Application of delayed sternal closure in cardiac surgery:a report of 11 cases / 解放军医学杂志

ABSTRACT

Objective To investigate the application of delayed sternal closure in the process of open heart surgery.Methods Delayed sternal closure was performed from Mar.2000 to Jun.2005 in 11 patients(4 males and 7 females,aged 16-67 years with an average of 42 years) after cardiac surgery.The indication included cardiac dilatation(4 cases),intractable arrhythmia(4 cases),continuous bleeding(2 cases) and severe pulmonary edema(1 case).During the open chest period,the wound was covered with 3-layers of latex temporarily,and the delayed sternal closure was performed when bleeding was controlled,heart size reduced,and hemodynamic condition became stable.Results Except two patients died of acute kidney failure during open chest period,delayed sternal closure was successfully carried out in 9 patients 8-43 hours(23.7?11.0) after cardiac surgery.Except one patient died of cardiac arrest 21 days after operation,the 8 others survived and were discharged from ICU 1-8 days(3.9?2.4) after sternal closure,and the wounds healed well.Follow-up for the 8 survivors revealed an improvement of NYHA class(class Ⅰfor 4 cases,class Ⅱfor 2 cases,and class Ⅲ for 2 cases).Conclusion The delayed sternal closure is an effective method in the treatment of postoperative cardiac compression,severe bleeding and arrhythmia,and it does not increase the incidence of complications such as sternal infection.