Post-cardiotomy open chest management. A single-unit experience.
OBJECTIVE
Post-cardiotomy open chest management is used either for salvage or as a planned therapeutic option in patients with low cardiac output, hemorrhage, or intractable arrhythmias. We reviewed our experience with these patients.


METHODS
Over a 3-year period, 2534 adult cardiac patients were operated on and 35 (1.4%) had delayed sternal closure. The median age was 72 years (range 46-86 years) and mean logistic EuroSCORE I was 11.29 (range 1.33-84.99). The patients were divided into two groups: group A (22/35, 62.9%) left the operating room without sternal closure due to hemodynamic instability after coming off cardiopulmonary bypass; group B (13/35, 37.1%) had a resternotomy and sternal closure was delayed due to acute deterioration in the cardiac intensive care unit.


RESULTS
The median intensive care unit stay was 17 days (range 2-70 days). Mortality was 25.7% (9 patients). All survivors were followed-up for at least 2 years, with a 2-year survival rate of 57.1%. Overall mortality was broadly similar in both groups. There was a high rate of postoperative complications in both groups, including chest sepsis (77%), liver failure (14.3), renal failure requiring renal replacement therapy (42.9%), sternal wound infection (28.6%), gut ischemia (2.9%), cerebrovascular accident (11.4), and multiorgan failure (31.4%).


CONCLUSIONS
Some may argue that open chest management is an acceptable salvage procedure, however, follow-up demonstrated significant adverse cardiac or cerebrovascular events in a short period following discharge, thus delayed sternal closure is really a salvage procedure but useful in centers without access to extracorporeal membrane oxygenation.
Department of Cardiac Surgery, Royal Victoria Hospital, Belfast, UK.
Niamh
N
Haughey
Department of Cardiac Surgery, Royal Victoria Hospital, Belfast, UK.
Karen
K
Booth
Department of Cardiac Surgery, Royal Victoria Hospital, Belfast, UK hparissis@yahoo.co.uk.
Haralabos
H
Parissis
D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D005260:Female; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009660:Northern Ireland; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects* / Q000401:mortality; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D058106:Wound Closure Techniques / Q000009:adverse effects / Q000401:mortality
Cardiac surgical procedures; Hemodynamics; Postoperative care; Reoperation; Sternum; Treatment outcome