Routine Delayed Sternal Closure after Left Ventricular Assist Device Implantation with Vacuum Assisted Device

Abstract

Purpose Bleeding after implantation of left ventricular assist device (LVAD) is a frequently encountered issue and lengthy hemostasis before chest closure is common. It was believed delayed sternal closure (DSC) increases incidence of sternal infection, however, recent reports have shown low rates. We introduced routine DSC after implantation of LVAD with hypothesis that it may reduce operation time by packing the mediastinum and decrease sternal infection by reducing pool of clot in the mediastinum. This study compared routine DSC with primary sternal closure (PSC). Methods and Materials From May 2008 to October 2012, 52 patients underwent LVAD implantation. Prior to January 2011, 12 patients (23.1%) underwent PSC. Afterward all patients (n=40, 76.9%) did DSC routinely. The sternum was left open with vacuum assisted device and observed in ICU followed by closure the following day. Results Operation time was not significantly shorter in DSC group (314.6 vs. 330.8 minutes, p=0.45). Postoperative requirement for blood transfusion (3.3 vs. 3.8 units of packed red blood cell, p=0.15), duration of inotropic support (149 vs. 128 hours, p=0.67), length of ICU stay (11.4 vs. 15.3 days, p=0.40) and hospital stay (20.7 vs. 27.6 days, p=0.42) were not increased in DSC compared with PSC. There was no sternal infection in either group. Time to extubation was longer in DSC (57.0 vs. 29.3 hours, p=0.022). Conclusions Routine DSC did not significantly decrease operation time or sternal infection. DSC did not increase requirement for blood transfusion. Although DSC increased time to extubation, it was not associated with longer ICU and hospital stay compared with PSC in patients after implantation of LVAD.