann Thorac Surg, 2011, 91(3):799-804.
20. Mehta PA, Cunningham CK, Colella CB, et al. Risk factors for sternal wound and other infections in pediatric cardiac surgery patients. Pediatr Infect Dis J, 2000, 19(10):1000-1004.

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Risk Factors for Delayed Sternal Closure in Operation for the Neonates with Congenital Heart Disease

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