Repair of cardiac injury

During resuscitative thoracotomy, temporizing maneuvers to control bleeding from cardiac injuries may include direct digital pressure on the wound while the patient is transported to the operating room, stapling the cardiac wound closed using a skin stapler with care to avoid the epicardial vessels, or suture closure of the cardiac injury.
Venous and atrial wounds can be repaired in a simple, running fashion using 3-0 or 4-0 sutures as depicited (A).
Appropriately trained individuals may choose to suture repair isolated ventricular cardiac injuries, usually using double-armed polypropylene (eg, Prolene) suture, preferably on a cardiovascular (CV) needle. Digital compression over the cardiac injury should be maintained while placing pledgeted horizontal mattress sutures with care to avoid injury to the epicardial vessels. As the finger is carefully withdrawn, an assistant gently pulls up on the suture, crossing the ends. Additional sutures can be placed, as needed, prior to tying the sutures.