J Thorac Cardiovasc Surg 1996;111:903
© 1996 Mosby, Inc.
Massive bleeding at resternotomy despite a polytetrafluoroethylene surgical membrane
Jaroslav Stark, MD, FRCS
Department of Cardiothoracic Surgery
Great Ormond Street Hospital for Children
Great Ormond Street
London WC1N 3JH, United Kingdom
To the Editor:
I have read with interest the short communication: "Massive Bleeding at Resternotomy Despite a Polytetrafluoroethylene Surgical Membrane" in the July 1995 issue of the Journal. It is true that the number of reported membrane implantations far exceeds the experience with reoperations in such cases. In my experience, reoperations, especially those involving extracardiac valved conduits, are greatly facilitated by the use of polytetrafluoroethylene membrane. The sternum can be opened quickly and damage to the underlying structures is avoided.
Although the use of polytetrafluoroethylene
* membrane is helpful, it is no substitute for careful surgical technique. We always open the external table of the sternum with an oscillating saw, but opening of the interior lamina is by careful dissection. If the saw is used through the entire sternum, the underlying structures can be damaged, whether the pericardium is intact or whether a pericardial substitute is used. This is particularly true if there is a dilatation of the conduit or aneurysm/pseudoaneurysm of the right ventricle, which may be due to residual ventricular septal defect and conduit obstruction. In summary, I continue using the membrane in patients in whom the risk of reoperation is high and would very much recommend its use to readers of the Journal.
