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[Delayed sternal closure for life-threatening massive bleeding during re-open heart surgery]
1First Department of Surgery, Yokohama City University, School of Medicine, Japan.
Insights
Delayed sternal closure effectively managed hemorrhage in cardiac reoperations. Coagulation recovery, not hemodynamics, guided timely chest closure, with minimal complications observed.
Area of Science:
- Cardiothoracic Surgery
- Surgical Hemorrhage Control
Background:
- Perioperative hemorrhage is a significant risk in cardiac reoperations.
- Traditional sternal closure may be insufficient for severe bleeding.
Purpose of the Study:
- To evaluate the efficacy and safety of delayed sternal closure (DSC) in managing perioperative hemorrhage during cardiac reoperations.
Main Methods:
- Delayed sternal closure (DSC) was employed in 4 patients requiring cardiac reoperations due to hemorrhage.
- Sternal closure was performed 48-72 hours post-operation.
Main Results:
- All 4 patients survived and were discharged in good condition.
- One patient developed a treatable abscess; others had no infections.
- Two patients experienced persistent hemodynamic instability due to pack compression, not infection.
- Coagulation function recovered, except for prothrombin time (PT) at definitive closure.
Conclusions:
- Delayed sternal closure is a viable strategy for controlling hemorrhage in complex cardiac reoperations.
- Coagulation status is a more reliable indicator for timing DSC than hemodynamic stability.
- Potential complications include infection and mechanical obstruction from packing, both manageable.
Abstract:
Delayed sternal closure (DSC) was used for 4 patients undergoing various cardiac reoperations to control perioperative hemorrhage. DSC was performed 48-72 hours later. All patients left the hospital alive and in good condition. The only recognized complication was an abscess formation around the bleeding area, which was successfully treated with systemic antibiotics. The remaining 3 patients manifested no infections. In two of these patients, hemodynamic instability was continued because of right ventricular outflow tract obstruction by compression of the packs which were left over the bleeding area. The function of coagulation of the blood was recovered except prothrombin time (PT) at the time of definitive closure of the chest. Recovery of the function of coagulation was useful in deciding the timing of DSC than hemodynamic state.