What is the final step before closing the sternum in traditional CABG?

• A. Sternum closed with wire sutures
• B. Pacemaker wires placed
• C. Chest tubes inserted
• D. Heart is rewarmed

Answer: (A)

The key step here is completing the chest closure by reapproximating the sternum with wires. After the bypass grafts are completed and the patient is stabilized, the surgeon ensures there is no bleeding and the mediastinal drainage is planned, then the sternum is closed using stainless steel wires to bring the halves together and provide chest stability. Other tasks like placing pacing wires or chest tubes are done during the closure process, but the act that finishes the closure itself is securing the sternum with wires. Heart rewarming and weaning from bypass occur earlier in the procedure and are not the final closure action.