Comparison of Sternal Fixation Strategies After Open-Heart Surgery Via a Median Sternal Incision
DOI:
https://doi.org/10.1532/hsf.4843Keywords:
sternal fixation, sternal wound infection, open cardiac surgery, sternal median incisionAbstract
Objectives: To explore the personalized treatment strategy of sternal fixation and closure of sternal median incision in open cardiac surgery.
Methods: A total of 293 patients who underwent open-heart surgery with a median sternal incision at Peking Union Medical College Hospital from January 2019 to March 2021 were divided into two groups, according to the timing and type of treatment. The first 169 patients received single-wire fixation and closure (control group), while the subsequent 124 patients received double-wire fixation and closure (study group). The patients were followed up for three months to observe the duration of pain, sternal instability, and occurrence of chest wound infection.
Results: The average age was 53±30 years in the control group and 55±34 years in the study group (P = 0.594). There were no significant differences in baseline data between the two groups (P > 0.05). Compared with the control group, the study group had a shorter duration of pain (P < 0.05), smaller drainage volume within three days postoperatively (650 ml vs. 770 ml, P < 0.05), lower incidence of superficial sternal wound infection (2.4% vs. 8.9%, P = 0.042), and lower incidence of sternal instability (1.6% vs. 8.3%, P = 0.026). Deep sternal wound infection occurred in two patients in the control group and none in the study group; however, this difference was not significant. No surgery-related deaths occurred.
Conclusions: Selecting the appropriate sternal fixation and closure method, according to the characteristics of patients, can reduce the incidence of sternal incision complications. We proposed a personalized selection strategy for sternal fixation and closure, which requires verification in clinical studies.
References
Alebrahim K, Al-Ebrahim E. 2020. Prevention, Classification and Management Review of Deep Sternal Wound Infection[J]. Heart Surg Forum. 23(5): E652-E657.
Bhattacharya S, Sau I, Mohan M, et al. 2007. Sternal bands for closure of midline sternotomy leads to better wound healing[J]. Asian Cardiovasc Thorac Ann. 15(1): 59-63.
Braxton JH, Marrin CA, Mcgrath PD, et al. 2000. Mediastinitis and long-term survival after coronary artery bypass graft surgery[J]. Ann Thorac Surg. 70(6): 2004-2007.
Cataneo DC, Dos RT, Felisberto G, et al. 2019. New sternal closure methods versus the standard closure method: systematic review and meta-analysis[J]. Interact Cardiovasc Thorac Surg. 28(3): 432-440.
Cleeland CS, Ryan KM. 1994. Pain assessment: global use of the Brief Pain Inventory[J]. Ann Acad Med Singap. 23(2): 129-138.
Eklund AM, Lyytikainen O, Klemets P, et al. 2006. Mediastinitis after more than 10,000 cardiac surgical procedures[J]. Ann Thorac Surg. 82(5): 1784-1789.
El OR, Wright JE. 1996. Postoperative mediastinitis: classification and management[J]. Ann Thorac Surg. 61(3): 1030-1036.
Filsoufi F, Castillo JG, Rahmanian PB, et al. 2009. Epidemiology of deep sternal wound infection in cardiac surgery[J]. J Cardiothorac Vasc Anesth. 23(4):488-494.
Franco S, Herrera AM, Atehortua M, et al. 2009. Use of steel bands in sternotomy closure: implications in high-risk cardiac surgical population[J]. Interact Cardiovasc Thorac Surg. 8(2): 200-205.
Friberg O, Dahlin LG, Soderquist B, et al. 2006. Influence of more than six sternal fixation wires on the incidence of deep sternal wound infection[J]. Thorac Cardiovasc Surg. 54(7): 468-473.
Gray AM, Murphy J, Altman DG, et al. 2017. One-year costs of bilateral or single internal mammary grafts in the Arterial Revascularisation Trial[J]. Heart. 103(21): 1719-1726.
