Delayed sternal closure after cardiac surgery

Fifty-seven patients undergoing various cardiac operations were managed with delayed sternal closure because of ongoing mediastinal hemorrhage or extreme cardiac dilatation. This strategy facilitated rapid access to the mediastinum for evacuation of clot when the risk of tamponade from hemorrhage was deemed great. When sternal closure over a dilated and edematous heart caused hemodynamically significant cardiac compression, wound closure without sternal reapproximation facilitated hemodynamic stability. Postoperative correction of hemodynamic and hemostatic functions allowed delayed sternal closure to be done a mean of 2.8 days later. Thirty-eight patients survived to leave the hospital. Recognized complications of delayed sternal closure included superficial wound infection (3 patients), sternal osteomyelitis (1 patient), and fatal mediastinal infection (1 patient). Delayed sternal closure may be beneficial in selected patients. Morbidity and mortality related to this technique have proved acceptable in this high-risk group.