Background: open chest management and delayed sternal closure has been described as a useful method in treatment of severely impaired contractility, uncontrollable hemorrhage, intractable arrhythmias, reperfusion myocardial edema or when either ventricular assist devices or transthoracic intra-aortic balloon pump. Patient and methods: From January 2010 to December 2010, thirty patients (1.25%) left the operating room with open chest after cardiac operations. Delayed sternal closure was performed after hemodynamic improvement. Analysis of indications, mortality and postoperative complications were done. Results: Open chest with delayed sternal closure was used in 30 patients (1.25%) out of 2387 patients. There were 20 men and 10 women, with an average age of 50.9 ± 8.6 years. In 16 patients, primary sternal closure was not possible as a consequence of postoperative low cardiac output, and in 14 patients due to bleeding/ coagulopathy. Emergency operations (46.7%) and aortic dissection surgery (20%) were more frequent. Delayed sternal closure was done after 14.3 ± 9.9 hours. Extubation was done after 46.4 ± 34.7 hours. Eighteen patients were weaned from inotropic support and discharged from the intensive care unit an average of 3.8 ± 1.9 days. One patient had mediastinitis and required sternal refixation. Conclusion: delayed sternal closure can be beneficial when all attempts to optimize cardiac function and hemostasis have failed.