Pericardial closure.

Closure of the pericardium after operation for coronary bypass is recommended. It affords protection for the right ventricle and overlying bypass grafts if repeat sternotomy is necessary, and may decrease the incidence of tamponade. A mild compressive effect on the heart has been noted at the time of pericardial closure that does not appear to affect clinical outcome. Hemodynamic studies support this impression. The supracardiac portion of this layer is not closed, and permits use of internal mammary artery conduits. Pericardial closure is not feasible in all instances, however. The need for increased filling pressures, the anticipation of cardiac rather than mediastinal postoperative bleeding, and occasional interference with the course of internal mammary pedicles may preclude closure.