Analysis of Different Aspects of Delayed Sternal Closure in Pediatrics and Adults: A Review

Introduction: Delayed sternal closure (DSC) has been shown to be useful following cardiac surgeries in case of indications including hemodynamic instability, noticeable myocardial edema, respiratory compromise, stubborn bleeding, placement of extra- corporeal support device,and persistent arrhythmias. In this review, we summarize the investigations on this topic to analyze the controversial aspects of DSC in pediatrics and adults. Methods: Med-Line systematic review of the relevant literatures, which hase been published through 1970-2010, was performed. Results: A total of 191 studies were identified, 62 of which were eventually deemed relevant to this review. According to proper indications, DSC has been used in several types of cardiac surgeries in pediatric (newborns, infants and children) and adult cardiac surger- ies in recent 35 years. The outcomes concerning survival and complications seem to be acceptable. Conclusion: DSC is more frequent in pediatric cardiac surgery rather than adult car- diac surgery. DSC is an effective and safe strategy in patients with appropriate indica- tions. Surgeons should be aware of its suitable use and also physiologic alterations and management of the patients when the sternum is still open. Several previous investi- gations showed wide variations in methods of DSC by institutions. Apparent differ- ences in post-operative care of the patients with DSC clarify the demand for planning prospective multicenter trials with available control groups which can result in the implementation of standardized supervision protocols across institutions.