Department of Pediatric Cardiac Critical Care Medicine, University of Alabama at Birmingham, AL, USA.
Department of Biostatistics, University of Alabama at Birmingham, AL, USA.
World J Pediatr Congenit Heart Surg. 2021 Sep;12(5):589-596. doi: 10.1177/21501351211022413.
Delayed sternal closure (DSC) has been used for patients who develop bleeding, chest wall edema, and malignant arrhythmia following cardiopulmonary bypass. Multiple factors can influence the timing of when to perform DSC. We aimed to describe our DSC experience in neonates and infants by comparing outcomes between patients undergoing early (<48 hours) versus late DSC ( 48 hours). We explored the associations between specific clinical and laboratory variables and the timing of DSC.
Retrospective chart review of neonates and infants (<one-year-old) with DSC after heart surgery from December 2012 to December 2018. Patients requiring extracorporeal membrane oxygenation were excluded.
A total of 121 patients were included in the analysis, 34% (n = 41) met late DSC criteria. The overall cohort had a 75% survival rate and a median time for open sternum of 42.5 hours (Q1:23-Q3:65). The median time for open sternum in the early and late DSC groups was 24 hours (Q1:21-Q3:43) and 93 hours (Q1:65-Q3:141), respectively ( < .01). There was no statistical difference in mortality rate between groups. Patients with late DSC endured longer intensive care unit stays (median 24.3 days [Q1:13-Q3:35.3] vs 36.8 [Q1:23.9, 73.6]; < .01) and a two-fold longer hospital stay compared to the early DSC group (multivariable analysis: relative risk = 2, 95% CI: 1.5-2.7; < .01). Univariate analysis revealed patients with late DSC had higher median lactates both intraoperatively (7.6 [Q1:5.9-Q3:10.7] vs 9.3 [Q1:7.5-Q3:12.1]; < .01) and 24 hours postoperatively (6.5 [Q1:4.3-Q3:10.3] vs 8.7 [Q1:5.7-Q3:14.70]; = .03). A higher vasoactive inotrope score at 36 hours was associated with late DSC (odds ratio = 1.1, 95% CI: 1.01-1.2; = .02).
Future research that explores additional clinical and laboratory variables that can help guide DSC decision-making and timing is needed.
体外循环后发生出血、胸壁水肿和恶性心律失常的患者可采用延迟胸骨闭合（DSC）。影响 DSC 时机的因素有很多。我们旨在通过比较接受早期（<48 小时）与晚期（48 小时）DSC 的患者的结局来描述新生儿和婴儿 DSC 的经验。我们探讨了特定的临床和实验室变量与 DSC 时机之间的关联。
对 2012 年 12 月至 2018 年 12 月接受心脏手术后行 DSC 的新生儿和婴儿（<1 岁）进行回顾性图表分析。排除需要体外膜氧合的患者。
共纳入 121 例患者进行分析，34%（n=41）符合晚期 DSC 标准。整体队列的存活率为 75%，胸骨开放中位时间为 42.5 小时（Q1：23-Q3：65）。早期和晚期 DSC 组的胸骨开放中位时间分别为 24 小时（Q1：21-Q3：43）和 93 小时（Q1：65-Q3：141）（<0.01）。两组死亡率无统计学差异。晚期 DSC 组患者的 ICU 住院时间更长（中位数 24.3 天[Q1：13-Q3：35.3]比 36.8[Q1：23.9，73.6]；<0.01），与早期 DSC 组相比，住院时间也延长了一倍（多变量分析：相对风险=2，95%CI：1.5-2.7；<0.01）。单变量分析显示，晚期 DSC 组患者术中（7.6[Q1：5.9-Q3：10.7]比 9.3[Q1：7.5-Q3：12.1]；<0.01）和术后 24 小时（6.5[Q1：4.3-Q3：10.3]比 8.7[Q1：5.7-Q3：14.70]；=0.03）的中位乳酸水平更高。36 小时时更高的血管活性正性肌力评分与晚期 DSC 相关（比值比=1.1，95%CI：1.01-1.2；=0.02）。
需要进一步研究可帮助指导 DSC 决策和时机的其他临床和实验室变量。
