Non-infectious sternal dehiscence after coronary artery bypass surgery

Abstract

Introduction Non-infectious sternal dehiscence (NISD) is a known complication following coronary artery bypass grafting (CABG), with previous studies estimating an incidence of 0.4–1% of surgeries. We aimed to study the incidence of NISD together with short- and long-term outcomes in a whole-nation cohort of patients. Materials and methods A retrospective study on consecutive CABG patients diagnosed with NISD at Landspitali from 2001 to 2020. Patients diagnosed with infectious mediastinitis (n = 20) were excluded. NISD patients were compared to patients with an intact sternum regarding patient demographics, cardiovascular risk factors, intra- and postoperative data, and estimated overall survival. The median follow-up was 9.5 years. Results Twenty out of 2280 eligible patients (0.88%) developed NISD, and the incidence did not change over the study period (p = 0.98). The median time of diagnosis was 12 days postoperatively (range, 4–240). All patients were re-operated using a Robicsek-rewiring technique, with two cases requiring a titanium plate for fixation. Patients with NISD were older, had a higher BMI and EuroSCORE II, lower LVEF, and more often had a history of COPD, MI, and diabetes compared to those without NISD. Length of stay was extended by 15 days for NISD patients, but short and long-term survival was not statistically different between the groups. Conclusions The incidence of NISD was low and in line with previous studies. Although the length of hospital stay was extended, both short- and long-term survival of NISD patients was not significantly different from patients with an intact sternum.

Combined Band and Plate Fixation as a New Individual Option for Patients at Risk of Sternal Complications after Cardiac Surgery: A Single-Center Experience

“…Postoperative sternum instability requiring reoperation after cardiac surgery occurs in 0.8% to 10% of patients [30][31][32][33]. In our cohort, no sternum instability was reported at the follow-up.…”

“…Considering that postoperative sternal instability and postoperative deep wound infections are relatively rare conditions occurring in 0.8% to 10% [30][31][32][33] and 1% to 10% [26][27][28][29] of patients, respectively, the sample size of this cohort was not sufficient enough to draw definitive conclusions on enhanced sternal closure with the SL360 after cardiac surgery. Third, even though the follow-up rate was 82%, sternal imaging is not routinely performed at our institution and was only available in 35% of the patients.…”

Trampas del procedimiento de Robicsek: alternativas de vanguardia más seguras para reducir las complicaciones quirúrgicas en el esternón

“…Con base en todos estos aspectos, nos interesamos sobre cómo abordar dichos inconvenientes y decidimos trabajar en una alternativa en paralelo a la técnica de Robicsek. Como resultado, comenzamos a utilizar SternaLock Blu® y SternaLock 360® de Zimmer Biomet (suministrados por Surgical Solutions®, Guaynabo, Puerto Rico) 4 . El sistema de cierre esternal SternaLock Blu® está compuesto por placas, tornillos y tres alambres de acero inoxidable, mientras que el tope de gama SternaLock 360® solo incluye tres placas y una cinta de titanio, que es de ayuda solo en los pacientes con osteoporosis y osteopenia 1 .…”

“/” wiring (Durukan weave) to prevent sternal cutting by wires: a propensity score matched comparison with Robicsek weave

“…Despite the shift towards minimally invasive procedures with lateral mini-thoracotomy and partial sternotomy, median midline full sternotomy is still the most employed technique in open heart surgery, providing excellent exposure [ 1 ]. However, sternal wound related complications and sternal dehiscence whether infectious or non-infectious are still concerns causing morbidity and/or mortality.…”

“…Robicsek weave, sternal cable systems, rigid plate fixation and thermoreactive nitinol clip implantation are currently employed methods for preventing aforementioned complications [ 1 , 2 ]. Robicsek weave, which was defined in 1977, is still the most frequently used sternal wiring method in high-risk patients to avoid such problems and is proven to be safe and cost-effective, yet time-consuming [ 2 , 3 ].…”