JUAN CRESTANELLO: Welcome to the Cardiovascular Surgery Series, where I review the latest research in cardiovascular surgery from the Mayo Clinic. I will discuss today the impact of time to chest closure on early and late survival in adults with delay external closure. We'll review the use of delay external closure on patients who had cardiac surgery over a 10-year period.

494 patients had delayed sternal closure. We sought to study the indications and temporal trends, the factors associated with time to chest closure, and the impact of delayed external closure on short-term and long-term outcomes. [INAUDIBLE] and [INAUDIBLE] dynamic instability were the most common indications for delayed sternal closure. The use of delayed sternal closure increased during the course of the study period. And the median time to chest closure was two days.

The use of preoperative or intraoperative ECMO, severe ventricular dysfunction, and diabetes were associated with longer time to chest closure. We use a landmark analysis to study the association of delayed external closure with operative mortality and long-term survival. We found that longer time to chest closure was associated with increased risk of operative complications and operative mortality, but it was not associated with late mortality. Factors associated with overall mortality were increased age, pulmonary hypertension, and greater number of prior sternotomis.

From this study, we conclude that longer time to chest closure was associated with increased rate of operative complications and operative mortality, but it was not associated with an impact in long-term survival. The long-term survival in this patient is most likely determined by the underlying cardiac dysfunction, as well as the comorbidities, rather than by the time they spent with an open chest. Thank you for listening to the Mayo Clinic Cardiovascular Surgery Series.