Delayed Sternal closure following complex cardiac surgery in neonates

Lotto, R ORCID: 0000-0002-4305-0513 and Lotto, A Delayed Sternal closure following complex cardiac surgery in neonates. World Journal for Pediatric and Congenital Heart Surgery. ISSN 2150-1351 (Accepted)

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Abstract

Background: Delayed sternal closure (DSC) is a well-established surgical intervention following complex congenital cardiac surgeries mitigating postoperative haemodynamic and respiratory instability. It is mostly used in neonates requiring prolonged cardiopulmonary bypass, aortic cross-clamp times or deep hypothermic circulatory arrest, predisposing to myocardial oedema or bleeding. Our study evaluates morbidity and mortality after DSC in neonates including superficial, deep sternal wound infections and requirement of surgical debridement. Methods: Retrospective review of neonates who underwent DSC after cardiac surgery in a single centre from 2015 to 2021. Results: 187 neonates were identified. Mean age and weight were 12.8 ± 6.8 days and 3.3 ± 0.5 kg, respectively. Mean days of opened chest were 3.8 ± 5.8 days. Two neonates (1.07%) required sternal wound debridement, whilst 19 cases (10.2%) had superficial wound infections. Mean ICU and hospital stay were 12.8 ± 16.6 and 25.9 ± 36.9 days. 30-days mortality occurred in 9 cases (4.8%). Univariate analysis indicated that DSC days (p= 0.01), ECMO (p= 0.000), aortic cross clamp time (p= 0.007) and CPB time (p=0.006) to be associated with 30-days mortality, whilst in multivariable analysis, only ECMO was significant (p= 0.002). RACHS-1 score was the only independent risk factor for sternal wound infection in univariate analysis (p =0.019) and multivariable analysis (p=0.05). Conclusion: DSC is a safe therapeutic option following complex neonatal cardiac surgery, where cardiac compression by sternal approximation is not tolerated because of, myocardial oedema, haemodynamic instability or coagulopathy. Higher RACHS-1 score was associated with greater incidence of sternal wound infections.

Item Type:	Article
Additional Information:	This is the Accepted Version accepted for publication in Journal Title World Journal for Pediatric and Congenital Heart Surgery
Subjects:	R Medicine > RD Surgery R Medicine > RT Nursing
Divisions:	Nursing and Advanced Practice
Publisher:	SAGE Publications
Date of acceptance:	1 June 2025
Date of first compliant Open Access:	2 July 2025
Date Deposited:	02 Jul 2025 09:19
Last Modified:	03 Jul 2025 12:45
URI:	https://researchonline.ljmu.ac.uk/id/eprint/26686

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