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Sternal anomalies in asymptomatic patients after median sternotomy and potential influencing factors


Rodriguez Cetina Biefer, Hector; Sündermann, Simon H; Alkadhi, Hatem; Genoni, Michele; Maisano, Francesco; Emmert, Maximilian Y; Plass, André (2017). Sternal anomalies in asymptomatic patients after median sternotomy and potential influencing factors. Thoracic and Cardiovascular Surgeon:Epub ahead of print.

Abstract

Background: We aimed to assess asymptomatic patients who had open-heart surgery with median sternotomy for potential sternal anomalies (SA), their related patient-specific risk factors, and treatment options for the prevention of SA.
Methods: Multiplanar CT scans (CTs) from 131 asymptomatic consecutive patients were analyzed retrospectively. Of these, 83 underwent CABG (63.4%), and 48 had aortic valve (AV) procedures via median sternotomy. Sternal bone healing was analyzed for SA and their exact location.
Results: In total, 49 SA were identified in 42 (32.1%) patients; 65% SA were found in the manubrium (n = 32). Five hundred thirty-two wires were implanted (4.2 ± 0.5 wires/patient), out of which 96.1% (n = 511) were figure 8 wires. There was no difference between normal and abnormal sterna with regard to the number of wires used for sternal closure (4.2 ± 0.5 vs. 4.3 ± 0.6, p = ns). The distance between wire placement to the proximal edge of the manubrium in normal and abnormal sterna was comparable (11.2 ± 4.2 vs. 10.9 ± 4.8 mm, p = ns). Patients who underwent CABG had a significantly higher risk for SA (OR = 2.4, p ≤ 0.05, 95% CI [1.2–4.9]). The use of BIMA (OR = 4.4, p ≤ 0.05, 95% CI [1.1–17.9]) and body mass index (BMI) > 31 kg/m2 (OR = 3.4, p ≤ 0.01, 95% CI [1.4–8.3]) significantly increased the risk of SA.
Conclusion: At least 30% of patients were at an increased risk for SA after receiving a median sternotomy. CABG, use of BIMA, and a BMI > 30 kg/m2 were potential risk factors for the development of SA and warrant close clinical follow-up. Sternal plate fixation, particularly in the manubrium, could be beneficial in such patients.

Abstract

Background: We aimed to assess asymptomatic patients who had open-heart surgery with median sternotomy for potential sternal anomalies (SA), their related patient-specific risk factors, and treatment options for the prevention of SA.
Methods: Multiplanar CT scans (CTs) from 131 asymptomatic consecutive patients were analyzed retrospectively. Of these, 83 underwent CABG (63.4%), and 48 had aortic valve (AV) procedures via median sternotomy. Sternal bone healing was analyzed for SA and their exact location.
Results: In total, 49 SA were identified in 42 (32.1%) patients; 65% SA were found in the manubrium (n = 32). Five hundred thirty-two wires were implanted (4.2 ± 0.5 wires/patient), out of which 96.1% (n = 511) were figure 8 wires. There was no difference between normal and abnormal sterna with regard to the number of wires used for sternal closure (4.2 ± 0.5 vs. 4.3 ± 0.6, p = ns). The distance between wire placement to the proximal edge of the manubrium in normal and abnormal sterna was comparable (11.2 ± 4.2 vs. 10.9 ± 4.8 mm, p = ns). Patients who underwent CABG had a significantly higher risk for SA (OR = 2.4, p ≤ 0.05, 95% CI [1.2–4.9]). The use of BIMA (OR = 4.4, p ≤ 0.05, 95% CI [1.1–17.9]) and body mass index (BMI) > 31 kg/m2 (OR = 3.4, p ≤ 0.01, 95% CI [1.4–8.3]) significantly increased the risk of SA.
Conclusion: At least 30% of patients were at an increased risk for SA after receiving a median sternotomy. CABG, use of BIMA, and a BMI > 30 kg/m2 were potential risk factors for the development of SA and warrant close clinical follow-up. Sternal plate fixation, particularly in the manubrium, could be beneficial in such patients.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiovascular Surgery
04 Faculty of Medicine > University Hospital Zurich > Clinic for Diagnostic and Interventional Radiology
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords:surgery - complications - sternum - outcomes - wound - healing
Date:7 October 2017
Deposited On:31 Oct 2017 16:49
Last Modified:19 Feb 2018 09:03
Publisher:Georg Thieme Verlag
ISSN:0171-6425
OA Status:Closed
Publisher DOI:https://doi.org/10.1055/s-0037-1607217
PubMed ID:28987082

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