Outcomes of Delayed Sternal Closure in Paediatric Cardiac Surgical Patients: A prospective single centre study
Prateek Vaswani, Sr.1, Manoj Kumar K. Sahu2, Sushama Gayatri B1, Bipin Challatil1, Palleti Rajashekar1, Velayoudam Devagourou1
1All India Institute of Medical Sciences, New Delhi, New Delhi, India, 2All India Institute of Medical Sciences, New Delhi, Delhi, India
Background: Delayed sternal closure (DSC) is being increasingly used as an interim support to help the dysfunctional heart in the road to recovery after complex paediatric cardiac surgeries. The purpose of this study was to assess the conduct of DSC at a tertiary care centre.Methods: Between 2018 and 2019, 185 consecutive paediatric patients (below 12 years of age) underwent cardiac surgery in a tertiary care centre. The incidence and causes of DSC were noted. The various pre, intra and post-operative factors till discharge or demise were noted and analysed.RESULTS: In this study DSC was done in 63 patients (34.05%) with a median age and weight of 29 days (18-100 days) and 4 kg (2-12.3 kg) respectively. TGA (41.27%) constituted the majority followed by TAPVC (26.98%). Myocardial oedema (49.21%) was the most common indication for DSC. Mean duration of open chest was 40.75 ± 18.58 hours. All-cause mortality was 19.05% (12/63). On multivariate analysis by logistic regression, the independent predictors of mortality were need for pre-operative mechanical ventilation (OR 42.82, 95 % CI=4.52-406.03, p < 0.001) and development of post-operative sepsis (OR 20.07, 95 % CI=2.12-189.80, p = 0.002).Conclusions: DSC is a safe and effective technique in management of complex paediatric cardiac surgeries. It provides assistance to the severely dysfunctional myocardium soon after the surgery and helps in stabilisation of hemodynamics with avoidance of post-operative mediastinal compression. Early sternal closure should be considered on the basis of cardiovascular function and / or resolution of primary indication for DSC.
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