ArticleJournal of cardiothoracic surgery2022
Delayed sternal closure for intractable bleeding after acute type A aortic dissection repair: outcomes and risk factors analyses.
Article in Journal of cardiothoracic surgery, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 11 citations in OpenAlex.
- Posterior Teflon-Felt-Reinforced Coronary Button Anastomosis in a Modified Bentall Procedure: Early Outcomes in a Single-Center Retrospective Study.Journal of clinical medicine · 2026Article
- Delayed Sternal Closure for High-Risk Cardiac Surgery Patients: Life-Saving Strategy for Improved Outcomes.Journal of clinical medicine · 2026Article
- Impact of delayed sternal closure and negative pressure therapy after complex cardiovascular surgery.Journal of cardiothoracic surgery · 2025Observational
- Postoperative Acute Refractory Hypoxemia After Acute Type A Aortic Dissection Surgery: Supporting the Two-Hit Mechanism of Transfusion-Related Acute Lung Injury. A Retrospective Cohort Study.Vascular health and risk management · 2025Article
- Acute type a aortic intramural hematoma complicated with preoperative hemopericardium: early and late surgical outcome analyses.Journal of cardiothoracic surgery · 2024Article
- Analysis of the hemostatic effect of preset wrapping technique for type A aortic dissection with abnormal coagulation.Journal of thoracic disease · 2024Article
- Perioperative Considerations in Management of the Severely Bleeding Coagulopathic Patient.Anesthesiology · 2023Article
- Risk Factors for Thoracic Aortic Dissection.Genes · 2022Review
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPerioperative coagulopathy and intractable bleeding are severe complications in acute type A aortic dissection (ATAAD) repair surgery. Mediastinal packing with delayed sternal closure (DSC) is a commonly adapted technique to stabilize the hemorrhagic tendency. This retrospective study aims to investigate the early and late outcomes and risk factors in patients who underwent DSC procedure during ATAAD repair surgery.
methodsThis study investigated 704 consecutive patients who underwent ATAAD repair at this institution between January 2007 and September 2020. These patients were dichotomized into the DSC (n = 109; 15.5%) and primary sternal closure (PSC) groups (n = 595; 84.5%). The clinical features, surgical information, postoperative complications, 5-years cumulative survival, and freedom from reoperation rates were compared. A multivariate logistic regression analysis was used to identify the independent risk factors for patients who underwent DSC.
resultsThe DSC group showed a higher rate of hemopericardium and preoperative malperfusion, and was associated with longer cardiopulmonary bypass and aortic clamping times and a higher rate of intraoperative extracorporeal membrane oxygenation (ECMO) support. The DSC group showed higher blood transfusion volumes and rate of reexploration for bleeding after surgery. However, the in-hospital mortality rates (17.4% vs. 13.3%; P = 0.249), 5-year survival rates (66.9% vs. 68.2%; P = 0.635), and freedom from reoperation rates (89.1% vs. 82.5%; P = 0.344) were comparable between the DSC and PSC groups. Multivariate analysis revealed that hemopericardium, preoperative malperfusion, and intraoperative ECMO support were risk factors for implementing DSC.
conclusionsDSC is an efficient life-saving technique to stabilize patients with intractable bleeding after undergoing ATAAD repair surgery, which leads to acceptable short- and long-term outcomes. Patients who were at risk for intractable bleeding should have early decision-making for implementing DSC.
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