title: Outcomes of delayed sternal closure after complex aortic surgery.
abstract: OBJECTIVE
  Open chest management during complex proximal aortic surgery may sometimes be necessary. Infectious complications such as mediastinitis and late aortic graft infection remain a concern. The objective of this study was to report our experience with open chest management and delayed sternal closure after complex proximal aortic surgery.
  
  
  METHODS
  Between 1991 and 2007, 12 patients (1.2%, 12/1011) required open chest management and delayed sternal closure. Eight patients were men (67%), with a mean age of 56 years (range 28-83 years). Four cases involved redo-median sternotomy (33%) and seven cases (58%) involved acute dissection. All procedures were performed using total cardiopulmonary bypass with profound hypothermic circulatory arrest. Reasons for open chest management included hemodynamic instability, mediastinal edema, bleeding, and respiratory compromise.
  
  
  RESULTS
  In-hospital mortality was 16.7% (2/12). Delayed sternal closure was achieved in 92% of patients (11/12). Mean time to closure was 3 days (range 1-9 days). Five patients (42%) required one or more mediastinal explorations prior to final closure. Mean length of stay was 51 days (range 1-186 days). Significant predictors of open chest management were pump time (p<0.0001) and intra-operative blood transfusions (p<0.002). Mean follow-up was 60 months (range 8-106 months). No patients developed mediastinitis or aortic graft infection during postoperative follow-up.
  
  
  CONCLUSIONS
  Open chest management with delayed sternal closure after complex aortic repairs may be performed with acceptable mortality. Open chest management does not appear to increase the risk of infectious complications (mediastinitis or graft infections) during complex proximal aortic replacement.
authors: Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School and Memorial Hermann Hospital, Houston, TX 77030, United States. anthony.l.estrera@uth.tmc.edu
authors: Anthony L
authors: AL
authors: Estrera
authors: Eyal E
authors: EE
authors: Porat
authors: Charles C
authors: CC
authors: Miller
authors: Riad
authors: R
authors: Meada
authors: Paul E
authors: PE
authors: Achouh
authors: Adel D
authors: AD
authors: Irani
authors: Hazim J
authors: HJ
authors: Safi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002315:Cardiopulmonary Bypass; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008480:Mediastinitis / Q000209:etiology; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011184:Postoperative Period; D013249:Sternum / Q000601:surgery*; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome