Kundan Simran, Tailor Kamlesh, Radhakrishnan Hari Bipin, Mohanty Smruti Ranjan, Bhavsar Keyur, Kadam Shankar, Joshi Preetha, Joshi Vinay, Karande Tanuja, Bobhate Prashant, Kulkarni Snehal, Rao Suresh Gururaja
Pediatric and Congenital Heart Surgery, Kokilaben Dhirubai Ambani Hospital, Mumbai, India.
Pediatric Cardiac Anesthesiologist and Intensivist, Kokilaben Dhirubai Ambani Hospital, Mumbai, India.
Indian J Thorac Cardiovasc Surg. 2019 Oct;35(4):530-538. doi: 10.1007/s12055-019-00830-1. Epub 2019 Jul 19.
Delayed sternal closure is used in paediatric cardiac surgery as a management strategy for patients with unstable hemodynamics or postoperative bleeding routinely. We hypothesise that planned postponement of sternal closure leads to better outcomes than emergent reopening in the intensive care unit (ICU) in patients exhibiting some hemodynamic indication for the same.
We retrospectively analysed the outcomes of delayed sternal closure 220/2111 (10.42%) out of which 14 sternums were opened in the ICU after shifting the patients.
A total of 220/2111 (10.42%) sternums were left open postoperatively, out of which 14 were opened after shifting to the ICU. Total mortality of the delayed sternal closure was 33/220, i.e. 15%. The patients whose sternums were left open from the theatre had a mortality of 23/206, i.e. 11.16%, whereas those patients whose sternums were opened in the ICU had a mortality of 10/14, i.e. 71.42%.
In doubtful postoperatively hemodynamic, the choice of leaving the sternum open electively has better outcomes, rather than opening the sternum as a terminal bail out procedure.
延迟胸骨闭合术在小儿心脏手术中常规用作血流动力学不稳定或术后出血患者的一种处理策略。我们假设，对于有血流动力学指征的患者，计划性推迟胸骨闭合术比在重症监护病房（ICU）紧急重新打开胸骨能带来更好的结果。
我们回顾性分析了220例（占2111例的10.42%）延迟胸骨闭合术的结果，其中14例在患者转移后于ICU打开胸骨。
共有220例（占2111例的10.42%）胸骨术后未闭合，其中14例在转入ICU后打开。延迟胸骨闭合术的总死亡率为33/220，即15%。术中即未闭合胸骨的患者死亡率为23/206，即11.16%，而在ICU打开胸骨的患者死亡率为10/14，即71.42%。
在术后血流动力学有疑问时，选择性地保持胸骨开放的选择比作为最终补救措施打开胸骨有更好的结果。
