Delayed Sternal Closure in Heart Surgery: Outcomes and Quality of Life

Abstract

Background

Delayed sternal closure (DSC) is a well-established strategy used to manage patients with hemodynamic instability and perioperative coagulopathy following cardiac surgery. The study aims to present our 15-year surgical experiences with DSC.

Methods

Between 2007 and 2022, DSC was performed in 227 out of 14,210 patients (1.7%) who underwent cardiac surgery at our institution. Perioperative data, outcomes, and long-term survival were analyzed. Quality of life (QoL) was assessed utilizing the EuroQol-5D-5L questionnaire.

Results

Indications for DSC included low cardiac output syndrome (LCOS) (44.1%) and coagulopathy during the index procedure (32.2%), as well as postoperative tamponade (22.9%). In coronary artery bypass grafting, LCOS was the primary indication for DSC (72.7%), whereas in acute type A aortic dissection, coagulopathy was the leading indication (70.6%). For other procedures, DSC indications were more evenly distributed. The overall 30-day survival was 57.5%, with survival rates of 43.3% for LCOS, 72.0% for coagulopathy, and 65.4% for tamponade. Multivariate logistic regression identified body mass index, postoperative renal replacement therapy, aggravated heart failure, and intraoperative packed red blood cell transfusion as negatively associated with 30-day survival. The mean follow-up period was 6.58 ± 3.19 years. Younger patients and DSC patients upon bleeding related indications reported higher QoL in comparison to older patients and patients with LCOS. Longer follow-up interval correlated with higher QoL.

Conclusion

The study emphasizes the significant impact of LCOS on outcomes in patients undergoing DSC. We provide QoL data demonstrating good rehabilitation potential upon survival of the acute phase.

Keywords

surgery - complications - outcomes (includes mortality - morbidity) - heart failure - sternum - quality of life - postoperative care

Data Availability Statement

The data presented in this study are available on request from the corresponding author.

Ethical Approval Statement

Ethical approval for this study was granted by the Institutional Review Board of the University of Regensburg, Germany (approval number 23–3427–104). All research was conducted in accordance with the Declaration of Helsinki (most recent revision in 2013).

Authors' Contribution

Conceptualization: H.H. and J.L.; Data curation: H.H., J.T., and J.L.; Formal analysis: H.H., Z.S., and A.T.; Investigation: H.H., Z.S., S.W., H.A., C.L., P.H., B.F., and J.L.; Methodology: H.H., Z.S., and J.L.; Project Administration: H.H. and J.L.; Resources: A.T, S.W., H.A., C.L., B.F., and C.S.; Software: H.H., Z.S., and J.L.; Supervision: J.L.; Validation: Z.S. and J.L.; Visualization: H.H. and Z.S.; Writing—original draft: H.H. and J.L.; Writing—review & editing: H.H., A.T., S.W., H.A., C.L., P.H., B.F., C.S., and J.L. All authors have read and agreed to the published version of the manuscript.

Publication History

Received: 09 January 2025

Accepted: 08 May 2025

Accepted Manuscript online:
14 May 2025

Article published online:
29 May 2025

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