DELAYED STERNAL CLOSURE AFTER NEONATAL CARDIAC OPERATIONS

We retrospectively compared the use of primary elective open sternum c oupled with delayed sternal closure with the;use of primary sternal cl osure in neonates after cardiac operations. Primary elective open ster num/delayed sternal closure was selectively used in patients who demon strated hemodynamic or respiratory deterioration, or both, during an i ntraoperative trial of sternal closure; otherwise primary sternal clos ure was used. Primary elective open sternum was used in 55 (61.8%) and primary sternal closure in 34 (38.2%) of the 89 patients studied. Ele ven (20%) patients having primary elective open sternum died compared with 5 (14.7%) patients having primary sternal closure (p = 0.6). Six (10.9%) of the patients with primary elective open sternum died before delayed sternal closure; the remaining 49 patients comprise the prima ry elective open sternum/delayed sternal closure group. The durations of mechanical ventilation (9.7 +/- 0.9 days [mean plus or minus standa rd error of the mean], median 7.7 versus 9.9 +/- 3.4 days, median 4.9; p = 0.0005) and hospital stay (21.1 +/- 1.4 days, median 17.7 versus 19.6 +/- 4.1 days, median 12.9; p = 0.004) were shorter in the primary sternal closure group. The overall. morbidity and duration of inotrop ic support were not significantly different between the two groups, al though seven (20.6%) of the patients with primary sternal closure did have to undergo delayed sternal reopening for refractory postoperative low cardiac output. There was one superficial wound infection in the primary elective open sternum/delayed sternal closure group. Primary e lective open sternum/delayed sternal closure is an effective treatment for postoperative neonatal mediastinal compression for the following reasons: (1) the morbidity is low; (2) the mortality of the critically ill group of neonates in whom primary elective open sternum/delayed s ternal closure was used was similar to that of the less critically ill primary sternal closure group; and (3) 20.6% of the primary sternal c losure group eventually had to undergo delayed sternal reopening to tr eat refractory postoperative low cardiac output.