scholarly journals Novel technique for delayed sternal closure: Soft tissue approximation with substernal bridge

2014 ◽  
Vol 148 (5) ◽  
pp. 2427-2429 ◽  
Author(s):  
Cha Rajakaruna ◽  
Gladys M. Rodriguez ◽  
Bijoy G. Rajbanshi ◽  
Bulat A. Ziganshin ◽  
John A. Elefteriades
Keyword(s):  
Soft Tissue ◽  
Novel Technique ◽  
Sternal Closure ◽  
Delayed Sternal Closure ◽  
Tissue Approximation

Management of open chest and delayed sternal closure with the vacuum assisted closure system

2008 ◽  
Vol 56 (S 1) ◽  
Author(s):  
T Fleck ◽  
P Mares ◽  
R Moidl ◽  
F Waldenberger ◽  
W Mohl ◽  
...  
Keyword(s):  
Closure System ◽  
Vacuum Assisted Closure ◽  
Sternal Closure ◽  
Open Chest ◽  
Delayed Sternal Closure

Liberal use of delayed sternal closure for postcardiotomy hemodynamic instability

2002 ◽  
Vol 73 (5) ◽  
pp. 1484-1488 ◽  
Author(s):  
Curtis A Anderson ◽  
Farzan Filsoufi ◽  
Lishan Aklog ◽  
Robert S Farivar ◽  
John G Byrne ◽  
...  
Keyword(s):  
Hemodynamic Instability ◽  
Sternal Closure ◽  
Delayed Sternal Closure

Delayed sternal closure: an effective procedure for life-saving in open-heart surgery

2010 ◽  
Vol 10 (2) ◽  
pp. 163-167 ◽  
Author(s):  
Haydar Yasa ◽  
Banu Bahriye Lafci ◽  
Levent Yilik ◽  
Mehmet Bademci ◽  
Aykut Sahin ◽  
...  
Keyword(s):  
Heart Surgery ◽  
Open Heart Surgery ◽  
Effective Procedure ◽  
Open Heart ◽  
Sternal Closure ◽  
Life Saving ◽  
Delayed Sternal Closure

Physiologic effects of delayed sternal closure following stage 1 palliation

2018 ◽  
Vol 28 (12) ◽  
pp. 1393-1403 ◽  
Author(s):  
Kimberly I. Mills ◽  
Sarah J. van den Bosch ◽  
Kimberlee Gauvreau ◽  
Catherine K. Allan ◽  
Ravi R. Thiagarajan ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Circulatory Arrest ◽  
Unit Length ◽  
Aortic Cross Clamp Time ◽  
Technical Performance ◽  
Sternal Closure ◽  
Ventilatory Parameters ◽  
Delayed Sternal Closure ◽  
Patients At Risk ◽  
Stage 1

AbstractBackgroundFollowing stage 1 palliation, delayed sternal closure may be used as a technique to enhance thoracic compliance but may also prolong the length of stay and increase the risk of infection.MethodsWe reviewed all neonates undergoing stage 1 palliation at our institution between 2010 and 2017 to describe the effects of delayed sternal closure.ResultsDuring the study period, 193 patients underwent stage 1 palliation, of whom 12 died before an attempt at sternal closure. Among the 25 patients who underwent primary sternal closure, 4 (16%) had sternal reopening within 24 hours. Among the 156 infants who underwent delayed sternal closure at 4 [3,6] days post-operatively, 11 (7.1%) had one or more failed attempts at sternal closure. Patients undergoing primary sternal closure had a shorter duration of mechanical ventilation and intensive care unit length of stay. Patients who failed delayed sternal closure had a longer aortic cross-clamp time (123±42 versus 99±35 minutes, p=0.029) and circulatory arrest time (39±28 versus 19±17 minutes, p=0.0009) than those who did not fail. Failure of delayed sternal closure was also closely associated with Technical Performance Score: 1.3% of patients with a score of 1 failed sternal closure compared with 18.9% of patients with a score of 3 (p=0.0028). Among the haemodynamic and ventilatory parameters studied, only superior caval vein saturation following sternal closure was different between patients who did and did not fail sternal closure (30±7 versus 42±10%, p=0.002). All patients who failed sternal closure did so within 24 hours owing to hypoxaemia, hypercarbia, or haemodynamic impairment.ConclusionWhen performed according to our current clinical practice, sternal closure causes transient and mild changes in haemodynamic and ventilatory parameters. Monitoring of SvO2following sternal closure may permit early identification of patients at risk for failure.

Early Versus Late Sternal Closure in Infants—Perioperative Associations and Outcomes

2021 ◽  
Vol 12 (5) ◽  
pp. 589-596
Author(s):  
Ahmed Asfari ◽  
Matthew G. Clark ◽  
Kristal M. Hock ◽  
Jordan L. Huskey ◽  
A. K. M. F. Rahman ◽  
...  
Keyword(s):  
Median Time ◽  
Heart Surgery ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Retrospective Chart Review ◽  
Future Research ◽  
Sternal Closure ◽  
Delayed Sternal Closure ◽  
Laboratory Variables ◽  
Neonates And Infants

Background: Delayed sternal closure (DSC) has been used for patients who develop bleeding, chest wall edema, and malignant arrhythmia following cardiopulmonary bypass. Multiple factors can influence the timing of when to perform DSC. We aimed to describe our DSC experience in neonates and infants by comparing outcomes between patients undergoing early (<48 hours) versus late DSC (> 48 hours). We explored the associations between specific clinical and laboratory variables and the timing of DSC. Methods: Retrospective chart review of neonates and infants (<one-year-old) with DSC after heart surgery from December 2012 to December 2018. Patients requiring extracorporeal membrane oxygenation were excluded. Results: A total of 121 patients were included in the analysis, 34% (n = 41) met late DSC criteria. The overall cohort had a 75% survival rate and a median time for open sternum of 42.5 hours (Q1:23-Q3:65). The median time for open sternum in the early and late DSC groups was 24 hours (Q1:21-Q3:43) and 93 hours (Q1:65-Q3:141), respectively ( P < .01). There was no statistical difference in mortality rate between groups. Patients with late DSC endured longer intensive care unit stays (median 24.3 days [Q1:13-Q3:35.3] vs 36.8 [Q1:23.9, 73.6]; P< .01) and a two-fold longer hospital stay compared to the early DSC group (multivariable analysis: relative risk = 2, 95% CI: 1.5-2.7; P < .01). Univariate analysis revealed patients with late DSC had higher median lactates both intraoperatively (7.6 [Q1:5.9-Q3:10.7] vs 9.3 [Q1:7.5-Q3:12.1]; P < .01) and 24 hours postoperatively (6.5 [Q1:4.3-Q3:10.3] vs 8.7 [Q1:5.7-Q3:14.70]; P = .03). A higher vasoactive inotrope score at 36 hours was associated with late DSC (odds ratio = 1.1, 95% CI: 1.01-1.2; P = .02). Conclusions: Future research that explores additional clinical and laboratory variables that can help guide DSC decision-making and timing is needed.

Pericardial Bridge for Delayed Sternal Closure

2021 ◽  
pp. 53-54
Author(s):  
John A. Elefteriades ◽  
Bulat A. Ziganshin
Keyword(s):  
Sternal Closure ◽  
Delayed Sternal Closure
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