Comparison of three different sternal closure techniques after cardiac surgery in elderly patients

Mazlum Şahin; Helin El; Fatma Tuba İlal Mert

doi:10.28982/josam.411872

Authors

Mazlum Şahin
Helin El
Fatma Tuba İlal Mert

DOI:

https://doi.org/10.28982/josam.411872

Keywords:

Nitinol clips, Sternotomy, Sternal closure, Stainless steel wires, Robicsek technique

Abstract

Aim: To identify the effectivity of stainless steel wires (SSW), Robicsek technique (RT) and thermoreactive nitinol clips (TNC) for sternal closure in elderly patients.

Methods: We conducted a prospective randomized study to compare SSW, RT and TNC in the sternal closure between January 2015 and January 2017. Patients over 60 years old who required sternal closure following cardiac surgery were enrolled into the study. Preoperative characteristics, operative parameters and EuroSCORE were recorded for each patient. In postoperative period, duration of intensive care unit stay and hospitalization, complications and mortality rates were analyzed. All patients evaluated according to the Visual analogue scale score (VAS) on 1st, 3rd and 5th day after the operation.

Results: 96 patients (32 patients with SSW, 32 patients with RT and 32 patients with TNC) required sternal closure. Patients in which sternal closure was performed with TNC, achieved significantly shorter hospitalization period (p=0.014) and no any dehiscence (p= 0.014). We achieved significantly better VAS scores in patients with TNC (p<0.001, p<0.001 and p<0.001, respectively). In multivariate regression analysis, superficial sternal wound infection (SSWI) and DSWI were the only predictive factors for sternal dehiscence (p=0.029 and p=0.015, respectively).

Conclusion: Our study showed that using TNC decreased the hospitalization duration, DSWI, sternal dehiscence development and postoperative pain intensity. SSWI and DSWI were found to be the only predictive factors for sternal dehiscence in multivariate regression analysis.

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