Analysis of Factors Influencing Thoracic Deformities after Median Sternotomy in Infants Who Underwent Congenital Cardiac Surgery

Abstract

Objective. To investigate the incidence of thoracic deformities after median sternotomy in infants who underwent congenital cardiac surgery and determine its influencing factors. Methods. This was a single-center retrospective study. A total of 156 infants who underwent congenital cardiac surgery with median sternotomy in a provincial hospital in China from September 2020 to January 2022 were included. Depending on whether thoracic deformities occurred, the patients were classified into the thoracic deformity group and the no thoracic deformity group. Relevant data were retrieved through an electronic medical record system, and statistical comparisons and analyses were performed. Results. The incidence of postoperative thoracic deformities in this cohort was 10.9%. Sternal pins for auxiliary sternal fixation were used in eighty-nine infants. After analysis, it was found that age at operation (1.9 ± 0.9 vs. 3.7 ± 1.2, $P<0.001$ ) and weight-for-age Z-scores (−2.0 ± 0.7 vs. −1.4 ± 0.7, $P=0.001$ ) of the thoracic deformity group were significantly lower than those of the no thoracic deformity group. In addition, sternal pin use was significantly higher in the no thoracic deformity group than in the thoracic deformity group (61.9% vs. 17.6%, $P=0.001$ ). Univariable analysis showed that age at operation (OR, 4.74; 95% CI, 2.38–9.46; $P<0.001$ ) and weight-for-age Z-scores (OR, 4.40; 95% CI, 1.74–11.12; $P=0.002$ ) were significant risk factors for postoperative thoracic deformity. Using sternal pins for auxiliary sternal fixation was an important protective factor (OR, 7.57; 95% CI, 2.08–27.59; $P=0.003$ ). Conclusions. In this study, 10.9% of infants undergoing congenital cardiac surgery through a median sternotomy developed thoracic deformities after surgery. Younger age at operation and poor nutritional conditions may be risk factors for postoperative thoracic deformity. Sternal pin-assisted fixation has a positive effect on the prevention of thoracic deformities.