Early and Mid-Term Outcomes of Delayed Sternum Closure Strategy in Adult Cardiac Surgery: A Single-Center Experience.

IF 0.7 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Heart Surgery Forum Pub Date : 2023-05-28 DOI:10.1532/hsf.5461
Sameh Alagha, Ferit Çiçekçioğlu, Hasan Ekim, Ökkeş Hakan Miniksar
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Abstract

Background: Delayed sternum closure is a crucial strategy in the management of hemodynamic instability after weaning from cardiopulmonary bypass. This study aimed to evaluate our outcomes with this technique in light of the literature.

Methods: We retrospectively reviewed the data of all the patients who developed postcardiotomy hemodynamic compromise and intraaotic balloon pump was inserted between November 2014 to January 2022. Patients were divided into two groups: primary sternal closure group, and delayed sternum closure group. Patients' demographic data, hemodynamic parameters, and postoperative morbidities were recorded.

Results: Delayed sternum closure was performed in 16 patients with an incidence of 3.6%. The most common indication was hemodynamic instability in 14 patients (82%), followed by arrhythmia in 2 patients (12%) and diffuse bleeding in 1 patient (6%). The mean time to sternum closure was 21 (±7) hours. Three patients died (19%), p > 0.999. The median follow-up period was 25 months. Survival analysis revealed that the survival rate was 92%, p = 0.921. Deep sternal infection was observed in one patient with (6%), p > 0.999. multivariate logistic regression analysis revealed that end-diastolic diameter [odds ratio (OR) 4.5, 95% CI (1.19-17), p = 0.027], right ventricle diameter [OR 3.9, 95% CI (1.3-10.7), p = 0.012] and aortic clamp time [OR 1.16, 95% CI (1.02-1.12), p = 0.008] were independent risk factors for delayed sternum closure.

Conclusions: Elective delayed sternal closure is a safe and effective method for treating postcardiotomy hemodynamic instability. It can be performed with a low incidence of mortality and sternal infections.

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成人心脏手术延迟胸骨闭合策略的早期和中期结果:单中心经验。
背景:延迟胸骨关闭是处理体外循环脱机后血流动力学不稳定的关键策略。本研究的目的是根据文献评估我们使用该技术的结果。方法:回顾性分析2014年11月至2022年1月期间所有发生心切术后血流动力学损害并置入球囊泵的患者资料。患者分为两组:原发性胸骨闭合组和延迟性胸骨闭合组。记录患者的人口学数据、血流动力学参数和术后发病率。结果:迟发性胸骨闭锁16例,发生率3.6%。最常见的适应症是14例(82%)的血液动力学不稳定,其次是2例(12%)的心律失常和1例(6%)的弥漫性出血。平均胸骨闭合时间为21(±7)小时。死亡3例(19%),p > 0.999。中位随访期为25个月。生存分析显示生存率为92%,p = 0.921。深胸骨感染1例(6%),p > 0.999。多因素logistic回归分析显示,舒张末期内径[比值比(OR) 4.5, 95% CI (1.19-17), p = 0.027]、右心室内径[比值比(OR) 3.9, 95% CI (1.3-10.7), p = 0.012]和主动脉夹闭时间[比值比(OR) 1.16, 95% CI (1.02-1.12), p = 0.008]是延迟胸骨闭合的独立危险因素。结论:择期延迟闭锁胸骨是治疗开心术后血流动力学不稳定的一种安全有效的方法。手术死亡率和胸骨感染发生率低。
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来源期刊
Heart Surgery Forum
Heart Surgery Forum 医学-外科
CiteScore
1.20
自引率
16.70%
发文量
130
审稿时长
6-12 weeks
期刊介绍: The Heart Surgery Forum® is an international peer-reviewed, open access journal seeking original investigative and clinical work on any subject germane to the science or practice of modern cardiac care. The HSF publishes original scientific reports, collective reviews, case reports, editorials, and letters to the editor. New manuscripts are reviewed by reviewers for originality, content, relevancy and adherence to scientific principles in a double-blind process. The HSF features a streamlined submission and peer review process with an anticipated completion time of 30 to 60 days from the date of receipt of the original manuscript. Authors are encouraged to submit full color images and video that will be included in the web version of the journal at no charge.
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