PACK AND CLOSE APPROACH TO PERSISTENT POSTCARDIOPULMONARY BYPASS BLEEDING

Persistent intraoperative hemorrhage after cardiopulmonary bypass was managed in three patients by packing the suspected bleeding sites with surgical sponges, leaving the packs in place and closing all layers o f the sternal wound. The maneuver reduced the rate of bleeding to acce ptable levels. The day after the primary operation the wounds were reo pened and the surgical sponges were removed. Bleeding had ceased and t he operative field remained dry in all three patients. Definitive clos ure of the sternotomy incisions was then performed. The method is prop osed as a simpler alternative to the commonly used approach of leaving the mediastinum open for days and closing the wound after the bleedin g stopped.