A policy of elective delayed sternal closure does not improve the outcome after arterial switch

Background. Delayed sternal closure is regularly used in the immediate mana gement of hemodynamic instability after neonatal cardiac procedures. The ai m of this study was to assess whether the routine, elective use of delayed sternal closure would reduce morbidity in neonates undergoing arterial swit ch for transposition of the great arteries. Methods. A retrospective statistical analysis was performed on 52 neonates operated on from 1991 to 1998. Until 1994, chest closure was routinely atte mpted in all patients after arterial switch; the policy was then changed to delayed sternal closure in all cases in the latter half of the study perio d. Results. Delayed sternal closure did not significantly alter the mean durat ion of ventilation (2.7 +/- 2.37 versus 2.7 +/- 1.3 days) nor intensive car e stay (4.1 +/- 2.8 versus 5.7 +/- 10.0 days; p = 0.46). There was no incre ase in the incidence of wound sepsis (7.7% versus 3.8%; p = 0.55), and mort ality was unchanged (7.7% in both groups). There was an increase in the inc idence of urgent reexploration (7.7% versus 19.2%; p = 0.22), which did not reach significance. Conclusions. This study does not support the hypothesis that elective delay ed sternal closure reduces the morbidity after arterial switch in neonates but does, however, confirm the safety and efficacy of the procedure. (Ann T horac Surg 2001;71:1553-5) (C) 2001 by The Society of Thoracic Surgeons.