Outcome of patients with delayed sternal closure after cardiac surgery

Objective: Delayed sternal closure (DSC) is a temporary solution for patients after complicated cardiac surgery. Aim of this study was to analyze the outcome of patients with DSC during routine clinical practice.

Methods: Data of all patients with DSC in the period from 01/05 to 08/11 (total number of cardiac operations performed=15071) was collected and analyzed. A total 282 patients (=1.8% of all patients treated during this time period) had DSC due to complicated operative course. 31.8% were female and mean age was 68.8±12.1 years. 23.7% of the patients had received isolated CABG, 27.7% isolated valve surgery, 15.4% treatment for aortic aneurysm, 4.0% treatment for Typ A aortic dissection, and 3.8% treatment for heart failure, including assist device implantation and heart transplant. 25.4% of the patients underwent combined procedures. Intraoperatively 12.8% required ECMO support. 70.2% of these 282 operations were urgent or emergency procedures. Median CPB time was 158min [57–600].

Results: Reasons for open chest management were low output syndrome (46.1%), persistent bleeding (35.1%), recurrent malignant arrhythmia (17.0%) or chronic infection with indication for lavage (1.8%). 155 (54.9%) patients were treated with open chest management directly following initial surgery, whereas 127 (45.1%) patients received DSC secondarily after initial sternal closure. Dress changes were performed in median once [0–15]. Overall in-hospital mortality was 45.7% (n=129); 31.0% (n=40) died before sternal closure. Patients that required open chest management for longer than 24 hours (n=69) demonstrated significantly worse in hospital mortality (79.7%) than those with earlier sternal closure (n=213; 34.7%) In total, superficial wound infection occurred in 5.6% and deep sternal wound infection (DSWI) in 2.4% of surviving patients.

Conclusion: Open chest management with DSC is an option for critical patients after cardiac surgical procedures. DSC is performed most frequently due to diffuse coagulopathy or low cardiac output syndrome following emergent procedures. Due to the high risk nature of this specific patient cohort overall mortality is high. However, the rate of DSWI in survivors was acceptable.