Application of delayed sternal closure following arterial switch operation for neonates with transposition of great arteries (D-TGA): A case control study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Xiaofeng ,  ZHUANG Jian , CHEN Jimei , LUO Dandong , ZHU Weizhong

Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, P.R.China;

Corresponding author：

ZHUANG Jian, Email: zhuangjian5413@tom.com

Keywords：

Delayed sternal closure; infant, newborn; arterial switch operation; median sternotomy incision; mortality rate

DOI：

10.7507/1007-4848.201803001

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Objective To investigate the application of delayed sternal closure (DSC) following arterial switch operation for neonates with transposition of great arteries (D-TGA). Methods We retrospectively analyzed clinical data of 172 neonates underwent arterial switch operation with transposition of great arteries (D-TGA) between June 1st 2009 and December 31st 2015. These neonates were divided into 2 groups including a DSC group (118 patients with 99 males and 19 females) and a non-DSC group (54 patients with 47 males and 7 females). The outcome of the two groups were compared. Results Preoperative mechanical ventilation(P<0.001), emergency surgery (P=0.023) and extracorporeal circulation time (P<0.001) were the risk factors for delayed sternal closure. The incidence of complications of median sternotomy incision in the DSC group was not higher than that in the non-DSC group. The mortality rate in the DSC group was markedly higher than that in the non-DSC group (P<0.001). However, DSC was not a risk factor for the death of the neonates. Conclusion Delayed sternal closure does not increase the incidence of complications of the median sternotomy incision, nor is it a risk factor for the death of the neonates. Reasonable application of delayed sternal closure is helpful for early postoperative recovery of the neonates.

Citation： LI Xiaofeng, ZHUANG Jian, CHEN Jimei, LUO Dandong, ZHU Weizhong. Application of delayed sternal closure following arterial switch operation for neonates with transposition of great arteries (D-TGA): A case control study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(10): 834-838. doi: 10.7507/1007-4848.201803001 Copy

1.	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.
2.	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.
3.	Ozker E, Saritas B, Vuran C, et al. Delayed sternal closure after pediatric cardiac operations; single center experience: a retrospective study. J Cardiothorac Surg, 2012, 7: 102-107.
4.	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.
5.	Shim MS, Jun TG, Yang JH, et al. Current expectations of the arterial switch operation in a small volume center: a 20-year, single-center experience. J Cardiothorac Surg, 2016, 11: 34-43.
6.	Traiber C, Piva JP, Fritsher CC, et al. Profile and consequences of children requiring prolonged mechanical ventilation in three Brazilian pediatric intensive care units. Pediatr Crit Care Med, 2009, 10(3): 375-380.
7.	Shi S, Zhao Z, Liu X, et al. Perioperative risk factors for prolonged mechanical ventilation following cardiac surgery in neonates and young infants. Chest, 2008, 134(4): 768-774.
8.	Erek E, Yalcinbas YK, Turkekul Y, et al. Indications and risks of delayed sternal closure after open heart surgery in neonates and early infants. World J Pediatr Congenit Heart Surg, 2012, 3(2): 229-235.
9.	López-Herce Cid J, Leyton Avilés P, Urbano Villaescusa J, et al. Risk factors for prolonged mechanical ventilation after cardiac surgery in children. Med Intensiva, 2008, 32(8): 369-377.
10.	Kagen J, Lautenbach E, Bilker WB, et al. Risk factors for mediastinitis following median sternotomy in children. Pediatr Infect Dis J, 2007, 26(7): 613-618.
11.	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.
12.	McAnally HB, Cutter GR, Ruttenber AJ, et al. Hypothermia as a risk factor for pediatric cardiothoracic surgical site infection. Pediatr Infect Dis J, 2001, 20: 459-462.
13.	Al-Sehly AA, Robinson JL, Lee BE, et al. Pediatric poststernotomy mediastinitis. Ann Thorac Surg, 2005, 80(6): 2314-2320.
14.	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.
15.	Mastropietro CW, Barrett R, Davalos MC, et al. Cumulative corticosteroid exposure and infection risk after complex pediatric cardiac surgery. Ann Thorac Surg, 2013, 95(6): 2133-2139.
16.	李晓峰, 罗丹东, 朱卫中, 等. 延迟关胸对小儿心脏术后伤口清创发生率的影响. 中国胸心血管外科临床杂志, 2015, 22(7): 642-645.
17.	Harder EE, Gaies MG, Yu S, et al. Risk factors for surgical site infection in pediatric cardiac surgery patients undergoing delayed sternal closure. J Thorac Cardiovasc Surg, 2013, 146(2): 326-333.
18.	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.

1. 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.
2. 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.
3. Ozker E, Saritas B, Vuran C, et al. Delayed sternal closure after pediatric cardiac operations; single center experience: a retrospective study. J Cardiothorac Surg, 2012, 7: 102-107.
4. 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.
5. Shim MS, Jun TG, Yang JH, et al. Current expectations of the arterial switch operation in a small volume center: a 20-year, single-center experience. J Cardiothorac Surg, 2016, 11: 34-43.
6. Traiber C, Piva JP, Fritsher CC, et al. Profile and consequences of children requiring prolonged mechanical ventilation in three Brazilian pediatric intensive care units. Pediatr Crit Care Med, 2009, 10(3): 375-380.
7. Shi S, Zhao Z, Liu X, et al. Perioperative risk factors for prolonged mechanical ventilation following cardiac surgery in neonates and young infants. Chest, 2008, 134(4): 768-774.
8. Erek E, Yalcinbas YK, Turkekul Y, et al. Indications and risks of delayed sternal closure after open heart surgery in neonates and early infants. World J Pediatr Congenit Heart Surg, 2012, 3(2): 229-235.
9. López-Herce Cid J, Leyton Avilés P, Urbano Villaescusa J, et al. Risk factors for prolonged mechanical ventilation after cardiac surgery in children. Med Intensiva, 2008, 32(8): 369-377.
10. Kagen J, Lautenbach E, Bilker WB, et al. Risk factors for mediastinitis following median sternotomy in children. Pediatr Infect Dis J, 2007, 26(7): 613-618.
11. 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.
12. McAnally HB, Cutter GR, Ruttenber AJ, et al. Hypothermia as a risk factor for pediatric cardiothoracic surgical site infection. Pediatr Infect Dis J, 2001, 20: 459-462.
13. Al-Sehly AA, Robinson JL, Lee BE, et al. Pediatric poststernotomy mediastinitis. Ann Thorac Surg, 2005, 80(6): 2314-2320.
14. 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.
15. Mastropietro CW, Barrett R, Davalos MC, et al. Cumulative corticosteroid exposure and infection risk after complex pediatric cardiac surgery. Ann Thorac Surg, 2013, 95(6): 2133-2139.
16. 李晓峰, 罗丹东, 朱卫中, 等. 延迟关胸对小儿心脏术后伤口清创发生率的影响. 中国胸心血管外科临床杂志, 2015, 22(7): 642-645.
17. Harder EE, Gaies MG, Yu S, et al. Risk factors for surgical site infection in pediatric cardiac surgery patients undergoing delayed sternal closure. J Thorac Cardiovasc Surg, 2013, 146(2): 326-333.
18. 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.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of delayed sternal closure following arterial switch operation for neonates with transposition of great arteries (D-TGA): A case control study

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