Division of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester 55905, USA.
J Heart Lung Transplant. 2012 Oct;31(10):1115-9. doi: 10.1016/j.healun.2012.08.015.
Delayed sternal closure (DSC) is employed after conventional cardiac surgery without a significantly increased risk of late mediastinitis or sternal wound infection. There are no data specifically examining its late effects on patients undergoing implantation with a ventricular assist device (VAD).
Between October 1996 and October 2010, 364 patients underwent primary VAD implant and DSC was utilized in 184 (51%) patients for coagulopathy (n = 155; 84%), hemodynamic instability (n = 103; 56%), isolated right ventricular dysfunction (n = 15; 8%) or unspecified reasons (n = 17; 9%).
Median duration of DSC was 1 day (range 1 to 7 days). Patients with DSC were older (54.5 vs. 50.3 years, p = 0.002), had a higher incidence of previous sternotomy (42% vs. 28%, p = 0.005), pre-operative intra-aortic balloon pump (50% vs. 30%, p < 0.001), pre-operative temporary extracorporeal mechanical circulatory support (23% vs 10%, p < 0.001), lower platelet counts (171,000 vs. 209,000, p < 0.001) and lower hematocrit levels (32% vs. 36%, p < 0.001). Operative (11% vs. 9%, p = 0.65) or late (2 years; 66 ± 7% vs 66 ± 7%, p = 0.720) mortality; composite incidence of mediastinitis, percutaneous drive-line infection, pocket infection and VAD-related endocarditis (15% vs. 16%, p = 0.79); re-exploration for bleeding (18% vs. 18%, p = 0.99); urgent transplantation for infection (4% vs. 3%, p = 0.99); or need for device exchange (9% vs. 10%, p = 0.16) was not increased after DSC when compared with immediate sternal closure. DSC increased ICU stay (10 vs. 5 days, p = 0.001).
DSC was performed most commonly for coagulopathy and/or hemodynamic instability, and patients were older with a greater severity of illness as shown by the higher incidence of right-sided circulatory failure and history of prior sternotomy. Although DSC was associated with longer ICU stay, DSC was not associated with a significantly increased risk of death or infection.
在常规心脏手术后采用延迟胸骨闭合（DSC）并不会显著增加晚期纵隔炎或胸骨伤口感染的风险。目前尚无专门研究其对接受心室辅助装置（VAD）植入患者的晚期影响的数据。
1996 年 10 月至 2010 年 10 月期间，364 例患者接受了原发性 VAD 植入，其中 184 例（51%）因凝血障碍（n=155；84%）、血流动力学不稳定（n=103；56%）、孤立性右心室功能障碍（n=15；8%）或不明原因（n=17；9%）采用 DSC。
DSC 的中位持续时间为 1 天（范围 1 至 7 天）。接受 DSC 的患者年龄更大（54.5 岁 vs. 50.3 岁，p=0.002），既往胸骨切开术发生率更高（42% vs. 28%，p=0.005），术前主动脉内球囊泵（50% vs. 30%，p<0.001）、术前临时体外机械循环支持（23% vs. 10%，p<0.001）、血小板计数较低（171,000 比 209,000，p<0.001）和较低的血细胞比容水平（32% vs. 36%，p<0.001）。手术（11% vs. 9%，p=0.65）或晚期（2 年；66±7% vs. 66±7%，p=0.720）死亡率；复合性纵隔炎、经皮导线感染、囊袋感染和 VAD 相关心内膜炎（15% vs. 16%，p=0.79）；因出血再次探查（18% vs. 18%，p=0.99）；因感染紧急移植（4% vs. 3%，p=0.99）；或需要更换设备（9% vs. 10%，p=0.16）在 DSC 后与即刻胸骨闭合相比并未增加。DSC 增加了 ICU 住院时间（10 天 vs. 5 天，p=0.001）。
DSC 最常用于凝血障碍和/或血流动力学不稳定，且患者年龄更大，右侧循环衰竭发生率更高，既往有胸骨切开术史，表明疾病严重程度更高。尽管 DSC 与 ICU 住院时间延长有关，但与死亡率或感染风险增加无关。
