Safety and efficacy of a novel temporary sternal spreader in the management of severe postcardiotomy cardiogenic shock: A preliminary report study.

Open chest management (OCM) with delayed sternal closure (DSC) is a valuable tool to manage patients with postcardiotomy hemodynamic instability related to cardiogenic shock with myocardial and lung edema and/or severe coagulopathy.1-4 OCM traditionally involves the use of plastic material (generally a syringe) acting as a stent between the 2 hemisternal halves, with the purposes to maintain the chest open to prevent compression and to avoid traumatic injuries on the underlying mediastinal structures.1-4 The use of these ‘‘passive’’ plastic stents, however, is linked to the ‘‘all or nothing’’ rule, which makes the decision on stent removal and chest closure tricky and potentially associated with a renewed hemodynamic instability.4 The risk for passive stent dislocation with potential sternal fracture or mediastinal injury has also been reported.1-5 We tested a new device for temporary sternal stenting, the Temporary Sternal Spreader (TSS; Futura Engineering, Cerbara, PG, Italy), which allows ‘‘closed’’ remote spreading variations over time until complete reapproximation of the sternal halves is accomplished, while keeping the wound continuously covered by a sterile elastic membrane. The trial was coupled with continuous hemodynamic monitoring to titrate sternal reapproximation on objective hemodynamic improvements.