Outcomes After Primary Versus Delayed Sternal Closure in Acute Type A Aortic Dissection Repair
Bibliographic record
Abstract
Background Acute type A aortic dissection (ATAD) is life‐threatening and requires emergency surgical repair. Patients face increased risk of postoperative coagulopathy and hemodynamic instability, prompting some surgeons to leave the chest open and return 48–72 h later for delayed sternal closure (DSC). Whether DSC increases postoperative complications remains understudied. This study aims to evaluate outcomes after ATAD repair in patients undergoing DSC versus primary sternal closure (PSC). Methods This single‐center retrospective study included 130 ATAD patients who underwent surgery between 2016 and 2024. Patients left the OR with either a closed chest (PSC) or an open chest for DSC. The primary outcome was all‐cause mortality at 90 days postoperatively. Secondary outcomes included length of stay, a composite of postoperative infection (superficial and deep sternal wound, graft infection, bacteremia, and pneumonia), and 5‐year mortality. Results Of 130 patients, 23% ( n = 30) left the OR with an open chest with a median time to DSC of 2 [2; 3] days. Cardiopulmonary bypass time was higher in open versus closed chest patients (open chest: 237.9 ± 76.4; closed chest: 194.0 ± 51.8 min; p = 0.006). The 90‐day mortality rate was 20.0% ( n = 26), with no significant difference between open versus closed chest patients (open chest: 23.3%, n = 7; closed chest: 19.0%, n = 19; p = 0.60, RR 1.2 [0.6; 2.6]). There was no significant difference in ICU length of stay (open chest: 9.8 ± 11.0; closed chest: 9.0 ± 12.3 days; p = 0.18) or hospital (open chest: 22.2 ± 18.4; closed chest: 20.2 ± 22.8 days; p = 0.21) length of stay. There was no significant difference in postoperative infection (open chest: 26.7%, n = 8; closed chest: 20.0%, n = 20; p = 0.44, RR 1.3 [0.7; 2.7]) or 5‐year mortality (open chest: 26.7%, n = 8; closed chest: 25.0%, n = 25; p = 0.86, RR 1.1[0.5; 2.1]). Conclusions In patients presenting with ATAD, postoperative outcomes are similar regardless of whether patients left the OR with a closed chest or with an open chest for DSC. Our findings indicate that leaving the chest open after ATAD repair is an appropriate strategy to mitigate perioperative coagulopathy and/or hemodynamic instability.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".