Age-related differences of intraischemic gap junction uncoupling in hearts during ischemia

Role of primary sternal closure in early outcomes following the Norwood procedure

OBJECTIVE

To evaluate the impact of primary sternal closure (PSC) after the Norwood procedure, focusing on perioperative factors and clinical outcomes.

METHODS

This single-institution retrospective review included 122 neonates who underwent the Norwood procedure (PSC, n = 30; delayed sternal closure [DSC], n = 92) between 2010 and 2022. DSC was further categorized as early (≤2 days) or late (>2 days). Intensive care unit (ICU) and hospital discharge rates were estimated using the Fine-Gray test.

RESULTS

Preoperative factors, chest reopening, and deep wound infection rates were similar in the PSC and DSC groups. Early mortality (30-day) was 0% for the PSC group and 8% for the DSC group (P = .19). In-hospital mortality was 3% for the PSC group and 17% for the DSC group (P = .07). The rate of ICU discharge by 14 days was 73.3% (95% confidence interval [CI], 59.1%-91.0%) for the PSC group and 41.3% (95% CI, 32.4%-52.7%) for the DSC group (Gray's P < .001). PSC was associated with less intraoperative blood product transfusion and lower grades of postbypass atrioventricular valve regurgitation (AVVR) (P < .001 for both). ICU discharge rates by 14 days were 73.3% (95% CI, 59.9%-89.7%) for PSC, 69.6% (95% CI, 54.2%-89.3%) for early DSC, and 46.9% (95% CI, 35.2%-62.6%) for late DSC.

CONCLUSIONS

PSC appears to be feasible in patients, with minimal transfusion requirements and less postbypass AVVR. Although PSC was associated with shorter length of stay, this advantage was observed mainly in late DSC cases. Early DSC demonstrated similar benefits as PSC, with low mortality and a shorter length of stay.

Mechanisms of Myocardial Edema Development in CVD Pathophysiology

Myocardial edema is the excess accumulation of fluid in the myocardial interstitium or cardiac cells that develops due to changes in capillary permeability, loss of glycocalyx charge, imbalance in lymphatic drainage, or a combination of these factors. Today it is believed that this condition is not only a complication of cardiovascular diseases, but in itself causes aggravation of the disease and increases the risks of adverse outcomes. The study of molecular, genetic, and mechanical changes in the myocardium during edema may contribute to the development of new approaches to the diagnosis and treatment of this condition. This review was conducted to describe the main mechanisms of myocardial edema development at the molecular and cellular levels and to identify promising targets for the regulation of this condition based on articles cited in Pubmed up to January 2024.