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This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Sarah Tabbutt Peter C. Laussen Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Tabbutt, S. Articles by Laussen, P. C. Search for Related Content PubMed Articles by Tabbutt, S. Articles by Laussen, P. C.

J Thorac Cardiovasc Surg 1997;114:874
© 1997 Mosby, Inc.

LETTERS TO THE EDITOR

Indication for delayed sternal closure

Departments of Cardiology and Anesthesia
Children's Hospital and Harvard Medical School
Longwood Ave.
Boston, MA 02115

Reply to the Editor:

We appreciate Misawa's comments regarding our retrospective review of pediatric patients who have an open sternum after cardiac operations. ¹ We presented only postoperative hemodynamic data; in 89% of our patients the sternum was left open in the operating room, and in most it was left open without attempted closure. Thus we did not address specific hemodynamic indications for leaving the sternum open in the operating room.

We described the cases of 158 patients (89%) who underwent successful sternal closure on mean postoperative day 3.4 ± 1.8. We found that patients with successful closure had a significant increase in the mean left atrial pressure from 7.7 ± 3.4 to 9.8 ± 4.1 mm Hg (p = 0.000001, n = 46) and in the mean right atrial pressure from 8 ± 3.2 to 10.1 ± 3.3 mm Hg (p = 0.000001, n = 108). None of these closures necessitated reopening.

Our patient population, which includes primarily infants (median age 10 days and median weight 3.4 kg) who have had reparative two ventricle or palliative single ventricle cardiac surgery, differs from that described by Misawa and associates. ² However, we agree with Misawa that, because of the limitations of a retrospective review, we cannot determine a specific increase in atrial pressure that will predict a successful sternal closure.

12/8/85044

References

1. Tabbutt S, Duncan BW, McLaughlin D, Wessel DL, Jonas RA, Laussen PC. Delayed sternal closure after cardiac operations in a pediatric population. J Thorac Cardiovasc Surg 1997;113:886-93. [Abstract/Free Full Text]
   
2. Misawa Y, Hasegawa T, Fukushima K, Sohara Y, Katoh M, Murayama F, et al. Delayed sternal closure after cardiac surgery. J Jpn Assoc Thorac Surg 1992;40:1085-8.
   

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Sarah Tabbutt Peter C. Laussen Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Tabbutt, S. Articles by Laussen, P. C. Search for Related Content PubMed Articles by Tabbutt, S. Articles by Laussen, P. C.