sTErnAl heMostasiS Trial

Inclusion Criteria:

* Patients are scheduled to undergo on-pump open chest cardiothoracic surgery.
* Patients must be willing and able to provide written informed consent.
* If the patient is of childbearing potential, they must have a negative pregnancy test within 24 hours of the index procedure.
* Patients must be at least 21 years of age.
* Patients have at least one of the following risk factors:

  1. Undergoing redo sternotomy
  2. Have a preoperative platelet count \<150 mg/dL
  3. Are on dual antiplatelet therapy (blood thinners) \< 5 days prior to sternotomy
  4. Have a BMI (body mass index)\> 35
  5. Are undergoing combined CABG (coronary artery bypass surgery)/valve surgery
  6. Have chronic kidney disease (GFR \<60 ml/min) or ESRD (end stage renal disease)

Exclusion Criteria:

* Patients who undergo thoracotomy approach
* Patients who are not deemed an appropriate candidate by the investigator.
* Patients who are pregnant or nursing, or who plan to become pregnant during the course of this study.