Packing the chest: a useful technique for intractable bleeding after open heart operation

Mediastinal bleeding can be a problem after cardiac surgery, either as a result of coagulation derangements or technical problems. We evaluated 100 patients, treated with temporary chest packing for intractable bleeding, of 9,383 undergoing open heart operations during a 10-year period. Preoperatively, 60 of these patients had one or more predisposing factors for bleeding. There were four predominant sites of hemorrhage: general ooze, needle holes of the aortic and atrial suture lines, inaccessible origin, and another specific place. The chest was packed in the operating room in 84 patients and in the intensive care unit in 16. Four methods of temporary chest closure were used: the skin alone, partial sternal approximation plus skin closure, full closure, and the wound open and covered by a Steri-drape dressing. The bleeding was controlled in 65 patients who had been packed once, and in 29 patients after reexploration and multiple packings, for a total of 94 patients (94%). Sternal wound infection, generalized sepsis, and sternal dehiscence was present in 24 patients, 8 of whom died. The venue for inserting or removing the packs did not affect the incidence of infections. Our experience suggests that packing of the chest after cardiac procedures for intractable bleeding allows a reasonable patient salvage rate and complication risks.