title: A newly designed thorax support vest prevents sternum instability after median sternotomy.
abstract: OBJECTIVE
  Sternum infection remains one of the primary causes of postoperative morbidity and mortality after median sternotomy. We report the clinical efficacy for primary reinforcement of the sternum with a new design of thorax support vest.
  
  
  METHODS
  A prospective randomized study including 455 patients was started in September 2007 to evaluate the effectiveness of the Posthorax sternum vest (Epple Inc., Vienna, Austria). One hundred and seventy five patients were treated with the sternum dressing postoperatively (group A), 227 patients did not receive the vest (group B) and 53 patients refused it (group C). Several clinical and operative data were evaluated. All patients were recorded using the STS risk scoring analysis for mediastinitis after cardiac surgery.
  
  
  RESULTS
  The median age and gender distribution were comparable in both groups. Preoperative data like renal failure, chronic obstructive pulmonary disease, peripheral artery disease, and myocardial infarction were not significant. There were more patients with diabetes in group A and C (A: 39.4%, B: 29.1%, C: 43.4%, p = 0.036). A total of 55.8% underwent coronary bypass grafting, 15.4% aortic valve replacement, 7.7% mitral valve repair and 21.1% concomitant cardiac procedures. The median risk factor analysis and body mass index were comparable. In the follow-up period up to 90 days, in group A we observed 0.6% sternum wound complications, in group B 4.9%, and in group C 9.4% (group A vs B: Fisher's exact test p = 0.0152 and group A vs C: p = 0.0029).
  
  
  CONCLUSIONS
  The use of the Posthorax sternum vest shows a favourable outcome to prevent sternum instability after cardiac surgery. There was one reoperation in patients treated with this sternum vest compared to 16 in the control groups.
authors.affiliation: Department of Cardiovascular Surgery, Hospital Hietzing, Wolkersbergenstr. 1, A-1130 Vienna, Austria. michael.gorlitzer@wienkav.at
authors.forename: Michael
authors.initials: M
authors.lastname: Gorlitzer
authors.forename: Sandra
authors.initials: S
authors.lastname: Folkmann
authors.forename: Johann
authors.initials: J
authors.lastname: Meinhart
authors.forename: Peter
authors.initials: P
authors.lastname: Poslussny
authors.forename: Markus
authors.initials: M
authors.lastname: Thalmann
authors.forename: Gabriel
authors.initials: G
authors.lastname: Weiss
authors.forename: Manfred
authors.initials: M
authors.lastname: Bijak
authors.forename: Martin
authors.initials: M
authors.lastname: Grabenwoeger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001915:Braces; D006348:Cardiac Surgical Procedures; D003020:Clothing; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain; D011182:Postoperative Care / Q000295:instrumentation* / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D013249:Sternum / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000517:prevention & control; D035441:Thoracic Wall