title: Preliminary experience with a new device for delayed sternal closure strategy in cardiac surgery.
abstract: OBJECTIVE
  Open chest management with delayed sternal closure (DSC) is a valuable strategy in the management of patients with postcardiotomy hemodynamic instability or severe coagulopathy. The conventional extemporized material available for off-label sternal stenting however may limit its efficacy. We evaluated outcomes of patients with refractory severe postcardiotomy cardiogenic shock (SPCCS) treated with DSC using a novel temporary sternal spreader (NTSS) which allows myocardial recovery by progressive controlled approximation of the sternal edges.
  
  
  METHODS
  Seven patients (4 male, mean age 66.5 ± 5 years) with refractory SPCCS showing acute hemodynamic instability at sternal closure, were implanted with the NTSS, consisting of stainless-steel branches linked to 2 diverging plates of polyether-ether ketone, whose progressive opening/closing mechanism can be controlled from outside the chest with a rotating steel wire. The sternal wound was closed by an elastic membrane to achieve a sterile field. Swan-Ganz monitoring was employed, and clinical outcomes evaluated.
  
  
  RESULTS
  The device was successfully implanted in all patients without device-related complications or failures. Progressive approximation of sternal edges, titrated on cardiac index values, was successfully completed allowing subsequent uneventful sternal closure in all. Mean time from SPCCS to sternal closure was 70 ± 21 hours. No patient developed infective complications or late hemodynamic instability after device removal and sternal closure. One patient (14%) died of multiorgan failure on postoperative day 9.
  
  
  CONCLUSIONS
  Despite the limited number of patients enrolled, the NTSS proved safe and effective in allowing complete myocardial recovery after SPCCS, avoiding hemodynamic instability related to abrupt sternal closure, with no occurrence of infective complications.
authors.affiliation: Division of Cardiac Surgery, University of Verona Medical School, Verona - Italy. francesco.santini@univr.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Santini
authors.forename: Francesco
authors.initials: F
authors.lastname: Onorati
authors.forename: Mariassunta
authors.initials: M
authors.lastname: Telesca
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Faggian
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mazzucco
mesh_terms: D000368:Aged; D001577:Benzophenones; D001672:Biocompatible Materials; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D002407:Catheterization, Swan-Ganz; D004867:Equipment Design; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007659:Ketones; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D011092:Polyethylene Glycols; D011108:Polymers; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013193:Stainless Steel; D056346:Sternotomy / Q000009:adverse effects* / Q000401:mortality; D013523:Surgical Equipment; D013997:Time Factors; D016896:Treatment Outcome; D058106:Wound Closure Techniques / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality
chemical_list: D001577:Benzophenones; D001672:Biocompatible Materials; D007659:Ketones; D011108:Polymers; D013193:Stainless Steel; C063834:polyetheretherketone; D011092:Polyethylene Glycols