Using eye speculum as a sternal retractor for delayed sternal closure after pediatric heart surgery

2021 ◽  
Author(s):  
Abdullah Doğan ◽  
Elif Tekin Ada ◽  
Rıza Türköz
Keyword(s):  
Heart Surgery ◽  
Sternal Closure ◽  
Pediatric Heart Surgery ◽  
Delayed Sternal Closure

scholarly journals Outcomes of Delayed Sternal Closure in Pediatric Heart Surgery: Single-Center Experience

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Daniel Hurtado-Sierra ◽  
Juan Calderón-Colmenero ◽  
Pedro Curi-Curi ◽  
Jorge Cervantes-Salazar ◽  
Juan Pablo Sandoval ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Therapeutic Option ◽  
Hemodynamic Instability ◽  
Control Group ◽  
Single Center ◽  
Sternal Closure ◽  
Pediatric Heart Surgery ◽  
Single Center Experience ◽  
Delayed Sternal Closure

Background. Delayed sternal closure (DSC) after cardiac surgery is a therapeutic option in the treatment of the severely impaired heart in pediatric cardiac surgery. Methods. A single-center retrospective review of all bypass surgeries performed over a 10-year period (2003–2012). Results. Of a total of 2325 patients registered in our database, the DSC group included 259 cases (11%), and the remaining 2066 cases (89%) constituted the control group (PSC). RACHS-1 risk was higher for the DSC group (74% had a score of 3 or 4) than for the PSC group (82% had a score of 2 or 3). The most frequent diagnosis for the DSC group was transposition of the great arteries (28%). We found out that hemodynamic instability was the main indication observed in patients aged ≤ 8 years (63%), while bleeding was the principal indication for patients aged ≥ 8 years (94%) (p≤0.001). The average time between surgery and sternal closure was 2.3±1.4 days. Overall mortality rates were higher for patients of the DSC group (22%) than for the PSC group (8.7%) (OR: 0.4 (95% CI: 0.4 to 0.5), p<0.05). There were six patients with DSC who developed mediastinitis (2.3%). The risk of mediastinitis was significantly higher when DSC was performed 4 days after the primary surgery. Conclusions. DSC is an important management strategy for congenital cardiac surgery in infants and children. The prolonged sternal closure time is associated with an increased rate of postoperative mediastinitis.

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

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.

scholarly journals Clinical Evaluation of Delayed Sternal Closure following Open Heart Surgery in Neonates and Infants.

1992 ◽  
Vol 21 (2) ◽  
pp. 149-154
Author(s):  
Masanao IMAI ◽  
Masahiro YAMAGUCHI ◽  
Hidetaka OHASHI ◽  
Yoshihiro OSHIMA ◽  
Naoki YOSHIMURA ◽  
...  
Keyword(s):  
Clinical Evaluation ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Sternal Closure ◽  
Delayed Sternal Closure ◽  
Neonates And Infants

Multicenter Quality Improvement Project to Prevent Sternal Wound Infections in Pediatric Cardiac Surgery Patients

2017 ◽  
Vol 8 (4) ◽  
pp. 453-459 ◽  
Author(s):  
Cathy Woodward ◽  
Richard Taylor ◽  
Minnette Son ◽  
Roozbeh Taeed ◽  
Marshall L. Jacobs ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Quality Improvement ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Wound Infections ◽  
Improvement Project ◽  
Sternal Closure ◽  
Increased Risk ◽  
Delayed Sternal Closure ◽  
Sternal Wound Infections

