Innominate Vein Injury Secondary to First-Time Sternotomy.

Innominate vein injury is a known potential complication of redo sternotomy, but transection of the innominate vein after first-time median sternotomy has not been previously described. A 71-year-old woman experienced left innominate vein transection upon division of the sternum for coronary artery bypass grafting. Subsequent massive bleeding required digital compression of the transected vessel ends, open manual cardiac massage, institution of a massive transfusion protocol, and pharmacologic support before hemodynamic control was gained by instituting cardiopulmonary bypass. Left innominate vein injury can occur with both first-time and redo sternotomy.