PMID: 15226848Mar 1, 1986Paper

Delayed sternal closure as a safe adjunct to support biventricular failure after open heart surgery

Texas Heart Institute Journal
R A MoggioG E Reed

Abstract

Over a four-year period, 22 patients of 2495 undergoing open heart surgery sustained severe biventricular failure (BVF) and would not tolerate primary sternal closure. Reasons for BVF included intraoperative injury, perioperative infarction, global dysfunction, cardiopulmonary edema, and intractable arrhythmia. Mechanical assist devices were required in nine patients. Average cardiac index fell to 1.1 L/min/m2 with attempts to close the chest, then stabilized at 1.9 with the sternum open and only soft tissue closed. After 3 to 11 days, cardiac index rose to 2.5 when assist devices were removed, inotropic agents decreased, and the sternum closed. Three early deaths (5-12 days) were caused by progressive biventricular failure. Five later deaths (19-64 days) were associated with renal and respiratory failure, superinfection, and sepsis. All of these required tracheostomy. Survival of 14 patients was not related to early low cardiac output, preoperative status, timing of sternal closure, or age, but was associated with early recovery of respiratory function without need for tracheostomy, avoidance of renal failure, and satisfactory alimentation. Sternal infection occurred in three patients, resulting in one death. The hospital stay...Continue Reading

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