Risk factors for delayed sternal closure after open-heart surgery in children under one year of age - 14/08/18
Résumé |
Background |
After congenital heart surgery, delayed sternal closure (DSC) can be used electively to aid in hemodynamic and respiratory stability in the initial postoperative period. Risk factors for DSC have been previously determined for neonates. The purpose of our study was to determine risk factors that may predict the need for DSC in children<1 year.
Patients and methods |
We retrospectively reviewed records of children<1 year who underwent open-heart surgery in our institution over a period of 5 years. The criteria for DSC were hemodynamic instability, deterioration of the central venous saturation, metabolic status and/or high ventilatory pressures. In total, 283 patients underwent open-heart surgery during the period and 89 (31.4%) had DSC. Mean age was 3.8 months (±3.3) and mean weight was 4.8kg (±1.8). The major congenital heart diseases encountered were ventricular septal defect (n=80), tetralogy of Fallot (n=41) and transposition of the great arteries (n=38). Ten patients (3.5%) needed sternal reopening during the first postoperative 24h. Thirteen patients (4.6%) died after the surgery.
Results |
Cardiopulmonary bypass (CPB) time was significantly longer in children who had DSC (189min±68 versus 130min±44, P<0.001). Among the studied factors, use of hypothermia, preoperative use of prostaglandin, preexistent renal insufficiency, pulmonary hypertension and cyanosis were significantly associated with DSC (r=0.406, P<0.001; r=0.335, P<0.001; r=0.250, P<0.001; r=0.164, P=0.006; respectively). Multivariate analysis determined an age<7 days, long CPB time, preoperative mechanical ventilation and renal insufficiency as independent risk factors for DSC. The best cut-off value was 147min (se=75%, sp=70%, AUC=0.79) for CPB time.
Conclusion |
Small age at surgery, long CPB time and altered preoperative condition are highly at risk for DSC in children<1 year. Further studies are needed to develop a predictive model for the anticipation of sternal closure in this population.
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Vol 10 - N° 3-4
P. 288 - septembre 2018 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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