STERNAL TRACTION AFTER OPEN-HEART OPERATION - AN EFFECTIVE ALTERNATIVE TO DELAYED STERNAL CLOSURE

Background. Routine closure of the sternum after cardiovascular surgic al procedures sometimes causes severe cardiac depression because of a tamponade-like reduction in ventricular filling, leading to cardiogeni c shock. Leaving the sternal halves apart, sealing the mediastinum by simply approximating the skin or using a prosthetic patch, and then pe rforming delayed sternal closure in several days is a widely practiced life-saving maneuver. Methods. Described herein is an experience with 5 patients with severe cardiac output depression of the type usually treated by delayed sternal closure. Instead, upward (outward) traction was applied to the anterior chest while the sternum was primarily clo sed. Traction was maintained with full-thickness chest wall sutures. R esults. The traction sutures were removed successfully in the intensiv e care unit between 1 and 4 days postoperatively, after appropriate vi gorous treatment of postbypass myocardial enlargement and pulmonary di stention and edema. Conclusions. This method of sternal traction allow s physiologic improvement equivalent to delayed sternal closure in som e patients and obviates the need for returning to the operating room t o close the sternum in the early postoperative period.