Asfari Ahmed, Jacobs Jeffrey P, Byrnes Jonathan W, Borasino Santiago, Prodhan Parthak, Zaccagni Hayden, Dabal Robert J, Sorabella Robert A, Hammel James M, Smith-Parrish Melissa, Zhang Wenying, Banerjee Mousumi, Schumacher Kurt R, Tabbutt Sarah
Division of Cardiology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.
Department of Cardiovascular Surgery, University of Florida, Gainesville, Florida.
Ann Thorac Surg. 2023 Mar;115(3):649-654. doi: 10.1016/j.athoracsur.2022.06.046. Epub 2022 Jul 19.
The Norwood operation is a complex neonatal surgery. There are limited data to inform the timing of sternal closure. After the Norwood operation, delayed sternal closure (DSC) is frequent. We aimed to examine the association of DSC with outcomes, with a particular interest in how sternal closure at the time of surgery compared with the timing of DSC. Our outcomes included mortality, length of ventilation, length of stay, and postoperative complications.
This retrospective study included neonates who underwent a Norwood operation reported in the Pediatric Cardiac Critical Care Consortium registry from February 2019 through April 2021. Outcomes of patients with closed sternum were compared to those with sternal closure prior to postoperative day 3 (early closure) and prior to postoperative day 6 (intermediate closure).
The incidence of DSC was 74% (500 of 674). The median duration of open sternum was 4 days (interquartile range 3-5 days). Comparing patients with closed sternum to patients with early sternal closure, there was no statistical difference in mortality rate (1.1% vs 0%) and the median hospital postoperative stay (30 days vs 31 days). Compared with closed sternum, patients with intermediate sternal closure required longer mechanical ventilation (5.9 days vs 3.9 days) and fewer subsequent sternotomies (3% vs 7.5%).
For important outcomes following the Norwood operation there is no advantage to chest closure at the time of surgery if the chest can be closed prior to postoperative day 3.
诺伍德手术是一种复杂的新生儿手术。关于胸骨闭合时机的相关数据有限。诺伍德手术后，延迟胸骨闭合（DSC）很常见。我们旨在研究DSC与预后的关联，特别关注手术时胸骨闭合与DSC时机相比的情况。我们的预后指标包括死亡率、通气时间、住院时间和术后并发症。
这项回顾性研究纳入了2019年2月至2021年4月在儿科心脏重症监护联盟登记处报告的接受诺伍德手术的新生儿。将胸骨闭合患者的预后与术后第3天之前（早期闭合）和术后第6天之前（中期闭合）进行胸骨闭合的患者的预后进行比较。
DSC的发生率为74%（674例中的500例）。胸骨开放的中位持续时间为4天（四分位间距3 - 5天）。将胸骨闭合患者与早期胸骨闭合患者进行比较，死亡率（1.1%对0%）和术后中位住院时间（30天对31天）无统计学差异。与胸骨闭合相比，中期胸骨闭合的患者需要更长时间的机械通气（5.9天对3.9天），且后续胸骨切开术较少（3%对7.5%）。
对于诺伍德手术后的重要预后指标，如果能在术后第3天之前闭合胸部，手术时闭合胸部并无优势。
