Delayed sternal closure: a life saving maneuver after open heart surgery

ABSTRACT

Sternal closure following open heart surgery may lead to life-threatening respiratory and hemodynamic embarrassment. To avoid a fatal outcome in these situations, sternal closure was postponed in seven patients by suturing the skin edges only. This maneuver, in a setting of optimal inotropic and ventilatory support allowed five patients out of seven [4 males and 3 females age at operation was 25 years and the mean weight was 60.8 kg] to survive. The diagnosis was rheumatic heart disease with different valve lesions in five patients and congenital heart disease [Fallot tetralogy] with previous shunt in two patients. The mean cross-clamp time was 95.8 minutes and the mean bypass time was 131.4 minutes. The indications for delayed sternal closure [DCS] was massive post bypass mediastinal bleeding in five patients and tamponade like symptom in two patients [myocardial edema]. The time of secondary sternal closure ranged from 8-24 hours. The overall morbidity was represented in two patients in the form of superficial wound infection. By this procedure, the life of any patient could be saved with cardia or respiratory embarrassment following open heart surgery