Yanagida Roh, Rajagopalan Navin, Davenport Daniel L, Tribble Thomas A, Bradley Mark A, Hoopes Charles W
Department of Cardiothoracic Surgery, Newark Beth Israel Medical Center, 201 Lyons Avenue, Newark, NJ, 07112, USA.
Division of Cardiology, University of Kentucky, Lexington, USA.
J Artif Organs. 2018 Mar;21(1):46-51. doi: 10.1007/s10047-017-0996-z. Epub 2017 Sep 25.
Delayed sternal closure (DSC) is occasionally adopted after implantation of left ventricular assist device (LVAD). Recent studies suggest that DSC be used for high risk group of patients with coagulopathy, hemodynamic instability or right ventricular failure. However, whether DSC is efficacious for bleeding complication or right ventricular failure is not known. This study is single center analysis of 52 patients, who underwent LVAD implantation. Of those 52 patients, 40 consecutive patients underwent DSC routinely. The sternum was left open with vacuum assist device after implantation of LVAD. Perioperative outcome of the patients who underwent routine DSC were compared with 12 patients who had immediate sternal closure (IC). Mean Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level of IC group and DSC group were 2.7 and 2.6, respectively. Postoperative bleeding (643 vs. 1469 ml, p < 0.001), duration of inotropic support (109 vs. 172 h, p = 0.034), and time to extubation (26 vs. 52 h, p = 0.005) were significantly increased in DSC group. Length of ICU stay (14 vs. 15 days, p = 0.234) and hospital stay (28 vs. 20 days, p = 0.145) were similar. Incidence of right ventricular failure and tamponade were similar in the two groups. Routine DSC after implantation of an LVAD did not prove to be beneficial in reducing complications associated with coagulopathy and hemodynamic instability including cardiac tamponade or right ventricular failure. We suggest that DSC be selectively applied for patients undergoing LVAD implant.
左心室辅助装置（LVAD）植入术后偶尔会采用延迟胸骨闭合（DSC）。近期研究表明，DSC适用于患有凝血病、血流动力学不稳定或右心室衰竭的高危患者群体。然而，DSC对于出血并发症或右心室衰竭是否有效尚不清楚。本研究是对52例行LVAD植入术患者的单中心分析。在这52例患者中，40例连续患者常规进行DSC。LVAD植入术后，胸骨采用真空辅助装置保持开放。将常规进行DSC患者的围手术期结果与12例立即胸骨闭合（IC）患者进行比较。IC组和DSC组的平均机械辅助循环支持机构间注册（INTERMACS）水平分别为2.7和2.6。DSC组术后出血量（643 vs. 1469 ml，p＜0.001）、血管活性药物支持持续时间（109 vs. 172 h，p = 0.034）和拔管时间（26 vs. 52 h，p = 0.005）均显著增加。重症监护病房（ICU）住院时间（14 vs. 15天，p = 0.234）和住院时间（28 vs. 20天，p = 0.145）相似。两组右心室衰竭和心包填塞的发生率相似。LVAD植入术后常规DSC在减少与凝血病和血流动力学不稳定相关的并发症（包括心包填塞或右心室衰竭）方面未被证明有益。我们建议DSC应选择性应用于接受LVAD植入的患者。
