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Outcomes of delayed sternal closure after complex aortic surgery

^a Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School and Memorial Hermann Hospital, Houston, TX, United States
^b Cardiothoracic Surgery, Rabin Medical Centre, Petah Tikva, Israel
^c Hospital Européen Georges Pompidou, Paris, France

Received 27 September 2007; received in revised form 14 February 2008; accepted 15 February 2008.

^_* Corresponding author. Address: Department of Cardiothoracic and Vascular Surgery, The University of Texas Houston Medical School, 6410 Fannin Street, Suite 450, Houston, TX 77030, United States. Tel.: +1 713 500 5304; fax: +1 713 500 0647. (Email: anthony.l.estrera{at}uth.tmc.edu).

Objective: Open chest management during complex proximal aortic surgery may sometimes be necessary. Infectious complications such as mediastinitis and late aortic graft infection remain a concern. The objective of this study was to report our experience with open chest management and delayed sternal closure after complex proximal aortic surgery. Methods: Between 1991 and 2007, 12 patients (1.2%, 12/1011) required open chest management and delayed sternal closure. Eight patients were men (67%), with a mean age of 56 years (range 28–83 years). Four cases involved redo-median sternotomy (33%) and seven cases (58%) involved acute dissection. All procedures were performed using total cardiopulmonary bypass with profound hypothermic circulatory arrest. Reasons for open chest management included hemodynamic instability, mediastinal edema, bleeding, and respiratory compromise. Results: In-hospital mortality was 16.7% (2/12). Delayed sternal closure was achieved in 92% of patients (11/12). Mean time to closure was 3 days (range 1–9 days). Five patients (42%) required one or more mediastinal explorations prior to final closure. Mean length of stay was 51 days (range 1–186 days). Significant predictors of open chest management were pump time (p < 0.0001) and intra-operative blood transfusions (p < 0.002). Mean follow-up was 60 months (range 8–106 months). No patients developed mediastinitis or aortic graft infection during postoperative follow-up. Conclusions: Open chest management with delayed sternal closure after complex aortic repairs may be performed with acceptable mortality. Open chest management does not appear to increase the risk of infectious complications (mediastinitis or graft infections) during complex proximal aortic replacement.

Key Words: Aortic surgery • Sternum

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