The challenge of respiratory therapy to delayed sternal closure after surgical repair of congenital heart defect

  • Pingping He, Department of cardiovascular surgery, Shanghai Children's Medical Center, Medical college of Shnaghai Jiaotong University, China
  • Liping Liu, Department of cardiovascular surgery, Shanghai Children's Medical Center, Medical college of Shnaghai Jiaotong University, China
  • Jun Bian, Department of cardiovascular surgery, Shanghai Children's Medical Center, Medical college of Shnaghai Jiaotong University, China
  • Gang Ji, Department of cardiovascular surgery, Shanghai Children's Medical Center, Medical college of Shnaghai Jiaotong University, China
  • Limin Zhu, Department of cardiovascular surgery, Shanghai Children’s Medical Center, Medical college of Shanghai Jiaotong University, China

    • Objective: Delayed sternal closure (DSC) is one of useful technique to prevent cardiac tempnade resulted from myocardial edema during the early period after open heart surgery. The aim was to establish the respiratory effect of DSC, and to guide ventilation management after closure immediately.
    Methods: Thirty-five infants with the median age 6 weeks (ranged from 2 days to 13 weeks) and median weight 4.0 kg (ranged from 1.7 to 9 kg) were involved in his study. Respiratory function and hemodynamic was measured 30 min before and after sternal closure prospectively in paralyzed ventilated infants.
    Results: After operation about (2.9±0.9)d were successful to close without mediastinal infection .The change of hemodynamic, air way mechanism and oxygenation 30 min before and after DSC were shown in table 1, which showed a significant increase of peak airway pressure (PIP) (P<0.01, 11.2%) and a significant decrease of dynamic compliance (Cdyn ) (P<0.01, 32.2 %) 30 min after DSC. At the mean while, there was a significant decrease of PaO2/FiO2 ratio (279.4±78.3 versus 241.6±101.1, P<0.05), DA-aO2 (166.7±70.3 versus 203.8±82.3, P<0.01) and respiratory index (1.7±1.4 versus 2.4±1.9, P<0.01). Also, there was no significant change on hemodynamic. Fifty-four% of the patients developed pulmonary atelectasis or effusion. Three cases developed ventilation associated pneumonia account for the incidence of 12%.
    Conclusion: The respiratory function and oxygenation may be compromised after DSC and the mechanical ventilation should be very carefully. The best opportunity peri-DSC should improve the outcomes for the patients.