[Delayed sternal closure for life-threatening massive bleeding during re-open heart surgery]

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.