[Use of sternal zipper in open heart surgery].

A sternal zipper was used in 50 patients with an unstable haemodynamic condition after open heart surgery. The patients were 19 women and 31 men (average age 51.6 years, range 7 to 67 years). The indications for surgery were aortocoronary bypass in 25 cases, replacement of the ascending aorta in 7 cases, valve replacement in 16 cases and correction of congenital heart disease in 2 cases. Twenty eight patients required circulatory assistance. The sternal zipper was used for 4 to 72 hours (average 29.5 hours) and mediastinal toilet was performed at least every 24 hours. At each opening of the zipper, 3 bacteriological swabs were taken from 3 different sites in the mediastinum and sent for culture. Global mortality was 36% (N = 18). The cause of death was a low output syndrome in 12 cases, hepatic and renal failure in 2 cases, resistant arrhythmia in 1 case, neurological complication in 1 case and septicaemia in 2 cases. There was one late death 3 months after hospital discharge which was attributed to a cardiac arrhythmia. The sternal zipper would seem to be a valuable option when the operative conditions are difficult, allowing the chest to remain open, so preventing cardiac compression during a critical period.