{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T19:04:51Z","timestamp":1790449491005,"version":"4.1.0"},"reference-count":19,"publisher":"Cambridge University Press (CUP)","issue":"12","license":[{"start":{"date-parts":[[2018,8,28]],"date-time":"2018-08-28T00:00:00Z","timestamp":1535414400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cardiol Young"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S1047951118001385_abs1\" sec-type=\"general\"><jats:title>Background<\/jats:title><jats:p>Following stage 1 palliation, delayed sternal closure may be used as a technique to enhance thoracic compliance but may also prolong the length of stay and increase the risk of infection.<\/jats:p><\/jats:sec><jats:sec id=\"S1047951118001385_abs2\" sec-type=\"methods\"><jats:title>Methods<\/jats:title><jats:p>We reviewed all neonates undergoing stage 1 palliation at our institution between 2010 and 2017 to describe the effects of delayed sternal closure.<\/jats:p><\/jats:sec><jats:sec id=\"S1047951118001385_abs3\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>During the study period, 193 patients underwent stage 1 palliation, of whom 12 died before an attempt at sternal closure. Among the 25 patients who underwent primary sternal closure, 4 (16%) had sternal reopening within 24 hours. Among the 156 infants who underwent delayed sternal closure at 4 [3,6] days post-operatively, 11 (7.1%) had one or more failed attempts at sternal closure. Patients undergoing primary sternal closure had a shorter duration of mechanical ventilation and intensive care unit length of stay. Patients who failed delayed sternal closure had a longer aortic cross-clamp time (123\u00b142 versus 99\u00b135 minutes, p=0.029) and circulatory arrest time (39\u00b128 versus 19\u00b117 minutes, p=0.0009) than those who did not fail. Failure of delayed sternal closure was also closely associated with Technical Performance Score: 1.3% of patients with a score of 1 failed sternal closure compared with 18.9% of patients with a score of 3 (p=0.0028). Among the haemodynamic and ventilatory parameters studied, only superior caval vein saturation following sternal closure was different between patients who did and did not fail sternal closure (30\u00b17 versus 42\u00b110%, p=0.002). All patients who failed sternal closure did so within 24 hours owing to hypoxaemia, hypercarbia, or haemodynamic impairment.<\/jats:p><\/jats:sec><jats:sec id=\"S1047951118001385_abs4\" sec-type=\"conclusion\"><jats:title>Conclusion<\/jats:title><jats:p>When performed according to our current clinical practice, sternal closure causes transient and mild changes in haemodynamic and ventilatory parameters. Monitoring of SvO<jats:sub>2<\/jats:sub>following sternal closure may permit early identification of patients at risk for failure.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s1047951118001385","type":"journal-article","created":{"date-parts":[[2018,8,28]],"date-time":"2018-08-28T13:33:24Z","timestamp":1535463204000},"page":"1393-1403","source":"Crossref","is-referenced-by-count":9,"title":["Physiologic effects of delayed sternal closure following stage 1 palliation"],"prefix":"10.1017","volume":"28","author":[{"given":"Kimberly I.","family":"Mills","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah J.","family":"van den Bosch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberlee","family":"Gauvreau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine 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