Elective Primary or Secondary Delayed Sternal Closure Improves Outcome in Severely Compromised Patients.
Delayed sternal closure (DSC) in patients with severely compromised preoperative hemodynamics can be helpful as the chest sometimes cannot be able to contain both lungs and heart. We report our experience to evaluate the midterm results of this strategy in an adult population.



From May 2009 till July 2015, 33 patients had DSC as first treatment of severe hemodynamic deterioration after cardiac surgery. Surgical procedures were valvular (9.27%) or coronary artery bypass grafting + others (24.73%). Stepwise logistic regression (SLR) showed that patients with lower ejection fraction, dilated right ventricle, and severe pulmonary hypertension were more likely to need DSC. Patients were divided in two groups: group A (n= 17), when the sternum was reopened before any hemodynamic collapse, or was never closed, and group B (n= 16), when the sternum was reopened after hemodynamic collapse.



Inhospital mortality was 39% (n= 13), 18% in group A and 62% in group B (p< 0.0001). In 28 patients where the sternum was reopened, cardiac index increased from 1.7 (1.6, 1.9) L/m2to 2.8 (2.4, 3) L/m2,p< 0.0001. The sternum was closed in 28 patients (85%), 94% in group A and 75% in group B (p= 0.13), after a median of 4 (2.5) days. SLR showed that only group B (p< 0.0001) was a risk factor for early death. Two-year survival was 48 ± 9%, higher in group A (71 ± 13) than in group B (25 ± 11),p< 0.0001. Cox's analysis showed that group B (p< 0.0001) and redo (p< 0.0001) were risk factors for lower survival.



Elective DSC represents a useful strategy in severely compromised patients, entailing an improvement of hemodynamics and a higher survival.
Departments of Cardiac Surgery and Critical Care, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
Antonio M
AM
Calafiore
Departments of Cardiac Surgery and Critical Care, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
Azmat A
AA
Sheikh
Departments of Cardiac Surgery and Critical Care, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
Juan J
JJ
Alfonso
Departments of Cardiac Surgery and Critical Care, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
Tarek
T
Tantawi
Departments of Cardiac Surgery and Critical Care, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
Belgeit
B
Maklouf
Departments of Cardiac Surgery and Critical Care, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
Ahmed
A
Shawki
Departments of Cardiac Surgery and Critical Care, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.|Department of Cardiothoracic Surgery, Ain Shams Univeristy, Ain Shams, Egypt.
Ahmed
A
Allam
Departments of Cardiac Surgery and Critical Care, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.|Department of Cardiothoracic Surgery, Benha University, Benha, Egypt.
Mohammed O
MO
Awadi
Departments of Cardiac Surgery and Critical Care, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.|Department of Critical Care, Cairo University, Cairo, Egypt.
Ahmed A
AA
Osman
Departments of Cardiac Surgery and Critical Care, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.|Department of Critical Care, Cairo University, Cairo, Egypt.
Aly M
AM
Habib
Departments of Cardiac Surgery and Critical Care, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.|Department of Cardiology, L'Aquila University, L'Aquila, Palermo, Italy.
Michele
M
Di Mauro
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D000066491:Clinical Decision-Making; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012769:Shock / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology*; D013249:Sternum / Q000601:surgery*; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D058106:Wound Closure Techniques / Q000009:adverse effects / Q000401:mortality