HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Yoshio Misawa Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Misawa, Y. Search for Related Content PubMed PubMed Citation Articles by Misawa, Y.

J Thorac Cardiovasc Surg 1997;114:874
© 1997 Mosby, Inc.

LETTERS TO THE EDITOR

Indication for delayed sternal closure

Department of Thoracic and Cardiovascular Surgery
Jichi Medical School
Yakushiji 3311-1
Minami-Kawachi
Tochigi, 329-04, Japan

To the Editor:

In the May 1997 issue of this Journal, Tabbutt and colleagues ¹ reported an interesting study about delayed sternal closure after infant cardiac operations. Successful sternal closure was accomplished in 89% of 158 patients. Left and right atrial pressure increased about 2 mm Hg with delayed sternal closure. Although their study showed excellent clinical results, they failed to give the indications for delayed sternal closure because the study was retrospective.

A previous prospective study published by my colleagues and me ² suggested criteria for delayed sternal closure. The study, carried out between August 1989 and July 1991, comprised 201 patients. Sternal closure was delayed when mean left atrial or central venous pressure persistently increased 2 mm Hg or more above the initial value at the tentative sternal closure. In seven patients including six adults and only one infant, delayed sternal closure was performed, and all the patients underwent successful sternal closure 6 ± 3 days after the initial operation. We had no unsuccessful attempts, and catecholamine administration was maintained at a similar level to presternal closure even after sternal closure. In addition, in no case did filling pressure increase by 2 mm Hg or more at delayed sternal closure. No patients required sternal reopening because of hemodynamic deterioration caused by cardiac compression other than fluid or blood accumulation.

Our patient number was too small to conclude that a 2 mm Hg or greater rise of filling pressure is a standard criterion for delayed sternal closure after cardiac operations. Tabbutt and colleagues described a 2 mm Hg increase in left atrial pressure and right atrial pressure with delayed sternal closure. Although patient profiles were different between ours and theirs, I am concerned about reopening the sternum in patients with such an increase in filling pressure at sternal closure.

12/8/85045

References

1. Tabbutt S, Duncan BW, McLaughlin D, Wessel DL, Jonas RA, Laussen PC. Delayed sternal closure after cardiac operations in a pediatric population. J Thorac Cardiovasc Surg 1997;113:886-93. [Abstract/Free Full Text]
   
2. Misawa Y, Hasegawa T, Fukushima K, Sohara Y, Katoh M, Murayama F, et al. Delayed sternal closure after cardiac surgery. J Jpn Assoc Thorac Surg 1992;40:1085-8.
   

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Yoshio Misawa Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Misawa, Y. Search for Related Content PubMed PubMed Citation Articles by Misawa, Y.