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Talay S. 1, Abud B. 2, Karaarslan K. 2, Kara H. 3, Turhan S. 2, Şahin A. 4
1 Canakkale State Hospital, Cardiovascular Surgery Department, Canakkale, Turkey;
2 Izmir Tepecik Research and Education Hospital, Cardiovascular Surgery Department, Izmir, Turkey;
3 Ada Hospital, Cardiovascular Surgery Department, Giresun, Turkey;
4 Izmir Katip Celebi University, Atatürk Training and Education Hospital, Cardiovascular Surgery Department, Izmir, Turkey
We report the case of a rare complication after coronary artery bypass graft (CABG) with non-traumatic fracture of nitinol thermoreactive sternal clips resulting a postoperative partial sternal dehiscence. A 61-year-old female patient administered to our department with severe coronary stenosis by coronary angiography and stabil angina pectoris symptoms. Physical examination were within normal limits. The electrocardiogram showed a normal sinus rhythm for 75/min. Arterial blood pressure was 130/90 mmHg. Lungs and heart were clear to auscultation. Patient was diagnosed with diabetes mellitus (DM) for several years with insulin treatment. She was obese with body mass index (BMI) 36.8 kg/m2. Rest of the physical and clinical evaluation was within normal limits. After preoperative preperation, patient underwent to three vessel CABG with conventional cardiopulmonary bypass. Due to intraoperative findings of obvious sternal osteoporosis and co-morbidities such as DM and higher BMI we applied 3 nitinol thermoreactive sternal clips besides 4 conventional stainless steel sternal wire applications during sternal closure. Postoperative period was uneventful and patient was discharged at the tenth postoperative day. However, patient conrol at the seventeenth postoperative day revealed a partial sternal dehiscence with fracture of two distally located nitinol sternal clips. Patient did not describe any kind of trauma which otherwise meight be related to clip fracture. We did not reoperate the patient for sternal re-union because of the partial nature of the dehiscence. Afterwards, sternum was examined with healing of dehiscence in three months follow-up. Nevertheless, we advocate that it is possible to observe a postoperative fracture of nitinol thermoreactive clips even with the absence of a certain trauma. Therefore, we suggest to combine this relatively new technique and sternal closure equipment of nitinol clips with conventional stainless steel sternal closure wires for selected high risk patients. Otherwise, a postoperative fracture of these clips presents an absolute candidate for reoperation.