Background: Children undergoing cardiac surgery are at risk for sternal wound infections (SWIs) leading to increased morbidity and mortality. Single-center quality improvement (QI) initiatives have demonstrated decreased infection rates utilizing a bundled approach. This multicenter project was designed to assess the efficacy of a protocolized approach to decrease SWI. Methods: Pediatric cardiac programs joined a collaborative effort to prevent SWI. Programs implemented the protocol, collected compliance data, and provided data points from local clinical registries using Society of Thoracic Surgery Congenital Heart Surgery Database harvest-compliant software or from other registries. Results: Nine programs prospectively collected compliance data on 4,198 children. Days between infections were extended from 68.2 days (range: 25-82) to 130 days (range: 43-412). Protocol compliance increased from 76.7% (first quarter) to 91.3% (final quarter). Ninety (1.9%) children developed an SWI preprotocol and 64 (1.5%) postprotocol, P = .18. The 657 (15%) delayed sternal closure patients had a 5% infection rate with 18 (5.7%) in year 1 and 14 (4.3%) in year 2 P = .43. Delayed sternal closure patients demonstrated a trend toward increased risk for SWI of 1.046 for each day the sternum remained open, P = .067. Children who received appropriately timed preop antibiotics developed less infections than those who did not, 1.9% versus 4.1%, P = .007. Conclusion: A multicenter QI project to reduce pediatric SWIs demonstrated an extension of days between infections and a decrease in SWIs. Patients who received preop antibiotics on time had lower SWI rates than those who did not.

Minimization of Surgical Site Infections in Patients With Delayed Sternal Closure After Pediatric Cardiac Surgery

2019 ◽  
Vol 10 (4) ◽  
pp. 400-406 ◽  
Author(s):  
Mouhammad Yabrodi ◽  
Jeremy L. Hermann ◽  
John W. Brown ◽  
Mark D. Rodefeld ◽  
Mark W. Turrentine ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Recent Literature ◽  
Surgical Site Infections ◽  
Congenital Heart Surgery ◽  
Infectious Complications ◽  
Pediatric Cardiac Surgery ◽  
Clinical Sepsis ◽  
Sternal Closure ◽  
Delayed Sternal Closure

Background: Delayed sternal closure (DSC) following pediatric cardiac surgery is commonly implemented at many centers. Infectious complications occur in 18.7% of these patients based on recent multicenter data. We aimed to describe our experience with DSC, hypothesizing that our practices surrounding the implementation and maintenance of the open sternum during DSC minimize the risk of infectious complications. Methods: We reviewed patients less than 365 days who underwent DSC between 2012 and 2016 at our institution. Infectious complications as defined by the Society of Thoracic Surgeons Congenital Heart Surgery Database were recorded. Patients with and without infectious complications were compared using Wilcoxon rank sum tests or Fisher exact tests as appropriate. Results: We identified 165 patients less than 365 days old who underwent DSC, 135 (82%) of whom had their skin closed over their open sternum. Median duration of open sternum was 3 days (range: 1-32 days). Infectious complications occurred in 15 (9.1%) patients—13 developed clinical sepsis with positive blood cultures, one patient developed ventilator-associated pneumonia, and one patient developed wound infection (0.6%). No cases of mediastinitis occurred. No statistical differences in characteristics between patients with and without infectious complications could be identified. Conclusion: Infectious complications after DSC at our institution were notably less than reported in recent literature, primarily due to minimization of surgical site infections. Practices described in the article, including closing skin over the open sternum whenever possible, could potentially aid other institutions aiming to reduce infectious complications associated with DSC.

scholarly journals Risk factors for delayed sternal closure after open-heart surgery in children under one year of age

2018 ◽  
Vol 10 (3-4) ◽  
pp. 288
Author(s):  
Stéphanie Delange ◽  
Jean-Benoît Thambo ◽  
Zakaria Jalal ◽  
Jean-Baptiste Mouton ◽  
Xavier Iriart ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Sternal Closure ◽  
Delayed Sternal Closure ◽  
One Year

A simple method of sternal traction to relieve compression of the heart after open heart surgery

1994 ◽  
Vol 4 (1) ◽  
pp. 82-83 ◽  
Author(s):  
Osamu Matsuki ◽  
Toshikatsu Yagihara ◽  
Yasunaru Kawashima
Keyword(s):  
Heart Surgery ◽  
Simple Technique ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Risk Of Infection ◽  
Simple Method ◽  
Sternal Closure ◽  
Delayed Sternal Closure

AbstractA simple technique is described with which to relieve postoperative compression of the heart. Although delayed sternal closure has conventionally been used to deal with postoperative compression, this maneuver always exposes the patient to the risk of infection. We have recently employed a simple method of sternal traction when there are signs of compression on temporary sternal closure. One or two couples of sutures in the sternum are used supported by bags of saline. This simple and effective method is applicable to patients, but especially to infants and neonates, without worrying about overindications.

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