When Should the Sternum Be Closed After Aortic Surgery?

Abstract

Introduction: There are many factors affecting postoperative morbidity and mortality in patients managed with delayed sternal closure (DSC) after aortic surgery. This study aimed to examine the postoperative management of patients after DSC and the factors affecting morbidity and mortality. Patients and Methods: Among 2151 patients who underwent ascending aorta and/or aortic valve surgery between January 2012 and December 2020, 64 patients managed with DSC were included in the study. The records of the patients were obtained from the hospital archive/hospital electronic database. Postoperative day 30 was determined as early mortality. Results: Uncontrollable bleeding 34.4% (n= 22), LCOS (Low Cardiac Output Syndrome) 31.4% (n= 20) and mediastinal edema 28.1% (n= 18)were the main causes for DSC. In the remaining patients (6.3%, n= 4), DSC was preferred for other non-specific reasons such as uncontrollable arrhythmia. Forty-five patients’ chests (70.3%) were closed in the postoperative period, and 19 patients (29.7%) could not be closed due to death (p< 0.001). Early mortality was observed in 27 patients (42.2%), and sepsis was observed in 10 patients (15.6%). Deep sternal wound infection (DSWI) was present in 4.7% of the patients and the rate of sepsis was higher in this patient group (66.7%-13.1%, p< 0.05). There was no statistically significant difference in the probability of sepsis in the culture-positive patient group (p> 0.05). However, the closure time was longer in patients with a previous operation history, postoperative acute renal failure, surgical site infection, and postoperative bleeding revision/surgical revision (p< 0.05). Conclusion: DSC can be preferred as a life-saving method for various reasons such as bleeding diathesis, mediastinal edema, and malignant arrhythmia after open-heart surgery. Accurate timing and close follow-up are important for sternal closure. In these patients, a multidisciplinary approach is required in the postoperative period.