DELAYED STERNAL CLOSURE AFTER CARDIAC OPERATIONS IN A PEDIATRIC POPULATION

Objective: The purpose of this study was to assess morbidity and morta lity associated with delayed sternal closure after pediatric cardiac o perations, Methods: Hospital records were reviewed of all patients wit h an open sternum after a cardiac operation at Children's Hospital, Bo ston, from January 1992 to December 1995. Results: A total of 178 pati ents had delayed sternal closure,vith an overall mortality rate of 19% . The most common diagnosis of patients with delayed sternal closure w as hypoplastic left heart syndrome (29%), Although myocardial distenti on or chest wall edema (n = 47) was a common indication to delay stern al closure, In many patients (n = 47) the sternum was left open electi vely to avoid postoperative cardiac or respiratory compromise, Success ful sternal closure was achieved in 158 patients (89%) at a mean of 3. 4 +/- 1.8 days after opening, There were significant increases in left atrial pressure (7.7 +/- 3.4 to 9.8 +/- 4.1 mm Hg, p = 0.00001) and r ight atrial pressure (8 +/- 3.2 to 10.1 +/- 3.3 mm Hg, p = 0.00001) wi th sternal closure, There was a small but statistically significant dr op in pH (7.44 +/- 0.05 to 7.41 +/- 0.08, p < 0.0001) during sternal c losure, The peak inspiratory pressure, delivered breaths per minute, a nd fraction of inspired oxygen all significantly increased during ster nal closure, Clinical evidence of surgical site infection occurred in 12 (6.7%) of the patients with delayed sternal closure; mediastinitis developed in 7 (3.9%) patients, Conclusions: Although delayed sternal closure after complex operations for congenital heart disease is often necessary in the operating room because of edema, unstable hemodynami c conditions, or bleeding, it can also be used electively to aid in he modynamic and respiratory stability in the initial postoperative perio d, Our review supports a low morbidity associated with delayed sternal closure in a pediatric population.