Comparison of sternal intramedullary bleeding prevention strategies in cardiac surgery

Authors: MURAT TAVLAŞOĞLU, AHMET BARIŞ DURUKAN, MUSTAFA KÜRKLÜOĞLU, ADEM GÜLER, ZEKERİYE ARSLAN, MEHMET ALİ ŞAHİN, HASAN ALPER GÜRBÜZ, LEYLA GÜLER

Abstract: Sternal intramedullary bleeding is an important contributor to postcardiac surgery hemorrhage. The aim of this study is to investigate the effects of bone wax, oxidized regenerated cellulose, and electrocoagulation on sternal intramedullary hemostatic control. Materials and methods: A total of 142 patients undergoing on-pump coronary bypass surgery were prospectively studied. The patients were randomized into 3 groups; bone wax concomitant with electrocauterization, oxidized regenerated cellulose concomitant with electrocauterization, and electrocauterization alone. The amount of postoperative hemorrhage was noted at the 1st, 2nd, 3rd, 6th, 12th and 24th hours. Rates of reexploration for hemorrhage and number of units of blood and its products used were also studied. Results: The mean age of the patients was 64.23 ± 5.81 years. There were 114 (79.7%) male patients. The patients were comparable regarding preoperative demographics except age and intraoperative variables. The amount of postoperative hemorrhage was lowest in the oxidized regenerated cellulose and highest in the electrocauterization alone group. The number of fresh frozen plasma and erythrocyte suspension used was also lowest in the oxidized regenerated cellulose group. Conclusion: To overcome hemorrhage originating from the sternal intramedullary space, oxidized regenerated cellulose use concomitant with electrocauterization is effective and can be safely used immediately before closing the chest in open heart surgery.

Keywords: Sternum, hemorrhage, electrocoagulation, cellulose, oxidized, bone wax

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