Primary closure of median sternotomy with interposition of hydroxyapatite blocks. A new approach in pediatric cardiac surgery.

Chest closure after correction of congenital heart disease with subsequent enlargement of the heart has been a problem encountered throughout departments performing pediatric cardiac surgery. Present techniques using Rehbein struts or an open chest with a Gore-Tex patch skin closure have not solved this issue satisfactorily. Between January 1989 and September 1990, median sternotomies could not be closed primarily due to hemodynamic consequences in nine patients age 3 months to 19 years operated upon in our department. In three children, a conduit exchange, in two a Mustard correction, in two a correction of Fallot's tetralogy, in one a prosthetic valve exchange and in one, a new implantation of a homograft was performed. Primary chest closure was achieved by interposing hydroxyapatite blocks (50 mm x 15 mm x 6 mm) without hemodynamic consequences. In a follow-up period of 10 +/- 8 months, all children are alive and well. There was no complication resulting from the implanted blocks. Due to the excellent functional and cosmetic results of this technique and the outstanding histomorphological characters of hydroxyapatite, we regard the implantation of hydroxyapatite blocks as a superb method for primary sternotomy closure especially in pediatric cardiac surgery.