Application of delayed sternal closure in pediatric heart transplantation

doi:10.3877/cma.j.issn.1674-3903.2022.02.004

Abstract

Abstract:

Objective

To explore the value of delayed sternal closure in pediatric heart transplantation.

Methods

The clinical data of 73 children with heart transplantation in the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 1, 2018 to August 31, 2021 were analyzed retrospectively. According to the primary sternal closure after operation, they were divided into delayed sternal closure group (n=10) and non-delayed sternal closure group (n=63). The effects of delayed sternal closure on the recovery of graft function, surgical incision infection, pulmonary infection, 30 days mortality after operation and mortality during hospitalization were analyzed.

Results

The protopathy of recipients in the delayed sternal closure group consisted largely of complex congenital heart disease heart failure, and the non-delayed sternal closure group was mainly cardiomyopathy heart failure. The median delayed sternal closure time in the delayed sternal closure group was 4 d, all recipients used the sternal closure technique once or several times, and the sternum were all successfully closed. The mean age and weight of recipients in the delayed sternal closure group were (6.4±5.3) years and (16.3±11.4) kg, both lower than those in the non-delayed sternal closure group [(9.7±4.7) years and (29.5±15.6) kg]; the donor recipient weight ratio of the delayed sternal closure group was (3.1±1.4), which was higher than that in the non-delayed sternal closure group (1.9±0.7). The differences were statistically significant (t=2.0, 3.2 and -4.5, all P<0.05). The preoperative and postoperative usage rate of VA-ECMO assistance, postoperative renal replacement treatment usage rate, pulmonary infection rate and mortality during hospitalization in the delayed sternal closure group were all higher than those in the non-delayed sternal closure group, and the differences were statistically significant (all P<0.05). The right ventricular volume change fraction in the delayed sternal closure group (37.0±5.8)% at 2 weeks after operation was lower than those (43.1±7.8)% in the non-delayed sternal closure group, and the difference was statistically significant (t=2.4, P<0.05). There was no significant difference in sex, preoperative serum total bilirubin and creatinine, left ventricular ejection fraction 2 weeks after operation, incision infection rate and mortality within 30 days after operation between the two groups (all P>0.05).

Conclusion

Delayed sternal closure is a safe and effective treatment strategy in pediatric heart transplantation when the donor recipient weight is mismatched.

Key words: Delayed sternal closure, Pediatric heart transplantation, Donor recipient weight mismatch

Lu Tong, Wei Su, Yongfeng Sun, Jin Zhang, Nianguo Dong, Jiawei Shi. Application of delayed sternal closure in pediatric heart transplantation[J]. Chinese Journal of Transplantation(Electronic Edition), 2022, 16(02): 83-87.

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组别	例数	性别(例，男/女)	年龄(岁，±s)	体质量(Kg，±s)	供受者体质量比(±s)	ECMO辅助(例)	总胆红素(μmol/L，±s)	血清肌酐(mmol/L，±s)	原发病(例)
组别	例数	性别(例，男/女)	年龄(岁，±s)	体质量(Kg，±s)	供受者体质量比(±s)	ECMO辅助(例)	总胆红素(μmol/L，±s)	血清肌酐(mmol/L，±s)	心肌病	先天性心脏病	瓣膜病	其他
延迟关胸组	10	5/5	6.4±5.3	16.3±11.4	3.1±1.4	2	45.6±16.3	23.9±15.4	4	5	1	0
非延迟关胸组	63	31/32	9.7±4.7	29.5±15.6	1.9±0.7	4	52.0±21.0	27.7±20.8	51	9	2	1
t值	-	-	2.0	3.2	-4.5	-	0.6	0.9	-
P值	-	>0.05	<0.05	<0.05	<0.05	<0.05	>0.05	>0.05	>0.05

组别	例数	性别(例，男/女)	年龄(岁，±s)	体质量(Kg，±s)	供受者体质量比(±s)	ECMO辅助(例)	总胆红素(μmol/L，±s)	血清肌酐(mmol/L，±s)	原发病(例)
组别	例数	性别(例，男/女)	年龄(岁，±s)	体质量(Kg，±s)	供受者体质量比(±s)	ECMO辅助(例)	总胆红素(μmol/L，±s)	血清肌酐(mmol/L，±s)	心肌病	先天性心脏病	瓣膜病	其他
延迟关胸组	10	5/5	6.4±5.3	16.3±11.4	3.1±1.4	2	45.6±16.3	23.9±15.4	4	5	1	0
非延迟关胸组	63	31/32	9.7±4.7	29.5±15.6	1.9±0.7	4	52.0±21.0	27.7±20.8	51	9	2	1
t值	-	-	2.0	3.2	-4.5	-	0.6	0.9	-
P值	-	>0.05	<0.05	<0.05	<0.05	<0.05	>0.05	>0.05	>0.05

组别	例数	ECMO辅助(例)	肾脏替代治疗(例)	术后2周LVEF(%，±s)	术后2周RVFAC(%，±s)	手术切口感染(例)	肺部感染(例)	术后30 d死亡(例)	住院期间死亡(例)
延迟关胸组	10	6	9	62.4±3.8	37.0±5.8	2	7	1	4
非延迟关胸组	63	0	3	63.6±7.0	43.1±7.8	4	16	2	3
t值	-	-	-	0.5	2.4	-	-	-	-
P值	-	<0.05	<0.05	>0.05	<0.05	>0.05	<0.05	>0.05	<0.05

组别	例数	ECMO辅助(例)	肾脏替代治疗(例)	术后2周LVEF(%，±s)	术后2周RVFAC(%，±s)	手术切口感染(例)	肺部感染(例)	术后30 d死亡(例)	住院期间死亡(例)
延迟关胸组	10	6	9	62.4±3.8	37.0±5.8	2	7	1	4
非延迟关胸组	63	0	3	63.6±7.0	43.1±7.8	4	16	2	3
t值	-	-	-	0.5	2.4	-	-	-	-
P值	-	<0.05	<0.05	>0.05	<0.05	>0.05	<0.05	>0.05	<0.05

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