Primary versus Delayed Sternal Closure in Left Ventricular Assist Device Implantation Patients: Impact on Infection

Abstract

Purpose Postoperative delayed chest closure (DCC) in LVAD patients, is often required in cases of bleeding due to coagulopathy or right heart distention. Despite the absence of data about the increased risk of infection, this bias limits the use of DCC in most centers. We retrospectively analyzed patients with left ventricular assist devices (LVADs) who underwent DCC in our center and evaluated the impact of this approach on postoperative infection rates. Methods Between May 2012 and June 2018, we reviewed the medical records of 294 consecutive first-time, LVAD patients and divided them into two groups based on the chest closure approaches: the DCC group and the primary chest closure (PCC) group. Postoperative LVAD-related infection (DLI + PPI), sternal wound infection and mediastinal exploration rates after definite chest closure were documented and compared in two groups. Results 183 patients had PCC (63%) and 107 patients (37%) underwent DCC. Four patients died before chest closure; they were excluded from further analysis. Demographics were similar in both group except for overrepresentation of men (91% vs 74%, p=0.028), INTERMACS class 1 patients (59% vs 30%, p Conclusion Based on these data, it seems that DCC is safe and does not impact the incidence of LVAD-related or sternal wound infections.