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The Journal of Cardiovascular Surgery 2001 October;42(5):601-3

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Reinforced sternal closures for prevention of sternal dehiscence in high risk patients

Totaro P., Lorusso R., Zogno M.

From the 2nd Division of Cardiac Surgery Civic Hospital, Brescia, Italy


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Background. Sternal dehis­cence is ­still a fre­quent com­pli­ca­tion ­after car­diac sur­gery pro­ce­dures, per­formed ­through mid­line ster­not­o­my. Its cumu­la­tive inci­dence ­has ­been report­ed to be ­around 2.5%, ­but sev­er­al ­risk fac­tors ­for ­increased inci­dence ­have ­also ­been iden­ti­fied. In ­past ­years sev­er­al tech­niques ­have ­been pro­posed to ­achieve rein­forced ster­nal approx­i­ma­tion, main­ly con­sid­ered ­for ­the treat­ment of ster­nal dehis­cence, ­more ­than ­for ­its pre­ven­tion. The objec­tive of ­this ­paper is ­the eval­u­a­tion of ­the ­results, in ­terms of pre­ven­tion of ster­nal dehis­cence in ­high-­risk ­patients, ­using rein­forced clo­sure tech­niques com­pared to stan­dard tech­nique.
Methods. Our ­study pop­u­la­tion includ­ed 212 ­patients ­who under­went car­diac sur­gery pro­ce­dure ­and pre­sent­ed at ­least ­one of ­the ­increased ­risk fac­tor ­for ster­nal dehis­cence. Fifty-­six ­patients (26.4%) ­received a rein­forced ster­nal clo­sure tech­nique (RC ­group), 156 ­patients (73.6%) ­received a con­ven­tion­al ster­nal clo­sure (CC ­group).
Results. The cumu­la­tive inci­dence of ster­nal ref­ix­a­tion, in ­this select­ed pop­u­la­tion, ­was 5.6% ­with a sta­tis­ti­cal­ly sig­nif­i­cant dif­fer­ence in ­favour of ­the RC ­group. The ­results of ­this ­study clear­ly ­show ­that ­the appro­pri­ate util­isa­tion ­and selec­tion of ­one of ­the sev­er­al tech­niques of rein­forced ster­nal clo­sures ­can be effec­tive in ­the reduc­tion of ster­nal dehis­cence in ­high ­risk ­patients.
Conclusions. A rein­forced tech­nique ­should there­fore be util­ised in ­all ­patients under­go­ing car­diac sur­gery, pre­sent­ing ­one or ­more ­risk fac­tors ­for ­increased inci­dence of ster­nal dehis­cence.

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