Delayed sternal closure following cardiac operations

E. Milgater, G. Uretzky, D. V. Shimon, S. Silberman, A. Appelbaum, J. B. Borman

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    28 Scopus citations

    Abstract

    In 13 patients, sternal closure was delayed at the end of open heart procedures. Seven patients underwent coronary artery bypass surgery (CAB), 5 valve replacements, and one left ventricular aneurysmectomy and closure of post myocardial infarction VSD. In all, primary closure of the sternum was considered impossible or inadvisable. The major indications for delaying sternal closure were: cardiac dilatation with tamponade-like behaviour upon attempted sternal closure (8 patients); intractable bleeding; intractable arrhythmia; insertion of mediastinal assist devices and intraoperative non-cardiogenic pulmonary edema. In all, only the skin was closed. Delayed sternal closure (DSC) was performed 36-120 hours later on 10 of the patients, when their condition had stabilized. Nine patients are long term survivors. None of these patients hads developed mediastinitis, wound infection, osteomyelitis or instability of the sternum. The judicious use of DSC in selected situations has several advantages: hemodynamic deterioration from pressure upon the heart may be prevented; a quick access to the heart in case of tamponade or intractable arrhythmia is obtained; insertion of mediastinal assist devices is facilitated. With careful technique the risk of infection is low.

    Original languageEnglish
    Pages (from-to)328-331
    Number of pages4
    JournalJournal of Cardiovascular Surgery
    Volume27
    Issue number3
    StatePublished - 15 Oct 1986

    ASJC Scopus subject areas

    • Surgery
    • Cardiology and Cardiovascular Medicine

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