Outcomes of Primary versus Secondary Delayed Sternal Closure in Pediatric Cardiac Surgery.

Abstract Background Delayed sternal closure (DSC) is a management strategy for hemodynamic instability and severe coagulopathy after complex congenital heart surgery. We hypothesized that DSC results in better outcomes than perioperative sternal reopening. Methods We reviewed patients 2days (81 patients), and secondary DSC (45 patients) were analyzed. Results Median age was 120 days (range 3-6553) and median DSC duration was 2 days (range 1-60). The primary DSC >2 days group was the youngest group, and the distribution of procedures was different between groups. Indications for DSC were hemodynamic instability in 152 patients (67.9%) and severe coagulopathy in 33 patients (14.7%), with no difference between groups (p=0.141). Extracorporeal membrane oxygenation use was higher in the PDSC>2 days group than the other groups (47.5% vs 7.1%, p 2 days, p 2 days (44±6, p=0.01). Survival was better in PDSC regardless of duration than SDSC. Conclusions PDSC demonstrated better outcomes than SDSC. Sternal reopening can be life-saving, but when anticipated, PDSC can yield better outcomes.