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The Annals of Thoracic Surgery, Vol 49, 771-774, Copyright © 1990 by The Society of Thoracic Surgeons
JA Johnson, AE Gundersen, ID Stickney and TH Cogbill
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 coagulopathy were managed by immediate sternal closure. Continued
hemorrhage or tamponade 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 sternal 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.
ARTICLES
Selective approach to sternal closure after exploration for hemorrhage following coronary artery bypass
Department of Thoracic and Cardiovascular Surgery, Gundersen/Lutheran Medical Center, La Crosse, Wisconsin.
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