Effectiveness of Various Sternal Closure Devices Post Adult Cardiac Surgery.

Abstract

Background & aim: Sternotomy remains a commonly used technique to access the heart for cardiac surgery worldwide. To date, there is no clear consensus on the single superior sternal closure technique. Patient-specific factors such as osteoporosis, diabetes, old age, body habitus influence a surgeon's choice in this matter as do techniques commonly used during the training period and used in the current workplace. The goal is to achieve good bony union and prevent deep sternal wound infection and mediastinitis. Utilising stainless steel wires to repair the sternum is still the most prevalent technique. Numerous studies demonstrate no superiority with infection prevention or sternal dehiscence when comparing simple interrupted wiring techniques to more specialised techniques such as longitudinal sternal wiring or figure-of-eight wiring. There may be a reduction in wound complications with sternal plating compared to wiring. This is especially true for patients with one or more risk factors, who may benefit from sternal reinforcement with specialised or advanced wiring or additional plating. The aim of this study was to explore the optimal sternal closure technique post-adult cardiac surgery.

Method: A retrospective study of all patients undergoing cardiac surgery with the aid of sternotomy in the year 2021 was conducted at a quaternary hospital. Results were analysed following sternal re-approximation using wires, cables or plating in the short term (<30 days) and at 1-year follow up. The primary outcome measure was 1 year free from surgical reintervention with secondary outcome measures including rates of superficial infection, wound dehiscence, deep sternal infection and mediastinitis as well as the need for further active management or surgical reintervention.

Results: This study demonstrated superior outcomes following wire closure versus cable closure including a decreased need for surgical reintervention, intravenous antibiotics or readmission with a trend towards reduced sternal non-union. The results were similar among patients who had wires as opposed to plating. It was also observed that risk factors including diabetes, emergency surgery and the need to return to theatre increased the patient's risk for short-term postoperative sternal complications including superficial and deep infections, wound dehiscence and sternal non-union.

Conclusions: This study would support the use of wires as the superior sternal repair technique when taking into account the lower cost profile of wires vs sternal plating with similar sternal outcomes. There was an increased need for surgical reintervention, readmission and intravenous antibiotics following the use of cables for sternal closure.