In-hospital outcomes of delayed sternal closure after open cardiac surgery.

BACKGROUND

The purpose of this prospective study was to evaluate the current incidence, survival, morbidity, and predictors of mortality for open sternotomy at our center.

METHODS

Prolonged open chest was used in 126 of 2485 cardiac operations (5.0%) between June 2006 and January 2008. The indications were hemodynamic instability (98), bleeding (14), arrhythmia (five), cardiac edema (three), tamponade (three), and cardiac arrest (three). Delayed sternal closure (DSC) was performed in 81 of 126 patients at a mean of 2.35+/-1.73 days (range: 0.5 to 10 days).

RESULTS

Sixty-five of the 81 who had DSC (81.4%) survived. Forty-five patients (35.7%) died before DSC and 16 after this method. The 65 survivors (51.6%) were discharged from the hospital at a mean of 15.6+/-8.4 days (range: 7 to 50 days). The most common causes of death included low cardiac output (67.2%) and multiorgan failure (26.2%). Superficial sternal wound infection occurred in one of 81 (1.2%) patients after DSC, mediastinitis in four (4.9%), and sternal dehiscence in two (2.4%) patients. New onset of acute renal failure and the presence of intraaortic balloon pump (IABP) were predictive of in-hospital death.

CONCLUSIONS

This study shows that open chest with DSC is useful in the treatment of postoperatively impaired cardiac function, intractable bleeding, and persistent arrhythmias. It can be carried out with a relatively low incidence of sternal complications. Patients with new onset acute renal failure and who require IABP continue to have a high mortality rate.