Sternal Closure with Titanium Plate Fixation in OPCAB for High Risk Patients
Hiroshi Niinami, Kozo Morita, Shouichi Irie.
Saitama Medical University International Medical Center, Hidaka-shi, Saitama, Japan.
OBJECTIVE: Sternal instability or dehiscence results in serious wound infection. We sought to assess the early outcomes with such a plating system for sternal closure in comparison to the conventional wiring technique in OPCAB.
METHODS: A total of 856 patients who underwent OPCAB at our institute from January 2010 to April 2017 were enrolled. Three hundred patients received plate for sternal fixation (Plate group), while 556 received conventional wire technique (Wire group). High risk of sternal dehiscence was defined as patients having 3 or more established historical risk factors, including: COPD, re-operative surgery, chronic renal failure on hemodialysis, diabetes on insulin, chronic steroid use, morbid obesity, concurrent infection and acquired or iatrogenic immunosuppression. Intra-operative risk factors included off- midline sternotomy, osteoporosis, and transverse fractures of the sternum. Rigid plate fixation was performed using a combination of plates secured by bi-cortical screws with 2 or 3 sternal wires, after the cardiac surgical procedure was complete and hemostasis was secured. Propensity score matching was used to compare the 2 matched groups.
RESULTS: Rigid plate fixation was performed on 236 males and 64 females. The average age of patients was 68 (34-88) years. The average follow-up was 19 months (range 0.6-41.6 months). There were neither peri-operative deaths nor sternal dehiscence. Comparing the cohort of patients who received rigid plate fixation to a matched population of high-risk patients during a similar time period who received conventional wire closure, revealed a significant difference in the incidence of sternal dehiscence. The Wire group (n=274) had 1 death unrelated to sternal closure and had 5 patients who developed sternal dehiscence including 1 mediastinitis.
CONCLUSIONS: Patients who benefited from sternal closure with rigid plate fixation showed a significant decrease in the incidence of post-operative sternal dehiscence including mediastinitis when compared to similar population of patients whose sternum were closed with conventional wire technique. Application of this technique in high-risk patients for CABG prevents dehiscence.
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