# Delayed Sternal Closure for High-Risk Cardiac Surgery Patients: Life-Saving Strategy for Improved Outcomes

## TL;DR

Delayed sternal closure in high-risk cardiac surgery patients reduces complications and mortality by allowing better postoperative management.

## Contribution

Demonstrates that planned delayed sternal closure improves outcomes in high-risk cardiac surgery patients.

## Key findings

- DSC was used in 1.8% of cardiac surgeries, mainly due to bleeding or hemodynamic instability.
- DSC patients had higher mortality (16.1%) but no increased sternal infection rates.
- Planned DSC reduced perioperative complications in high-risk patients.

## Abstract

Background/Objectives: Delayed sternal closure (DSC) is a useful management strategy for complex cardiac interventions. The aim of this study was to investigate the patients who had DSC in our clinic over a 12-year period and to evaluate the postoperative results. Methods: A total of 124 DSC patients from a total cardiac surgery practice during a 12-year period (n = 6532, 1.8%, between January 2014 and September 2025) were retrospectively analyzed. Preoperative and intraoperative patient characteristics, morbidities, and mortality rates were collected and compared with the group undergoing primary sternal closure (PSC), which were matched with the DSC group in terms of preoperative and intraoperative patient characteristics. Results: A total of 124 (1.8%) patients required DSC, and 33.1% of the patients were females. The indications were bleeding (n = 81, 65%) and hemodynamic instability (n = 43, 35%). Total bypass times, cross-clamp times, and CPB temperature were higher in patients with DSC. A higher rate of inotropic support, intra-aortic balloon pump, extracorporeal lung support, blood transfusion, and bleeding were found in the DSC group. There was no difference in terms of sternal infection rate (2.4%). Intensive care unit stay, hospital stay, and mortality rate were also significantly increased in patients with DSC. Mortality rate in the DSC group was 16.1%. Conclusions: Multiple sternum revisions due to bleeding and low cardiac output syndrome may lead to increased mortality in high-risk patients. Planned postponement of sternal closure in these high-risk cardiac surgery patients helps to reduce perioperative morbidity and mortality.