THE TREATMENT OF LOW CARDIAC-OUTPUT SYNDROME FOLLOWING CARDIOPULMONARY BYPASS USING DELAYED STERNAL CLOSURE

The purpose of this study was to ascertain whether delayed sternal clo sure (DSC) could eliminate the need for an intra-aortic balloon pump ( IABP) or ventricular assist device (VAD) in patients with low cardiac output syndrome (LCOS) following coronary artery bypass grafting surge ry (CABG).To investigate this, the records of 3014 patients undergoing CABG were retrospectively reviewed. Sixty (2.0%) patients had a relat ive or absolute contraindication to IABP or VAD use and required DSC f or LCOS. DSC resolved 45 (75%) of these patients' LCOS, requiring an a verage of 1.6 +/- 0.7 days and producing a mean change in cardiac inde x of +1.0 +/- 0.3 L/min/m(2). Fifteen (25%) of these patients did not resolve their LCOS after DSC and required either an IABP (11) or a VAD (4). Significant postoperative morbidity occurred in 22 (36.7%) patie nts but were not related to DSC. Only one (1.7%) sternal wound infecti on occurred from a total of 147 patient-days of DSC. Operative mortali ty was 47 per cent (28) but was not unexpected based on the number of urgent/emergent (48; 80%) and reoperative (40; 67%) procedures but doe s not appear to be related to the technique of DSC. DSC appears to be a simple and safe method for treating LCOS following CABG. It is effec tive in resolving the majority of patients' LCOS without the addition of any significant morbidity. DSC also spares these patients the added morbidity, mortality, and cost associated with circulatory assist dev ices.