A case report of difficult sternal closure after open heart surgery--useful method of using bone cement as a sternal spacer
Ina, H.; Hiramatsu, H.; Hayase, S.; Kurahashi, M.; Nonoyama, M.; Hattori, T.
Nihon Kyobu Geka Gakkai 36(7): 1156-1160
1988
ISSN/ISBN: 0369-4739 PMID: 3183444 Document Number: 310798
Although uncommon, we experienced two cases of difficult sternal closure. Sternal closure resulted in unstable hemodynamic state. The first case was a female of sixty one years old who had MVR and TAP for her severe mitral stenosis and tricuspid regurgitation. The second one was a female of forty six years old. She had been suffering from infective endocarditis. Her mitral value was replaced because of developign heart failure due to mitral valve destruction. THeir hearts got so enalarge after open heart surgery that it was difficult to close their sternums without hemodynamic worsening. We used CMW bone cement as a sternal spacer to keep sternum open. Bone cement was shaped and placed to be firmly fixed between split sternal edges by sutures of steel wires. They survived postopera tive LOS and weaned from respirator without any difficulty. Because of their refusal of removal, bone cement had been left in place. They had no problem in daily life. Postoperative computed tomograms revealed no abnormal react ion around the bone cement. Spirometry showed they resumed more improved respiratory function than before. It was a useful method to use bone cement as a sternal spacer for a case of difficult sternal closure after open heart surgery. Its removal should be tried secondarily after they recovered completely.