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- W1990143944 abstract "OBJECTIVES: Open chest (OC) and subsequent delayed sternal closure (DSC)has been described as a useful method in the treatment of the severelyimpaired heart after cardiac surgery. METHODS: Prolonged open chest wasused in 142 to 3373 adult cardiac operations (4.2%) between January 1987and December 1993. The indications were: hemodynamic compromise (121),intractable bleeding (9) and arrhythmias (12). Delayed sternal closure wascarried out in 123 of 142 patients at a mean of 2.0 +/- 1.4 days (range0.5-8 days). Open chest and DSC were used proportionally more frequentlyafter combined cardiac surgery (28/293, 9.6%) than after coronary arterybypass grafting (CABG) alone (108/2891, 3.7%) or valve operation (6/230,2.6%). RESULTS: Ninety- seven of the 123 who had DSC (78.9%) survived andwere discharged an average of 8.6 +/- 4.2 days after closure. Fourty-fivepatients died: 19 before DSC and 26 after this method. Mortality wasrelated to indications for OC: when the indication was low cardiac outputthe mortality was 38.6%, for hemodynamic collapse on closure 0%, diffusebleeding 33.3% and arrhythmias 27.3%. Delayed sternal closure in patientswithout intraaortic balloon pump support was more likely to be successful(mortality rate 4/25, 16.0% versus 35/76, 46.3%, P < 0.01). Superficialsternal wound infection occurred in 2 of 123 (1.6%) patients after DSC,mediastinitis in 1 (0.8%) and sternal dehiscence in 3 (2.4%) patients,which does not differ from a control population that had primary sternalclosure. The follow-up of 97 survivors at an average of 28 +/- 4 monthsrevealed an improvement of NYHA class by 1.4 +/- 0.4. There were 16 deaths(13 cardia-related) during the follow-up period and 3 redo CABG. One caseof sternal osteomyelitis occurred without any other late sternal morbidity.CONCLUSIONS: This study shows that OC with DSC is a beneficial adjunct inthe treatment of postoperatively impaired cardiac function, profusehemorrhage and persistent arrhythmias. It can be performed withoutincreased sternal morbidity. Long-term results are also encouraging." @default.
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- W1990143944 date "1996-01-01" @default.
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- W1990143944 title "Open chest and delayed sternal closure after cardiac surgery" @default.
- W1990143944 doi "https://doi.org/10.1016/s1010-7940(96)80087-x" @default.
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