Chest packing with negative pressure for refractory mediastinal bleeding after cardiac surgery: a low-cost, simple technique as an alternative to vacuum-assisted closure systems in a retrospective study

BACKGROUND: Refractory mediastinal bleeding after cardiac surgery occasionally requires temporary open sternum and delayed sternal closure. We evaluated the feasibility and short‑term clinical performance of a modified chest‑gauze suction (c‑GSUC) technique that generates negative pressure using readily available materials. METHODS: We retrospectively reviewed 20 patients who underwent chest packing primarily for refractory bleeding following cardiac or thoracic aorta surgery. After routine drainage placement, gauze sponges were packed around the bleeding sites, and an additional temporary chest tube was positioned over the gauze. The open sternotomy was sealed with an adhesive drape and connected to a standard three-chamber drainage bottle to generate negative pressure and collapse the packed gauze. RESULTS: The median patient age was 57.0 years, and 19 patients (95.0%) underwent aorta-related procedures. Definitive chest closure was achieved within 2 days in 18 patients (90.0%). One patient (5.0%) required emergent washout for cardiac tamponade during open chest management. One patient (5.0%) developed mediastinitis after closure. Two patients (10.0%) died during hospitalization, one from septic shock and the other from intracranial hemorrhage. CONCLUSION: Temporary open sternum with negative‑pressure gauze packing using the c‑GSUC technique was feasible in patients with refractory mediastinal bleeding and was associated with acceptable short‑term outcomes. Although less sophisticated than commercial vacuum-assisted closure systems, this simple and inexpensive approach may be a practical alternative in selected cases.