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Delayed Sternal Closure After Cardiac Operations

Department of Cardiovascular and Thoracic Surgery Sanjay Gandhi Post-Graduate Institute of Medical Sciences Lucknow, Uttar Pradesh, India
For reprint information contact: Ashok Kumar Srivastava, MCh Tel: 91 522 44 0963 Fax: 91 522 44 0017 email: ashok{at}sgpgi.ac.in Department of Cardiovascular and Thoracic Surgery, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh 226014, India.

In 1,459 open heart operations performed between July 1995 and March 2000, sternal closure was delayed in 30 patients (2%) because of hemodynamic instability limiting primary sternal closure in 12 and uncontrollable bleeding in 18. Two patients died in the immediate postoperative period while the chest was open, due to persistent low cardiac output secondary to myocardial failure. The sternum was closed in 28 patients at an average of 22 ± 0.3 hours (range, 8 to 48 hours) postoperatively. Two patients died in the late postoperative period prior to hospital discharge after sternal closure. Nonfatal wound infections occurred in 8 patients. The 26 survivors (86.7%) were discharged and followed up for a mean of 11.2 months. This study demonstrates that delayed sternal closure is an effective method of dealing with unstable hemodynamics and uncontrollable hemorrhage.

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