Authors
Naumov A.B.1, Hubulava G.G.2, Marchenko S.P.2, Kupatadze D.D.1, Kulemin E.S.1, Andreev M.S.2, Seliverstova A.A.1, Tereshenko O.YU.2, Pilyugov N.G.2, Maryutina T.A.1, Nevmerzhickaya O.V.3, CHupaeva O.YU.1, Kalnoj P.S.4, CHernomordova A.V.2, Sazonov A.B.5, Volkov A.M.5
1 St. Petersburg State Pediatric Medical University, Saint-Petersburg
2 Pavlov First Saint Petersburg State Medical University, Saint Petersburg
3 City perinatal center№1, Saint Petersburg
4 Ural state medical university, Ekaterinburg
5 S.M. Kirov Military medical academy, St. Petersburg
Abstract
Aim of the study: to evaluate the influence of precise hemodynamic and laboratory criteria on the use of the surgical technique of delayed sternal closure on the course in the early postoperative period in cardiac surgery patients of infancy. Materials and methods: A retrospective single-center study of the results of treatment of 167 infants operated on for CHD was carried out using precise hemodynamic and laboratory criteria for determining the indications for delayed sternum suturing: 1) left ventricular stroke volume index less than 15 ml / m2; 2) central venous pressure more than 20 mm Hg. Art .; 3) pressure in the left atrium more than 16 mm Hg; 4) Δ pCO2 more than 12 mm Hg. for two-ventricular hemodynamics and ΔpCO2 more than 7.9 mm Hg. for single ventricular hemodynamics.
Results: delayed suturing of the chest was performed in 21.5% of cases. The use of the proposed criteria in the application of the «open sternum» technique made it possible to reduce the duration of mechanical ventilation, the duration of treatment in the intensive care unit, the period of the state of the sternum that was not removed, to reduce the incidence of acute renal injury and the use of peritoneal dialysis, and also to reduce the rate of nosocomial mortality. In patients after primary suturing of the sternum, using the proposed criteria, the incidence of hemodynamic disorders in the early postoperative period decreased by 17.8% compared to the control group (p = 0.039; OR = 0.479).
Conclusions: Accurate hemodynamic and laboratory criteria for the use of the surgical technique for delayed sternal closure can improve the results of postoperative nursing of patients by preventing the development of acute heart failure and non-cardiac complications.
Keywords: delayed sternum closure, congenital heart defects, acute heart failure.
References
1. Du X, Chen H, Song X, Hao Z, Yin L, Lu Z. Risk factors for low cardiac output syndrome in children with congenital heart disease undergoing cardiac surgery: A retrospective cohort study. BMC Pediatr. 2020; 20(1). doi: 10.1186/s12887-020-1972-y.
2. Furnary AP, Magovern JA, Simpson KA, Magovern GJ. Prolonged open sternotomy and delayed sternal closure after cardiac operations. Ann Thorac Surg. 1992; 54(2): 233–239. doi: 10.1016/0003-4975(92)91375-J.
3. Khabibullin IM, Mironov PI, Onegov DV, Zaripova RI. Analysis of the postoperative course with delayed sternal suturing after correction of complex congenital heart defects in children during the first months of life. Anesteziologiya i Reanimatologiya. 2016; 61(1): 11–14. (In Russ).
4. Riahi M, Tomatis LA, Schlosser RJ, Bertolozzi E, Johnston DW. Cardiac compression due to closure of the median sternotomy in open heart surgery. Chest. 1975; 67(1): 113–114. doi: 10.1378/chest.67.1.113.
5. Hurtado-Sierra D, Calderón-Colmenero J, Curi-Curi P, Cervantes-Salazar J, Pablo Sandoval J, García-Montes JA. Outcomes of delayed sternal closure in pediatric heart surgery: Single-center experience. Biomed Res Int. 2018; 2018. doi: 10.1155/2018/3742362.
6. Mills KI, Van Den Bosch SJ, Gauvreau K, Alla CK, Thiagarajan RR, Hoganson DM. Physiologic effects of delayed sternal closure following stage 1 palliation. Cardiol Young. 2018; 28(12): 1393–1403. doi: 10.1017/S1047951118001385.
7. Khubulava GG, Marchenko SP, Dubova EV, Suvorov VV. Role of modified ultrafiltration in reduce of the systemic inflammatory response syndrome in cardiac surgery. Pediatr. 2016; 7(1): 106–110. (In Russ).
8. Shaath GA, Jijeh AMZ, Ismail SR, Hijazi O, Sulaiman RA, Almadani W. Predictors of reopening the sternum in children after cardiac surgery. Pediatr Crit Care Med. 2020; 21(3): 235–239. doi: 10.1097/PCC.0000000000002188.
9. Kennedy JT, DiLeonardo O, Hurtado CG, Nelson JS. A systematic review of antibiotic prophylaxis for delayed sternal closure in children. World J Pediatr Congenit Hear Surg. August 2020: 215013512094768. doi: 10.1177/2150135120947685.
10. Iyer KS. Deferring sternal closure after complex congenital heart surgery — to do or not to do is the question! Indian J Thorac Cardiovasc Surg. 2019; 35(4): 528–529. doi: 10.1007/s12055-019-00825-y.
