Delayed sternal closure after arterial switch operations: a single center experience
Abstract
Purpose: Delayed sternal closure after arterial switch operation is a therapeutic option in the treatment of the hemorrhage, tamponade and edema. The purpose of this study is to evaluate the relationship between delayed sternal closure and mediastinitis after arterial switch operation.
Material and Methods: Between January 2011 and November 2016, 43 consecutive patients undergoing arterial switch surgery and delayed sternal closure due to major arterial transposition or Taussig-Bing anomaly were examined retrospectively. The patients' operations were performed by the same surgeon. Indications for delayed sternal closure, sternal closure time, pre- and post-cardiopulmonary bypass, and metabolic status, mortality, and infection parameters were recorded.
Results: The mean sternal closure time was 2.7 days. The mortality rate was 2.32 % (n=1). 5 (11.63%) patients required prolonged antibiotic use due to postoperative infection. There was gram negative microorganism predominance. There were no patients with postoperative mediastinitis. Postoperative infection rate statistically not increased with cardiopulmonary bypass time, sternal closure time and intensive care unit stay time. On the other hand, the mortality was seen only one patient. This patients’ diagnosis was taussing bing anomaly with single coronary ostia and postoperatively patient needed extracorporeal membrane oxygenation in Intensive care unit.
Conclusions: Use of delayed sternal closure is an important management strategy after arterial switch operations. In our study, the prolonged sternal closure time is not associated with increased rate of postoperative mediastinit.
Keywords
Delayed sternal closure,arterial switch operation,mediastinitis
References
- 1. Gielchinsky I, Parsonnet V, Krishnan B, Silidker M, Abel RM. Delayed sternal closure following open-heart operation. Ann Thorac Surg. 1981;32:273-7.
- 2. Riahi M, Tomatis LA, Schlosser RJ, Bertolozzi E, Johnston DW. Cardiac compression due to closure of the median sternotomy in open-heart surgery. Chest. 1975;67:113-4.
- 3. Furnary AP, Magovern JA, Simpson KA, Magovern GJ. Prolonged open sternotomy and delayed sternal closure after cardiac operations. Ann Thorac Surg. 1992;54:233-9.
- 4. Pye S, McDonnell M. Nursing considerations for children undergoing delayed sternal closure after surgery for congenital heart disease. Crit Care Nurse. 2010;30:50-61.
- 5. Yasa H, Lafcı BB, Yılık L, Bademci M, Sahin A, Kestelli M et al. Delayed sternal closure: an effective procedure for life-saving in openheart surgery. Anadolu Kardiyol Derg. 2010;10:163-7.
- 6. Alexi-Meskishvili V, Weng Y, Uhlemann F, Lange PE, Hetzer R. Prolonged open sternotomy after pediatric open heart operation: experience with 113 patients. Ann Thorac Surg. 1995;59:379-83.
- 7. Long CB, Shah SS, Lautenbach E, Coffin SE, Tabbutt S, Gaynor JW et al. Postoperative mediastinitis in children: epidemiology, microbiology, and risk factors for gram negative pathogens. Pediatr Infect Dis J. 2005;24:315-9.
- 8. Tabbutt S: Duncan BW, McLaughlin D, Wessel DL, JonasRA. Laussen PC. Delayed sternal closure after cardiac operations in a pediatric population. J Thorac Cardiovasc Surg. 1997;113:886-93.
- 9. Estrera AL, Porat EE, Miller CC 3rd, Meada R, Achouh PE, Irani AD et al. Outcomes of delayed sternal closure after complex aortic surgery. Eur J Cardiothorac Surgery. 2008;33:1039-42.
- 10. Fleck T, Kickinger B, Moidl R, Waldenberger F, Wolner E, Grabenwoger M et al. Management of open chest and delayed sternal closure with the vacuum assisted closure system: preliminary experience. Interact Cardiovasc Thorac Surg. 2008;7:801-4.
