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Elective delayed sternal closure portends better outcomes in congenital heart surgery: a retrospective observational study

  • Simran KundanEmail author
  • Kamlesh Tailor
  • Hari Bipin Radhakrishnan
  • Smruti Ranjan Mohanty
  • Keyur Bhavsar
  • Shankar Kadam
  • Preetha Joshi
  • Vinay Joshi
  • Tanuja Karande
  • Prashant Bobhate
  • Snehal Kulkarni
  • Suresh Gururaja Rao
Original Article
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Abstract

Introduction

Delayed sternal closure is used in paediatric cardiac surgery as a management strategy for patients with unstable hemodynamics or postoperative bleeding routinely. We hypothesise that planned postponement of sternal closure leads to better outcomes than emergent reopening in the intensive care unit (ICU) in patients exhibiting some hemodynamic indication for the same.

Methods

We retrospectively analysed the outcomes of delayed sternal closure 220/2111 (10.42%) out of which 14 sternums were opened in the ICU after shifting the patients.

Results

A total of 220/2111 (10.42%) sternums were left open postoperatively, out of which 14 were opened after shifting to the ICU. Total mortality of the delayed sternal closure was 33/220, i.e. 15%. The patients whose sternums were left open from the theatre had a mortality of 23/206, i.e. 11.16%, whereas those patients whose sternums were opened in the ICU had a mortality of 10/14, i.e. 71.42%.

Conclusion

In doubtful postoperatively hemodynamic, the choice of leaving the sternum open electively has better outcomes, rather than opening the sternum as a terminal bail out procedure.

Keywords

Delayed sternal closure Cardiac surgery Hemodynamics 

Notes

Compliance with ethical standards

No animals were involved in the study.

Funding

None.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Indian Association of Cardiovascular-Thoracic Surgeons 2019

Authors and Affiliations

  • Simran Kundan
    • 1
    Email author
  • Kamlesh Tailor
    • 2
  • Hari Bipin Radhakrishnan
    • 1
  • Smruti Ranjan Mohanty
    • 1
  • Keyur Bhavsar
    • 2
  • Shankar Kadam
    • 2
  • Preetha Joshi
    • 3
  • Vinay Joshi
    • 3
  • Tanuja Karande
    • 4
  • Prashant Bobhate
    • 4
  • Snehal Kulkarni
    • 4
  • Suresh Gururaja Rao
    • 1
  1. 1.Pediatric and Congenital Heart SurgeryKokilaben Dhirubai Ambani HospitalMumbaiIndia
  2. 2.Pediatric Cardiac Anesthesiologist and IntensivistKokilaben Dhirubai Ambani HospitalMumbaiIndia
  3. 3.Pediatric and Neonatal IntensivistKokilaben Dhirubai Ambani HospitalMumbaiIndia
  4. 4.Pediatric CardiologistKokilaben Dhirubai Ambani HospitalMumbaiIndia

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