Öz
Purpose: Delayed sternal closure after arterial switch operation is a therapeutic option in the treatment of the hemorrhage, tamponade and edema. The purpose of this study is to evaluate the relationship between delayed sternal closure and mediastinitis after arterial switch operation.
Material and Methods: Between January 2011 and November 2016, 43 consecutive patients undergoing arterial switch surgery and delayed sternal closure due to major arterial transposition or Taussig-Bing anomaly were examined retrospectively. The patients' operations were performed by the same surgeon. Indications for delayed sternal closure, sternal closure time, pre- and post-cardiopulmonary bypass, and metabolic status, mortality, and infection parameters were recorded.
Results: The mean sternal closure time was 2.7 days. The mortality rate was 2.32 % (n=1). 5 (11.63%) patients required prolonged antibiotic use due to postoperative infection. There was gram negative microorganism predominance. There were no patients with postoperative mediastinitis. Postoperative infection rate statistically not increased with cardiopulmonary bypass time, sternal closure time and intensive care unit stay time. On the other hand, the mortality was seen only one patient. This patients’ diagnosis was taussing bing anomaly with single coronary ostia and postoperatively patient needed extracorporeal membrane oxygenation in Intensive care unit.
Conclusions: Use of delayed sternal closure is an important management strategy after arterial switch operations. In our study, the prolonged sternal closure time is not associated with increased rate of postoperative mediastinit.
Anahtar Kelimeler
Delayed sternal closure arterial switch operation mediastinitis
Kaynakça
- 1. Gielchinsky I, Parsonnet V, Krishnan B, Silidker M, Abel RM. Delayed sternal closure following open-heart operation. Ann Thorac Surg. 1981;32:273-7.
- 2. 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;67:113-4.
- 3. Furnary AP, Magovern JA, Simpson KA, Magovern GJ. Prolonged open sternotomy and delayed sternal closure after cardiac operations. Ann Thorac Surg. 1992;54:233-9.
- 4. Pye S, McDonnell M. Nursing considerations for children undergoing delayed sternal closure after surgery for congenital heart disease. Crit Care Nurse. 2010;30:50-61.
- 5. Yasa H, Lafcı BB, Yılık L, Bademci M, Sahin A, Kestelli M et al. Delayed sternal closure: an effective procedure for life-saving in openheart surgery. Anadolu Kardiyol Derg. 2010;10:163-7.
- 6. Alexi-Meskishvili V, Weng Y, Uhlemann F, Lange PE, Hetzer R. Prolonged open sternotomy after pediatric open heart operation: experience with 113 patients. Ann Thorac Surg. 1995;59:379-83.
- 7. Long CB, Shah SS, Lautenbach E, Coffin SE, Tabbutt S, Gaynor JW et al. Postoperative mediastinitis in children: epidemiology, microbiology, and risk factors for gram negative pathogens. Pediatr Infect Dis J. 2005;24:315-9.
- 8. Tabbutt S: Duncan BW, McLaughlin D, Wessel DL, JonasRA. Laussen PC. Delayed sternal closure after cardiac operations in a pediatric population. J Thorac Cardiovasc Surg. 1997;113:886-93.
- 9. Estrera AL, Porat EE, Miller CC 3rd, Meada R, Achouh PE, Irani AD et al. Outcomes of delayed sternal closure after complex aortic surgery. Eur J Cardiothorac Surgery. 2008;33:1039-42.
- 10. Fleck T, Kickinger B, Moidl R, Waldenberger F, Wolner E, Grabenwoger M et al. Management of open chest and delayed sternal closure with the vacuum assisted closure system: preliminary experience. Interact Cardiovasc Thorac Surg. 2008;7:801-4.
- 11. Shin HJ, Jhang WK, Park JJ, Yun TJ: Impact of delayed sternal closure on postoperative infection or wound dehiscence in patients with congenital heart disease. Ann Thorac Surg. 2011;92:705-9.
- 12. Pollock EM, Ford-Jones EL, Rebeyka I, Mindorff CM, Bohn DJ, Edmonds JF et al. Early nosocomial infections in pediatric cardiovascular surgery patients. Crit Care Med. 1990;18:378-84.
- 13. Elella RA, Najm HK, Balkhy H, Bullard L, Kabbani MS. Impact of blood stream infection on the outcome of children undergoing cardiac surgery. Pediatr Cardiol. 2010;31:483-9.
- 14. McElhinney DB, Reddy VM, Parry AJ, Johnson L, Fineman JR, Hanley FL. Management and outcomes of delayed sternal closure after cardiac surgery in neonates and infants. Crit Care Med. 2000;28:1180-4.
