Role of primary sternal closure in early outcomes following the Norwood procedure.

OBJECTIVE

To evaluate the impact of primary sternal closure (PSC) after the Norwood procedure, focusing on perioperative factors and clinical outcomes.

METHODS

This single-institution retrospective review included 122 neonates who underwent the Norwood procedure (PSC, n = 30; delayed sternal closure [DSC], n = 92) between 2010 and 2022. DSC was further categorized as early (≤2 days) or late (>2 days). Intensive care unit (ICU) and hospital discharge rates were estimated using the Fine-Gray test.

RESULTS

Preoperative factors, chest reopening, and deep wound infection rates were similar in the PSC and DSC groups. Early mortality (30-day) was 0% for the PSC group and 8% for the DSC group (P = .19). In-hospital mortality was 3% for the PSC group and 17% for the DSC group (P = .07). The rate of ICU discharge by 14 days was 73.3% (95% confidence interval [CI], 59.1%-91.0%) for the PSC group and 41.3% (95% CI, 32.4%-52.7%) for the DSC group (Gray's P < .001). PSC was associated with less intraoperative blood product transfusion and lower grades of postbypass atrioventricular valve regurgitation (AVVR) (P < .001 for both). ICU discharge rates by 14 days were 73.3% (95% CI, 59.9%-89.7%) for PSC, 69.6% (95% CI, 54.2%-89.3%) for early DSC, and 46.9% (95% CI, 35.2%-62.6%) for late DSC.

CONCLUSIONS

PSC appears to be feasible in patients, with minimal transfusion requirements and less postbypass AVVR. Although PSC was associated with shorter length of stay, this advantage was observed mainly in late DSC cases. Early DSC demonstrated similar benefits as PSC, with low mortality and a shorter length of stay.