ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text (PDF)
Right arrow References
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Joel A. Johnson
Irwin D. Stickney
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Johnson, J. A.
Right arrow Articles by Cogbill, T. H.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Johnson, J. A.
Right arrow Articles by Cogbill, T. H.

Ann Thorac Surg 1990;49:771-774
© 1990 The Society of Thoracic Surgeons

Articles

Selective approach to sternal closure after exploration for hemorrhage following coronary artery bypass

Joel A. Johnson, MD, A.Erik Gundersen, MD, Irwin D. Stickney, PA-C, Thomas H. Cogbill, MD*

Department of Thoracic and Cardiovascular Surgery and the Wisconsin Heart Institute, Gundersen/Lutheran Medical Center, La Crosse, Wisconsin, USA

Accepted for publication December 28, 1989.

* Address reprint requests to Dr Coghill, Department of Surgery, Gundersen Clinic, Ltd, 1836 South Ave, La Crosse, WI 54601.

Thirty-six (4.6%) patients required exploration for hemorrhage after 788 coronary artery bypass grafting procedures. Twenty-three (64%) patients with a specific site of bleeding that was surgically controlled or with improving congulopathy were managed by immediate sternal closure. Continued hemorrhage or toinponade necessitated reexploration in 5 of these patients. All 5 patients were then treated by open sternotomy and delayed sternal closure. There were no deaths or sternal wound infections in this subgroup. Thirteen (36%) patients explored for hemorrhage were initially treated by open sternotomy and delayed sternal closure because of ongoing coagulopathy with refractory bleeding. Twelve patients recovered without further complication. One patient died 30 days after delayed sterral closure. There were no sternal wound infections. This experience supports a selective approach to sternal closure after exploration for hemorrhage following coronary artery bypass grafting. Immediate closure is recommended if a specific site of bleeding can be located and corrected. However, in the presence of refractory hemorrhage due to coagulopathy, delayed sternal closure should be considered to avoid the subsequent morbidity of continued bleeding, including cardiac tamponade, multiple reexplorations with sternal trauma, and retained mediastinal hematoma.




This article has been cited by other articles:


Home page
 Eur J Cardiothorac SurgHome page
U. Boeken, A. Assmann, A. Mehdiani, P. Akhyari, and A. Lichtenberg
Open chest management after cardiac operations: outcome and timing of delayed sternal closure
Eur J Cardiothorac Surg, November 1, 2011; 40(5): 1146 - 1150.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
C. P. Charalambous, C. S. Zipitis, and D. J. Keenan
Chest Reexploration in the Intensive Care Unit After Cardiac Surgery: A Safe Alternative to Returning to the Operating Theater
Ann. Thorac. Surg., January 1, 2006; 81(1): 191 - 194.
[Abstract] [Full Text] [PDF]

Home page
 Asian Cardiovascular and Thoracic AnnalsHome page
M. Mubeen, S. Dan, S. K. Agarwal, A. K. Srivastava, and V. M. Kanhere
Delayed Sternal Closure after Cardiac Operations
Asian Cardiovascular and Thoracic Annals, June 1, 2001; 9(2): 82 - 85.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
S. Tabbutt, B. W. Duncan, D. McLaughlin, D. L. Wessel, R. A. Jonas, and P. C. Laussen
DELAYED STERNAL CLOSURE AFTER CARDIAC OPERATIONS IN A PEDIATRIC POPULATION
J. Thorac. Cardiovasc. Surg., May 1, 1997; 113(5): 886 - 893.
[Abstract] [Full Text]

Home page
 Ann. Thorac. Surg.Home page
R. S. Iyer, J. P. Jacobs, M. R. de Leval, J. Stark, and M. J. Elliott
Outcomes After Delayed Sternal Closure in Pediatric Heart Operations: A 10-Year Experience
Ann. Thorac. Surg., February 1, 1997; 63(2): 489 - 491.
[Abstract] [Full Text]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
M. J. Moulton, L. L. Creswell, M. E. Mackey, J. L. Cox, and M. Rosenbloom
REEXPLORATION FOR BLEEDING IS A RISK FACTOR FOR ADVERSE OUTCOMES AFTER CARDIAC OPERATIONS
J. Thorac. Cardiovasc. Surg., May 1, 1996; 111(5): 1037 - 1046.
[Abstract] [Full Text]

Home page
 Ann. Thorac. Surg.Home page
N. Bouboulis, L. F. Rivas, J. Kuo, D. Dougenis, J. H. Dark, and M. P. Holden
Packing the chest: A useful technique for intractable bleeding after open heart operation
Ann. Thorac. Surg., April 1, 1994; 57(4): 856 - 860.
[Abstract] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
M. Hakimi, H. L. Walters III, W. W. Pinsky, M. J. Gallagher, and J. M. Lyons
Delayed sternal closure after neonatal cardiac operations
J. Thorac. Cardiovasc. Surg., March 1, 1994; 107(3): 925 - 933.
[Abstract] [Full Text]

Home page
 Ann. Thorac. Surg.Home page
A. P. Furnary, J. A. Magovern, K. A. Simpson, and G. J. Magovern
Prolonged open sternotomy and delayed sternal closure after cardiac operations
Ann. Thorac. Surg., August 1, 1992; 54(2): 233 - 239.
[Abstract] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 1990 by The Society of Thoracic Surgeons.