Double-Wire versus Single-Wire Sternal Closure in Obese Patients: a Randomized Prospective Study

• Published in: The Thoracic and cardiovascular surgeon Vol. 65; no. 4; p. 332
• Main Authors: Loladze, Giorgi, Kuehnel, Ralf Uwe, Claus, Thomas, Hartrumpf, Martin, Kuepper, Frank, Pohl, Manfred, Albes, Johannes Maximilian
• Format: Journal Article
• Language: English
• Published: Germany 01.06.2017
• Subjects: Aged; Body Mass Index; Bone Wires; Coronary Artery Bypass - adverse effects; Coronary Artery Disease - complications; Coronary Artery Disease - diagnosis; Coronary Artery Disease - surgery; Female; Germany; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Obesity - complications; Obesity - diagnosis; Odds Ratio; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Prospective Studies; Risk Factors; Sternotomy - adverse effects; Sternum - diagnostic imaging; Sternum - surgery; Time Factors; Treatment Outcome; Wound Closure Techniques - adverse effects; Wound Closure Techniques - instrumentation; Wound Healing
• ISSN: 1439-1902
• DOI: 10.1055/s-0036-1582257

Sternal instability after coronary artery bypass grafting (CABG) is a serious complication. Obese patients are at high risk for sternal instability after CABG. This study was conducted to assess the positive impact of double-wire sternal closure on sternal instability.  A total of 200 obese patients with a body mass index ≥ 30 kg/m undergoing isolated CABG with left internal mammary artery (LIMA) graft were randomly assigned to sternal closure either by eight single wires (  = 100) or by a combination of four double wires and four single wires.  There was a total of 21 cases with sternal instability: 5 cases (i.e., 5%) in the double-wire group versus 16 cases (16%) in the single-wire group (  = 0.019). Logistic regression analysis showed sternal closure via double wires as an independent protection factor (odds ratio [OR]: 0.276;  = 0.029). Smoking (OR: 5.5;  = 0.006) and postoperative delirium (OR: 3.5;  = 0.033) turned out to be independent risk factors for the development of sternal instability.  Double-wire sternal closure significantly reduces postoperative sternal instability in obese patients undergoing isolated CABG with LIMA graft.