Abstract
Background We aimed to assess asymptomatic patients who had open-heart surgery with median sternotomy
for potential sternal anomalies (SA), their related patient-specific risk factors,
and treatment options for the prevention of SA.
Methods Multiplanar CT scans (CTs) from 131 asymptomatic consecutive patients were analyzed
retrospectively. Of these, 83 underwent CABG (63.4%), and 48 had aortic valve (AV)
procedures via median sternotomy. Sternal bone healing was analyzed for SA and their
exact location.
Results In total, 49 SA were identified in 42 (32.1%) patients; 65% SA were found in the
manubrium (n = 32). Five hundred thirty-two wires were implanted (4.2 ± 0.5 wires/patient), out of
which 96.1% (n = 511) were figure 8 wires. There was no difference between normal and abnormal sterna
with regard to the number of wires used for sternal closure (4.2 ± 0.5 vs. 4.3 ± 0.6,
p = ns). The distance between wire placement to the proximal edge of the manubrium in
normal and abnormal sterna was comparable (11.2 ± 4.2 vs. 10.9 ± 4.8 mm, p = ns). Patients who underwent CABG had a significantly higher risk for SA (OR = 2.4, p ≤ 0.05, 95% CI [1.2–4.9]). The use of BIMA (OR = 4.4, p ≤ 0.05, 95% CI [1.1–17.9]) and body mass index (BMI) > 31 kg/m2 (OR = 3.4, p ≤ 0.01, 95% CI [1.4–8.3]) significantly increased the risk of SA.
Conclusion At least 30% of patients were at an increased risk for SA after receiving a median
sternotomy. CABG, use of BIMA, and a BMI > 30 kg/m2 were potential risk factors for the development of SA and warrant close clinical
follow-up. Sternal plate fixation, particularly in the manubrium, could be beneficial
in such patients.
Keywords
surgery - complications - sternum - outcomes - wound - healing
