Thorac Cardiovasc Surg 2017; 65(04): 332-337
DOI: 10.1055/s-0036-1582257
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Double-Wire versus Single-Wire Sternal Closure in Obese Patients: a Randomized Prospective Study

Giorgi Loladze
1   Department of Cardiovascular Surgery, Heart Center Brandenburg, Bernau, Germany
,
Ralf Uwe Kuehnel
1   Department of Cardiovascular Surgery, Heart Center Brandenburg, Bernau, Germany
,
Thomas Claus
1   Department of Cardiovascular Surgery, Heart Center Brandenburg, Bernau, Germany
,
Martin Hartrumpf
1   Department of Cardiovascular Surgery, Heart Center Brandenburg, Bernau, Germany
,
Frank Kuepper
1   Department of Cardiovascular Surgery, Heart Center Brandenburg, Bernau, Germany
,
Manfred Pohl
2   Institute of Medical Physics and Biophysics, University Hospital Charité, Berlin, Germany
,
Johannes Maximilian Albes
1   Department of Cardiovascular Surgery, Heart Center Brandenburg, Bernau, Germany
› Author Affiliations
Further Information

Publication History

27 November 2015

02 January 2016

Publication Date:
18 April 2016 (online)

Abstract

Background Sternal instability after coronary artery bypass grafting (CABG) is a serious complication. Obese patients are at high risk for sternal instability after CABG. This study was conducted to assess the positive impact of double-wire sternal closure on sternal instability.

Methods A total of 200 obese patients with a body mass index ≥ 30 kg/m2 undergoing isolated CABG with left internal mammary artery (LIMA) graft were randomly assigned to sternal closure either by eight single wires (n = 100) or by a combination of four double wires and four single wires.

Results There was a total of 21 cases with sternal instability: 5 cases (i.e., 5%) in the double-wire group versus 16 cases (16%) in the single-wire group (p = 0.019). Logistic regression analysis showed sternal closure via double wires as an independent protection factor (odds ratio [OR]: 0.276; p = 0.029). Smoking (OR: 5.5; p = 0.006) and postoperative delirium (OR: 3.5; p = 0.033) turned out to be independent risk factors for the development of sternal instability.

Conclusion Double-wire sternal closure significantly reduces postoperative sternal instability in obese patients undergoing isolated CABG with LIMA graft.

 
  • References

  • 1 Julian OC, Lopez-Belio M, Dye WS, Javid H, Grove WJ. The median sternal incision in intracardiac surgery with extracorporeal circulation; a general evaluation of its use in heart surgery. Surgery 1957; 42 (4) 753-761
  • 2 Alhalawani AM, Towler MR. A review of sternal closure techniques. J Biomater Appl 2013; 28 (4) 483-497
  • 3 Berdajs D, Zünd G, Turina MI, Genoni M. Blood supply of the sternum and its importance in internal thoracic artery harvesting. Ann Thorac Surg 2006; 81 (6) 2155-2159
  • 4 Graeber GM. Harvesting of the internal mammary artery and the healing median sternotomy. Ann Thorac Surg 1992; 53 (1) 7-8
  • 5 Ridderstolpe L, Gill H, Granfeldt H, Ahlfeldt H, Rutberg H. Superficial and deep sternal wound complications: incidence, risk factors and mortality. Eur J Cardiothorac Surg 2001; 20 (6) 1168-1175
  • 6 Losanoff JE, Basson MD, Gruber SA, Huff H, Hsieh FH. Single wire versus double wire loops for median sternotomy closure: experimental biomechanical study using a human cadaveric model. Ann Thorac Surg 2007; 84 (4) 1288-1293
  • 7 Kiessling AH, Isgro F, Weisse U, Möltner A, Saggau W, Boldt J. Advanced sternal closure to prevent dehiscence in obese patients. Ann Thorac Surg 2005; 80 (4) 1537-1539
  • 8 Losanoff JE, Jones JW, Richman BW. Primary closure of median sternotomy: techniques and principles. Cardiovasc Surg 2002; 10 (2) 102-110
  • 9 Negri A, Manfredi J, Terrini A , et al. Prospective evaluation of a new sternal closure method with thermoreactive clips. Eur J Cardiothorac Surg 2002; 22 (4) 571-575
  • 10 Kun H, Xiubin Y. Median sternotomy closure: review and update research. J Med College PLA 2009; 24 (2) 112-117
  • 11 Casha AR, Yang L, Kay PH, Saleh M, Cooper GJ. A biomechanical study of median sternotomy closure techniques. Eur J Cardiothorac Surg 1999; 15 (3) 365-369
  • 12 Bruhin R, Stock UA, Drücker JP , et al. Numerical simulation techniques to study the structural response of the human chest following median sternotomy. Ann Thorac Surg 2005; 80 (2) 623-630
  • 13 Robicsek F, Fokin A, Cook J, Bhatia D. Sternal instability after midline sternotomy. Thorac Cardiovasc Surg 2000; 48 (1) 1-8
  • 14 Losanoff JE, Richman BW, Jones JW. Disruption and infection of median sternotomy: a comprehensive review. Eur J Cardiothorac Surg 2002; 21 (5) 831-839
  • 15 Schimmer C, Reents W, Berneder S , et al. Prevention of sternal dehiscence and infection in high-risk patients: a prospective randomized multicenter trial. Ann Thorac Surg 2008; 86 (6) 1897-1904
  • 16 Fowler VG, O'Brien SM, Muhlbaier LH, Corey GR, Ferguson TB, Peterson ED. Clinical predictors of major infections after cardiac surgery. Circulation 2005; 12: 358-365
  • 17 Molina JE, Lew RS, Hyland KJ. Postoperative sternal dehiscence in obese patients: incidence and prevention. Ann Thorac Surg 2004; 78 (3) 912-917 , discussion 912–917
  • 18 Borger MA, Rao V, Weisel RD , et al. Deep sternal wound infection: risk factors and outcomes. Ann Thorac Surg 1998; 65 (4) 1050-1056
  • 19 Kamiya H, Al-maisary SS, Akhyari P , et al. The number of wires for sternal closure has a significant influence on sternal complications in high-risk patients. Interact Cardiovasc Thorac Surg 2012; 15 (4) 665-670
  • 20 Friberg O, Dahlin LG, Söderquist B, Källman J, Svedjeholm R. Influence of more than six sternal fixation wires on the incidence of deep sternal wound infection. Thorac Cardiovasc Surg 2006; 54 (7) 468-473
  • 21 McGregor WE, Trumble DR, Magovern JA. Mechanical analysis of midline sternotomy wound closure. J Thorac Cardiovasc Surg 1999; 117 (6) 1144-1150
  • 22 Dasika UK, Trumble DR, Magovern JA. Lower sternal reinforcement improves the stability of sternal closure. Ann Thorac Surg 2003; 75 (5) 1618-1621
  • 23 Shaikhrezai K, Robertson FL, Anderson SE, Slight RD, Brackenbury ET. Does the number of wires used to close a sternotomy have an impact on deep sternal wound infection?. Interact Cardiovasc Thorac Surg 2012; 15 (2) 219-222