Delayed Sternal Closure in Infants With Congenital Heart Disease: Can Chest Wall Edema Guide Timing?

IntroductionDelayed sternal closure is commonly used after complex congenital cardiac surgery in neonates and infants. The purpose of this study is to assess whether measurements on chest radiography can aid in determining optimal timing for delayed sternal closure.MethodsThis is a retrospective study evaluating 103 neonates and infants <3 months of age who underwent cardiac surgery with delayed sternal closure from January 2018 to June 2021. A Thoracic Radiographic Edema Ratio was calculated using chest radiography by dividing the thoracic cavity diameter by the total chest diameter, measured at the inferior aspect of T7. The ratios were measured on the day prior to surgery, the day of surgery, and each postoperative day until chest closure.ResultsPeak swelling was noted to take place on postoperative days 1 and 2. Chest closure timing ranged from postoperative day 1 to postoperative day 5 with approximately 60% (62/103) of chest closures occurring on postoperative days 2 and 3. Mean Thoracic Radiographic Edema Ratio prior to surgery, immediately after surgery, and on the day of chest closure was 0.82, 0.77, and 0.8, respectively, indicating that patients had less swelling at time of closure than on postoperative day 0 (P < .001).ConclusionThis study characterizes the natural history of postoperative chest wall edema. Timing of delayed sternal closure timing is a clinical decision based on multiple factors. The Thoracic Radiographic Edema Ratio can be a helpful tool in guiding delayed sternal closure timing in infants, as peak swelling is quantifiable, with evidence of peak chest wall edema appreciated on postoperative days 1 and 2.