Efficacy of Thermoreactive Nitinol Clip Implantation in Reconstruction of Sternal Dehiscence
DOI:
https://doi.org/10.1532/HSF98.20121056Abstract
Background: Sternal dehiscence is a severe complication of open heart surgery. Reinforced wiring, a system of reinforced sternal closure, fixation of a rigid plate, and implantation of thermoreactive nitinol clips (TRC) are some surgical procedures used. The aim of this study was to evaluate the role of TRC for secondary sternal reconstruction.
Methods: Of 1198 patients who underwent their operations via median sternotomy in 2 separate medical centers, sternal dehiscence was observed in 16 patients overall (1.33%). The mean (SD) age of the patients was 64.06 ± 9.18 years (range, 40-77 years). Sternal dehiscence was diagnosed in all patients between the fifth and 30th postoperative days.
Results: TRC were implanted in all of the patients who developed sternal dehiscence (16 patients). One patient developed severe respiratory failure, became ventilator dependent, and died from pneumonia on postoperative day 24. The other 15 patients were discharged without complications. Postoperative follow-up of the surviving patients revealed adequate and satisfactory sternal stability.
Conclusion: Implantation of TRC is an effective and easy method for fixing the sternum and can be performed rapidly and securely.
References
Avlonitis VS, Shrivastava V, Wallis JA, et al. 2008 Thermoreactive clips for sternotomy closure in sternal dehiscence. Ann Thorac Surg 85:2164-5.nBapat V, El-Muttardi N, Young C, Venn G, Roxburgh J. 2008. Experience with vacuum-assisted closure of sternal wound infections following cardiac surgery and evaluation of chronic complications associated with its use. J Card Surg 23:227-33.nBorger MA, Rao V, Weisel RD, et al. 1998. Deep sternal wound infection: risk factors and outcomes. Ann Thorac Surg 65:1050-6.nBroadhurst J, Moorjani N, Ohri S. 2010. Traumatic fracture of nitinol thermoreactive sternal clips. Interact Cardiovasc Thorac Surg 10:465-6.nDouville EC, Asaph JW, Dworkin RJ, et al. 2004. Sternal preservation: a better way to treat most sternal wound complications after cardiac surgery. Ann Thorac Surg 78:1659-64.nGummert JF, Barten MJ, Hans C, et al. 2002. Mediastinitis and cardiac surgery—an updated risk factor analysis in 10,373 consecutive adult patients. Thorac Cardiovasc Surg 50:87-91.nHuh J, Bakaeen F, Chu D, Wall MJ. 2008. Transverse sternal plating in secondary sternal reconstruction. J Thorac Cardiovasc Surg 136:1476-80.nNegri A, Manfredi J, Terrini A, et al. 2002. Prospective evaluation of a new sternal closure method with thermoreactive clips. Eur J Cardiothorac Surg 22:571-5.nOoi A, Franklin D, Ohri S. 2009. Improved technique of nitinol sternal clip application. Ann Thorac Surg 87:971-2.nPlass A, Grünenfelder J, Reuthebuch O, et al. 2007. New transverse plate fixation system for complicated sternal wound infection after median sternotomy. Ann Thorac Surg 83:1210-2.nRobicsek F, Daugherty HK, Cook JW. 1977. The prevention and treatment of sternum separation following open-heart surgery. J Thorac Cardiovasc Surg 73:267-8.nSong DH, Lohman RF, Renucci JD, Jeevanandam V, Raman J. 2004. Primary sternal plating in high-risk patients prevents mediastinitis. Eur J Cardiothorac Surg 26:367-72.nTocco MP, Costantino A, Ballardini M, et al. 2009. Improved results of the vacuum assisted closure and Nitinol clips sternal closure after postoperative deep sternal wound infection. Eur J Cardiothorac Surg 35:833-8.n