- 15. Johnson JN, Jaggers J, Li S, O'Brien SM, Li JS, Jacobs JP et al. Center variation and outcomes associated with delayed sternal closure after stage 1 palliation for hypoplastic left heart syndrome. J Thorac Cardiovasc Surg. 2010;139:1205-10.
- 16. Kagen J, Lautenbach E, Bilker WB, Matro J, Bell LM, Dominguez TE et al. Risk factors for mediastinitis following median sternotomy in children. Pediatr Infect Dis J. 2007;26:613-18.
- 17. Mehta PA, Cunningham CK, Colella CB, Alferis G, Weiner LB. Risk factors for sternal wound and other infections in pediatric cardiac surgery patients. Pediatr Infect Dis J. 2000;19:1000–4.
- 18. Allpress AL, Rosenthal GL, Goodrich KM, Lupinetti FM, Zerr DM. Risk factors for surgical site infections after pediatric cardiovascular surgery. Pediatr Infect Dis J. 2004;23:231-34.
- 19. McAnally HB, Cutter GR, Ruttenber AJ, Clarke D, Todd JK. Hypothermia as a risk factor for pediatric cardiothoracic surgical site infection. Pediatr Infect Dis J. 2001;20:459-62.
- 20. Main E, Elliott MJ, Schindler M, Stocks J. Effect of delayed sternal closure after cardiac surgery on respiratory function in ventilated infants. Crit Care Med. 2001;29:1798-1802.
- 21. Woodward CS, Son M, Calhoon J, Michalek J, Husain SA. Sternal wound infections in pediatric congenital cardiac surgery: a survey of incidence and preventative practice. Ann Thorac Surg. 2011;91:799–804.
Öz
Amaç: Arteryel switch ameliyatından sonra gecikmiş sternal kapanma hemoraji, tamponad ve ödem tedavisinde terapötik bir seçenektir. Bu çalışmanın amacı, arteryel switch operasyonu sonrası gecikmiş sternal kapanma ile mediastinit ilişkisini değerlendirmektir.
Gereç ve Yöntem: Ocak 2011 ile Kasım 2016 arasında, Büyük arter transpozisyonu veya Taussig-Bing anomalisi nedeniyle Arteryel switch ameliyatı yapılan ve gecikmiş sternal kapatma uygulanan ardışık 43 hasta retrospektif olarak incelendi. Hastaların aynı cerrah tarafından uygulandı. Gecikmiş sternal kapanma endikasyonu, sternal kapatılma zamanı, kardiyopulmoner bypass öncesi ve sonrası ve metabolik durum, mortalite, enfeksiyon parametreleri kaydedildi.
Bulgular: Ortalama sternal kapanma süresi 2.7 gün idi. Ölüm oranı 2.32% (n=1) idi. Postoperatif enfeksiyon nedeniyle 5 (11.63%) hastada antibiyotik kullanımı uzun sürdü. Gram negatif mikroorganizma baskınlığı vardı. Postoperatif mediastinitli hasta yoktu. Ameliyat sonrası enfeksiyon hızı istatistiksel olarak kardiyopulmoner baypas zamanı, sternal kapatma zamanı ve yoğun bakım ünitesinde kalış süresi ile birlikte artmadı. Öte yandan, mortalite sadece bir hastada görülmüştür. Bu hastaların tanıları bing anomalisini tek koroner ostia ile, postoperatif dönemde ise yoğun bakım ünitesinde ekstrakorporeal membran oksijenasyonuna ihtiyaç duydu.
Sonuç: Arterial anahtar işlemlerinden sonra gecikmiş sternal kapatmanın kullanılması önemli bir yönetim stratejisidir. Çalışmamızda, sternum kapanma süresinin uzaması postoperatif enfeksiyon ve mediastinit oranı ile ilişkili bulunmamıştır.
Anahtar Kelimeler
Gecikmiş sternal kapatma arteriel switch ameliyatı mediastinit
Kaynakça
- 1. Gielchinsky I, Parsonnet V, Krishnan B, Silidker M, Abel RM. Delayed sternal closure following open-heart operation. Ann Thorac Surg. 1981;32:273-7.
- 2. 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;67:113-4.
- 3. Furnary AP, Magovern JA, Simpson KA, Magovern GJ. Prolonged open sternotomy and delayed sternal closure after cardiac operations. Ann Thorac Surg. 1992;54:233-9.
- 4. Pye S, McDonnell M. Nursing considerations for children undergoing delayed sternal closure after surgery for congenital heart disease. Crit Care Nurse. 2010;30:50-61.
