Secondary sternotomy in pediatric heart surgery

PURPOSE: To analyze the results observed in children who underwent surgical correction of congenital anomalies, in whom the sternotomy was left open to avoid postoperative heart compression. METHODS: Fourteen children with mean age of 11 months, with different kind of congenital malformations who underwent definitive correction were submitted to the technique of delayed sternal closure. The indication was: hemodynamic instability due to sternal approximation (8), uncontrolled bleeding (4) and preventive (2). In all patients a bovine pericardial patch was sutured to the skin edges allowing a good decompression of the heart. RESULTS: Among the 14 children, two died in the immediate postoperative period, before the secondary sternal closure. There were two other deaths in the remaining 12 children who underwent sternal approximation, one due to acute pneumothorax and the other due to low cardiac output. The incision was closed after hemodynamic stabilization was achieved, and happened usually around the 3rd postoperative day. There were no cases of mediastinal infection. CONCLUSION: The technique of delayed sternal closure is an important approach in pediatric cardiac surgery and can be life saving. In our experience a bovine pericardial patch proved to be effective in decompressing the heart and also in protecting the mediastinal cavity.