DOI: 10.25881/BPNMSC.2021.21.67.003

Authors

Naumov A.B.1, Hubulava G.G.2, Marchenko S.P.2, Kupatadze D.D.1, Kulemin E.S.1, Andreev M.S.2, Seliverstova A.A.1, Tereshenko O.YU.2, Pilyugov N.G.2, Maryutina T.A.1, Nevmerzhickaya O.V.3, CHupaeva O.YU.1, Kalnoj P.S.4, CHernomordova A.V.2, Sazonov A.B.5, Volkov A.M.5

1 St. Petersburg State Pediatric Medical University, Saint-Petersburg

2 Pavlov First Saint Petersburg State Medical University, Saint Petersburg

3 City perinatal center№1, Saint Petersburg

4 Ural state medical university, Ekaterinburg

5 S.M. Kirov Military medical academy, St. Petersburg

Abstract

Aim of the study: to evaluate the influence of precise hemodynamic and laboratory criteria on the use of the surgical technique of delayed sternal closure on the course in the early postoperative period in cardiac surgery patients of infancy. Materials and methods: A retrospective single-center study of the results of treatment of 167 infants operated on for CHD was carried out using precise hemodynamic and laboratory criteria for determining the indications for delayed sternum suturing: 1) left ventricular stroke volume index less than 15 ml / m2; 2) central venous pressure more than 20 mm Hg. Art .; 3) pressure in the left atrium more than 16 mm Hg; 4) Δ pCO2 more than 12 mm Hg. for two-ventricular hemodynamics and ΔpCO2 more than 7.9 mm Hg. for single ventricular hemodynamics.

Results: delayed suturing of the chest was performed in 21.5% of cases. The use of the proposed criteria in the application of the «open sternum» technique made it possible to reduce the duration of mechanical ventilation, the duration of treatment in the intensive care unit, the period of the state of the sternum that was not removed, to reduce the incidence of acute renal injury and the use of peritoneal dialysis, and also to reduce the rate of nosocomial mortality. In patients after primary suturing of the sternum, using the proposed criteria, the incidence of hemodynamic disorders in the early postoperative period decreased by 17.8% compared to the control group (p = 0.039; OR = 0.479).

Conclusions: Accurate hemodynamic and laboratory criteria for the use of the surgical technique for delayed sternal closure can improve the results of postoperative nursing of patients by preventing the development of acute heart failure and non-cardiac complications.

Keywords: delayed sternum closure, congenital heart defects, acute heart failure.

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For citation

Naumov A.B., Hubulava G.G., Marchenko S.P., Kupatadze D.D., Kulemin E.S., Andreev M.S., Seliverstova A.A., Tereshenko O.YU., Pilyugov N.G., Maryutina T.A., Nevmerzhickaya O.V., CHupaeva O.YU., Kalnoj P.S., CHernomordova A.V., Sazonov A.B., Volkov A.M. Results of open chest in infants after cardiac surgery. Bulletin of Pirogov National Medical & Surgical Center. 2021;1(16):17-23. (In Russ.) https://doi.org/10.25881/BPNMSC.2021.21.67.003