ObjectiveTo explore the clinical effect of delayed sternal closure (DSC) after neonatal cardiac operations. MethodsWe 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. ConclusionDSC has been an essential part of neonatal heart surgery. It provides an opportunity for the recovery of cardiac function.
ObjectiveTo investigate the effect of delayed sternal closure (DSC) on sternal wound debridement after pediatric cardiac surgery. MethodsWe retrospectively analyzed clinical data of 491 pediatric patients underwent DSC in Guangdong General Hospital between June 2009 and June 2014. There were 333 males and 158 females with age of 1 day to 153.37 (5.68±17.24) months. The rate of sternal wound debridement between the DSC patients and the non-DSC patients was compared. ResultsA total of 454 pediatric patients with DSC initiated in the operation room. And 37 patients with DSC initiated in intensive care unit after emergency sternotomy. A total of 392 patients with delayed sternal closure were discharged. Eight patients gave up treatment for family reasons and 91 patients died. Patients with DSC had higher incidence of sternal wound debridement than the patients with non-DSC did (χ2=6.693, P=0.010). ConclusionDSC is an effective treatment for children with severe cardiac surgery, while it causes higher incidence of sternal wound debridement.
ObjectiveTo analyze the risk factors for delayed sternal closure (DSC) in the operation for the neonates with congenital heart defects. MethodsWe 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. ResultsThese 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. ConclusionWeight 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.
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.