Primary closure of median sternotomy with interposition of hydroxyapatite blocks. A new approach in pediatric cardiac surgery

• Published in: European journal of cardio-thoracic surgery Vol. 5; no. 7; pp. 383 - 385
• Main Authors: BAUMGART, D, HERBON, G, BOROWSKI, A, DE VIVIE, E. R
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Science B.V 01-01-1991; Elsevier Science
• Subjects: Adolescent; Adult; Biological and medical sciences; Cardiology. Vascular system; Cardiomegaly - etiology; Cardiomegaly - surgery; Child; Child, Preschool; Follow-Up Studies; Heart; Heart Defects, Congenital - surgery; Humans; Hydroxyapatites; Infant; Medical sciences; Postoperative Complications; Prostheses and Implants; Sternum - surgery; Suture Techniques; Human; Heart; Sternotomy; Congenital; Cardiovascular disease; Hydroxyapatite; Thorax; Thoracotomy; Plasty; Treatment; Malformation; Heart disease; Surgery; Child
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/1010-7940(91)90057-Q

Chest closure after correction of congenital heart disease withsubsequent enlargement of the heart has been a problem encounteredthroughout departments performing pediatric cardiac surgery. Presenttechniques using Rehbein struts or an open chest with a Gore-Tex patch skinclosure have not solved this issue satisfactorily. Between January 1989 andSeptember 1990, median sternotomies could not be closed primarily due tohemodynamic consequences in nine patients age 3 months to 19 years operatedupon in our department. In three children, a conduit exchange, in two aMustard correction, in two a correction of Fallot's tetralogy, in one aprosthetic valve exchange and in one, a new implantation of a homograft wasperformed. Primary chest closure was achieved by interposing hydroxyapatiteblocks (50 mm x 15 mm x 6 mm) without hemodynamic consequences. In afollow-up period of 10 +/- 8 months, all children are alive and well. Therewas no complication resulting from the implanted blocks. Due to theexcellent functional and cosmetic results of this technique and theoutstanding histomorphological characters of hydroxyapatite, we regard theimplantation of hydroxyapatite blocks as a superb method for primarysternotomy closure especially in pediatric cardiac surgery.