Sternal Steel Wire Combined with Sternal Closure Systems for The First Sternotomy Closures in Patients with High Risk for Sternal Complications; Thermoractive Nitinol Clips or Titanium Sternal Closure Plate?

Ersin Çelik, Ahmet Rıfkı Çora, Şenol Gülmen

2022

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DOI 10.47572/muskutd.857635
Data confidence 70 medium
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Abstract

In this study, we aimed to compare the sternal complication rates of traditional steel wire closure, steel wire combined with thermoreactive nitinol clips (TRC) or steel wire combined with titanium sternal closure plate (TSCP) methods used in first sternotomy closures in high risk patients. 210 patients (153 males, 57 females, mean age 62.87±10.21, distribution 21-86 years) that underwent open heart surgery via median sternotomy between May 2018-October 2020 were studied retrospectively. The patients were divided into three groups according to the methods used for sternal closure as; steel wire only (n=179), steel wire combined with TRC (n=17) and steel wire combined with TSCP (n=14). The groups were compared in terms of demographic changes, clinical specifications, and sternal complication rates. Sternal dehiscence was evaluated in 2 patients (1.1%) whose sternums were closed with only steel wire, and among all the patients included in the study, superficial wound infection was seen in these 2 patients (1.1%). Superficial wound infection was seen in 1 patient (7.1%) in the group where TSCP combined steel wire was used. No sternal dehiscence was seen in patient groups in which TSCP and TRC were used. There was no statistical significance observed regarding sternal complications among three group. DM ratio was higher among the TRC and TSCP groups (p=0.002). The patients were divided into four groups according to their body mass indexes (BMI). The BMI rates of 35-39.9 and> 40 kg/m2 were found to be significant in the patients for whom TRC and TSCP used (p <0.001) in comparison with the BMI rates of the patients to whom conventional steel wiring was applied. A forward stepwise multinomial logistic regression model was created to evaluate the use of TRC and TSCP. DM (OR=8.26) and 30-34.9 kg/m2 BMI (OR=14.28) were found significantly effective for TRC. 30-34.9 kg/m2 and 35-39.9 kg/m2 BMI (OR=10.75) were found significantly effective for TSCP. We believe that using reinforced stell wire with TSCP and TRC for closure of first sternotomies was safe and could prevent further possible sternal complications among the patients that have high risks of sternal dehiscence.