Delayed sternal closure following cardiac operation

Reports are presented of five cases in which sternal closure was delayed following surgery with cardiopulmonary bypass. The indications for delayed closure were cardiac distension, particularly of the right ventricle, and intractable bleeding. Four patients survived after delayed sternal closure, but one died of myocardial failure 23 days after the operation. In 3 additional cases (infants with severe congenital heart disease) the sternum was left open for the same reasons, but death from cardiac insufficiency occurred a few hours postoperatively. Delayed closure of the sternum is a useful manoeuvre and its judicious use adds flexibility in the management of selected and difficult cases.