- 5. Yasa H, Lafcı BB, Yılık L, Bademci M, Sahin A, Kestelli M et al. Delayed sternal closure: an effective procedure for life-saving in openheart surgery. Anadolu Kardiyol Derg. 2010;10:163-7.
- 6. Alexi-Meskishvili V, Weng Y, Uhlemann F, Lange PE, Hetzer R. Prolonged open sternotomy after pediatric open heart operation: experience with 113 patients. Ann Thorac Surg. 1995;59:379-83.
- 7. Long CB, Shah SS, Lautenbach E, Coffin SE, Tabbutt S, Gaynor JW et al. Postoperative mediastinitis in children: epidemiology, microbiology, and risk factors for gram negative pathogens. Pediatr Infect Dis J. 2005;24:315-9.
- 8. Tabbutt S: Duncan BW, McLaughlin D, Wessel DL, JonasRA. Laussen PC. Delayed sternal closure after cardiac operations in a pediatric population. J Thorac Cardiovasc Surg. 1997;113:886-93.
- 9. Estrera AL, Porat EE, Miller CC 3rd, Meada R, Achouh PE, Irani AD et al. Outcomes of delayed sternal closure after complex aortic surgery. Eur J Cardiothorac Surgery. 2008;33:1039-42.
- 10. Fleck T, Kickinger B, Moidl R, Waldenberger F, Wolner E, Grabenwoger M et al. Management of open chest and delayed sternal closure with the vacuum assisted closure system: preliminary experience. Interact Cardiovasc Thorac Surg. 2008;7:801-4.
- 11. Shin HJ, Jhang WK, Park JJ, Yun TJ: Impact of delayed sternal closure on postoperative infection or wound dehiscence in patients with congenital heart disease. Ann Thorac Surg. 2011;92:705-9.
- 12. Pollock EM, Ford-Jones EL, Rebeyka I, Mindorff CM, Bohn DJ, Edmonds JF et al. Early nosocomial infections in pediatric cardiovascular surgery patients. Crit Care Med. 1990;18:378-84.
- 13. Elella RA, Najm HK, Balkhy H, Bullard L, Kabbani MS. Impact of blood stream infection on the outcome of children undergoing cardiac surgery. Pediatr Cardiol. 2010;31:483-9.
- 14. McElhinney DB, Reddy VM, Parry AJ, Johnson L, Fineman JR, Hanley FL. Management and outcomes of delayed sternal closure after cardiac surgery in neonates and infants. Crit Care Med. 2000;28:1180-4.
- 15. Johnson JN, Jaggers J, Li S, O'Brien SM, Li JS, Jacobs JP et al. Center variation and outcomes associated with delayed sternal closure after stage 1 palliation for hypoplastic left heart syndrome. J Thorac Cardiovasc Surg. 2010;139:1205-10.
- 16. Kagen J, Lautenbach E, Bilker WB, Matro J, Bell LM, Dominguez TE et al. Risk factors for mediastinitis following median sternotomy in children. Pediatr Infect Dis J. 2007;26:613-18.
- 17. Mehta PA, Cunningham CK, Colella CB, Alferis G, Weiner LB. Risk factors for sternal wound and other infections in pediatric cardiac surgery patients. Pediatr Infect Dis J. 2000;19:1000–4.
- 18. Allpress AL, Rosenthal GL, Goodrich KM, Lupinetti FM, Zerr DM. Risk factors for surgical site infections after pediatric cardiovascular surgery. Pediatr Infect Dis J. 2004;23:231-34.
- 19. McAnally HB, Cutter GR, Ruttenber AJ, Clarke D, Todd JK. Hypothermia as a risk factor for pediatric cardiothoracic surgical site infection. Pediatr Infect Dis J. 2001;20:459-62.
- 20. Main E, Elliott MJ, Schindler M, Stocks J. Effect of delayed sternal closure after cardiac surgery on respiratory function in ventilated infants. Crit Care Med. 2001;29:1798-1802.
- 21. Woodward CS, Son M, Calhoon J, Michalek J, Husain SA. Sternal wound infections in pediatric congenital cardiac surgery: a survey of incidence and preventative practice. Ann Thorac Surg. 2011;91:799–804.
Ayrıntılar
| Konular | Sağlık Kurumları Yönetimi |
|---|---|
| Bölüm | Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Eylül 2017 |
| Kabul Tarihi | 23 Şubat 2017 |
| Yayımlandığı Sayı | Yıl 2017 Cilt: 42 Sayı: 3 |
