DELAYED STERNAL CLOSURE FOLLOWING OPERATION OF TYPE-A ACUTE AORTIC DISSECTION

In 7 patients with type-A acute aortic dissection, the sternum was not closed because of excessive hemorrhage after grafting. Only the skin was closed, the sternal edges being left apart and the anastomotic sit es being packed with dry gauze in the mediastinum to control the life- threatening sequela. All patients except for 1 who died of uncontrolla ble bleeding had successful delayed sternal closure within three days after the first operation. One patient who had late chest wound infect ion died, but the remaining 5 patients had neither mediastinitis nor c hest wound infection and are now in good or fair clinical condition. T he authors conclude that delayed sternal closure is an effective metho d of dealing with excessive postbypass bleeding following operation of type-A acute aortic dissection.