[Alternative closure of the sternum after heart surgery]

We report on 27 patients who, between November 1986 and December 1988, had a delayed sternal closure after cardiac surgery out of the following reasons: post-ECC low output syndrome: 17 patients (15 with IABP, 11 transfemoral, 4 transaortic), haemodynamic breakdown with sternal approximation: 9 patients, diffuse bleeding: one patient. In 13 patients perioperative infarction was diagnosed (4 right heart infarctions) as a cause for the poor cardiac condition. The surgery performed had been: 26 coronary artery bypass operations (18 combined with other procedures), and one double valve replacement. The temporary closure of the wound generally is now performed by a sterile zipper (Ethizip). Sternal closure was possible one to nineteen days postoperatively, most often (19 patients) on the 2nd postoperative day. We did not note any serious complications or wound infection due to the management with delayed sternal closure. Three patients died from cardiac failure with chest open, 4 patients died six days to eight weeks postoperatively with closed chest. Among the 20 patients discharged from hospital, 17 are at present in satisfactory clinical condition, one patient suffers from recurrent angina, one from cardiac insufficiency and one is in poor general condition. As a conclusion we think that delayed sternal closure after cardiac surgery is a helpful tool in patients with 1) haemodynamic breakdown with sternal approximation, 2) diffuse bleeding.