11. Khubulava GG, Shikhverdiev NN, Payvin AA, Zhuravlev VP, Biryukov AV, Romanovskiy DYu. Myocardial Protection During Heart Surgery. Saint-Petersburg: Diton; 2013. (In Russ).
12. Seliverstova AA, Savenkova ND, Khubulava GG, Marchenko SP, Naumov AB. Acute kidney injury in neonates and infants with congenital heart disorders after cardiac surgery. Nefrologiya. 2017; 1(3): 54–60. (In Russ). doi: 10.24884/1561-6274-2017-3-54-60.
13. Bokeriya LA, Kalash nikov SV, Stepanicheva OA, Berishvili DO. Description of enap correction of type A aortic arch break in combination with hypoplasia of the left heart. Detskie bolezni serdtsa i sosudov. 2016; 13(4): 238–242. (In Russ).
14. Seliverstova AA, Savenkova ND, Marchenko SP, Naumov AB. Cardiac surgery-associated acute kidney injury in children. Nefrologiya. 2016; 20(3): 17–27. (In Russ).
15. Khubulava GG, Marchenko SP, Naumov AV, Nevmerzhitckaya OV, Chupaeva OYu, Seliverstova AA, Aleksandrovich YuS, Pshenisnov KV, Pilyugov NG, Tereshenko OYu, Popova LL, Andreev MS. Peculiarities of hemodynamic status of healthy newborns in early neonatal period. Rossiyskiy Vestnik Perinatologii i Pediatrii. 2019; 64(1): 30–38. (In Russ). doi: 10.21508/1027.
16. Khubulava GG, Naumov AB, Marchenko SP, Chupaeva OYu, Seliverstova AA, Aleksandrovich YuS. Indicators of blood gas composition in newborns with small cardiac output syndrome after cardiac surgery. Byulleten’ NTsSSKh im. A.N. Bakuleva RAMN. 2018; 19(5): 676–687. (In Russ). doi: 10.24022/1810-0694-2018-19-5-676-687.
17. Naumov AB, Polushin YuS, Khubulava GG, Аleksandrovich YuS, Marchenko SP, Pshenisnov KV, Pilyugov NG. Systemic perfusion assessment in patients with univentricular hemodynamics based on blood gas parameters. Vestnik anesteziologii i reanimatologii. 2020; 17(3): 6–16. (In Russ). doi: 10.21292/2078-5658-2020-17-3-6-16.
18. Marchenko SP, Khubulava GG, Naumov AB, Seliverstоva AA, Tsypurdeeva ND, Suvorov VV. Pathophysiological principles and approaches to the assessment of hemodynamics. Pediatr. 2014; 5(4): 110–115. (In Russ).
19. Elassal AA, Eldib OS, Dohain AM, Abdelmohsen GA, Abdalla AH, Al-Radi OO. Delayed sternal closure in congenital heart surgery: A risk-benefit analysis. Heart Surg Forum. 2019; 22(5): E325-E330. doi: 10.1532/hsf.2471.
20. Kumar SR, Scott N, Wells WJ, Starnes VA. Liberal use of delayed sternal closure in children is not associated with increased morbidity. Ann Thorac Surg. 2018; 106(2): 581–586. doi: 10.1016/j.athoracsur.2018.03.053.
21. Tanaka Y, Miyamoto T, Naito Y, Yoshitake S, Sasahara A, Miyaji K. Sternal semi-closure using a bioresorbable osteosynthesis device: a new method for delayed sternal closure. Surg Today. 2018; 48(8): 748–755. doi: 10.1007/s00595-018-1652-9.
22. Fogt PR, Khubulava GG, Marchenko SP, Shikhverdiev NN, Naumov AB. Elimination of sternal infection in cardiac surgery. Saint-Petersburg: ITAR-TASS; 2020. 19p. (In Russ).
23. Khubulava GG, Shikhverdiev NN, Naumov AB, Suvorov VV, Marchenko SP, Averkin II. Pathophysiological mechanisms and risk factors of sternal wound infection in cardiac surgery Vestnik rossiyskoy voenno-meditsinskoy akademii. 2013; 1(41): 174–179. (In Russ).
24. Khubulava GG, Shikhverdiev NN, Vogt PR, Marchenko SP, Suvorov VV. Predicting the probability of the sternal wound infection in patients undergoing cardiac surgery. Vestnik khirurgii imeni I.I. Grekova. 2018; 177(1): 11–15. (In Russ). doi: 10.24884/0042-4625-2018-177-1-11-1525.
25. Khubulava GG, Shchikhverdiev NN, Vogt PR, Marchenko SP, Naumov AB, Suvorov VV, Averkin II. Results of application of the method of sternal infection elimination in cardiosurgical patients. Vestnik khirurgii imeni I.I. Grekova. 2015; 174(5): 57–60. (In Russ). doi: 10.24884/0042-4625-2015-174-5-57-60.
26. Shikhverdiev NN, Khubulava GG, Marchenko SP, Suvorov VV. Effect of topical vancomycin on organ functions after heart surgery. Patologiya krovoobrashcheniya i kardiokhirurgiya. 2015; 19(4): 34–37. (In Russ). doi: 10.21688/1681-3472-2015-4-34-37.