Kiessling AH, Isgro F, Weisse U, et al. 2005. Advanced sternal closure to prevent dehiscence in obese patients[J]. Ann Thorac Surg. 80(4): 1537-1539.
Kirbas A, Celik S, Gurer O, et al. 2011. Sternal wrapping for the prevention of sternal morbidity in elderly osteoporotic patients undergoing median sternotomy[J]. Tex Heart Inst J. 38(2): 132-136.
Liang M, Liu J, Miao Q, et al. 2018. Use of freeze-dried bone allografts in osteoporotic patients undergoing median sternotomy[J]. Cell Tissue Bank. 19(1): 27-33.
Loladze G, Kuehnel RU, Claus T, et al. 2017. Double-Wire versus Single-Wire Sternal Closure in Obese Patients: a Randomized Prospective Study[J]. Thorac Cardiovasc Surg. 65(4): 332-337.
Losanoff JE, Basson MD, Gruber SA, et al. 2007. Single wire versus double wire loops for median sternotomy closure: experimental biomechanical study using a human cadaveric model[J]. Ann Thorac Surg. 84(4): 1288-1293.
Milano CA, Kesler K, Archibald N, et al. 1995. Mediastinitis after coronary artery bypass graft surgery. Risk factors and long-term survival[J]. Circulation. 92(8): 2245-2251.
Muehrcke DD, Shimp WM, Aponte-Lopez R. 2009. Calcium phosphate cements improve bone density when used in osteoporotic sternums[J]. Ann Thorac Surg. 88(5):1658-1661.
Narang S, Banerjee A, Satsangi DK, et al. 2009. Sternal weave in high-risk patients to prevent noninfective sternal dehiscence[J]. Asian Cardiovasc Thorac Ann. 17(2): 167-170.
Nenna A, Nappi F, Dougal J, et al. 2019. Sternal wound closure in the current era: the need of a tailored approach[J]. Gen Thorac Cardiovasc Surg. 67(11): 907-916.
Nezafati P, Shomali A, Kahrom M, et al. 2019. ZipFix Versus Conventional Sternal Closure: One-Year Follow-Up[J]. Heart Lung Circ. 28(3): 443-449.
Nooh E, Griesbach C, Rosch J, et al. 2021. Development of a new sternal dehiscence prediction scale for decision making in sternal closure techniques after cardiac surgery[J]. J Cardiothorac Surg. 16(1): 174.
Robicsek F, Fokin A, Cook J, et al. 2000. Sternal instability after midline sternotomy[J]. Thorac Cardiovasc Surg. 48(1): 1-8.
Schimmer C, Sommer SP, Bensch M, et al. 2008. Sternal closure techniques and postoperative sternal wound complications in elderly patients[J]. Eur J Cardiothorac Surg. 34(1): 132-138.
Shafi A, Abuelgasim E, Abuelgasim B, et al. 2021. Sternal closure with single compared with double or figure of 8 wires in obese patients following cardiac surgery: A systematic review and meta-analysis[J]. J Card Surg. 36(3): 1072-1082.
Sharma R, Puri D, Panigrahi BP, et al. 2004. A modified parasternal wire technique for prevention and treatment of sternal dehiscence[J]. Ann Thorac Surg. 77(1): 210-213.
Song DH, Lohman RF, Renucci JD, et al. 2004. Primary sternal plating in high-risk patients prevents mediastinitis[J]. Eur J Cardiothorac Surg. 26(2): 367-372.
Tam DY, Nedadur R, Yu M, et al. 2018. Rigid Plate Fixation Versus Wire Cerclage for Sternotomy After Cardiac Surgery: A Meta-Analysis[J]. Ann Thorac Surg. 106(1): 298-304.
Wade SW, Strader C, Fitzpatrick LA, et al. 2014. Estimating prevalence of osteoporosis: examples from industrialized countries[J]. Arch Osteoporos. 9: 182.
