title: The use of Nitinol clips for primary sternal closure in cardiac surgery.
abstract: OBJECTIVE
  Deep sternal wound complications after cardiac surgery have an incidence of 2 to 8% and carry a significant mortality. The aim of this study was to evaluate the effect of thermo-reactive Nitinol clips on the incidence of postoperative deep sternal wound complications.
  
  
  METHODS
  We retrospectively reviewed 1119 consecutive patients that underwent major cardiac surgery via median sternotomy in our centre. Sternal closure was performed using Nitinol clips in 235 patients (Group I) and standard stainless steel wires in 884 patients (Group II). The risk factors that were identified between the two groups were age, EuroSCORE, body mass index, diabetes and pulmonary comorbidity.
  
  
  RESULTS
  The overall incidence of deep sternal wound complications was 2.2% (25/1119).The incidence was higher in Group II (2.3%) compared to Group I (1.7%) (p = 0?8).Mechanical sternal dehiscence occurred in 2 patients in Group II. Mortality related to sternal wound complications was 8% (2/21) in Group II whereas in Group I was 0%.
  
  
  CONCLUSIONS
  The incidence of sternal wound complications and the mortality related to them were lower in patients undergoing sternal closure with Nitinol clips. A randomized study to further evaluate the possible advantages of Nitinol clips is warranted.
authors.affiliation: Wessex Cardiac Centre, Southampton University Hospital, Southampton, UK.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Nikolaidis
authors.forename: Dimos
authors.initials: D
authors.lastname: Karangelis
authors.forename: Kavitha
authors.initials: K
authors.lastname: Mattam
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Tsang
authors.forename: Sunil
authors.initials: S
authors.lastname: Ohri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D001864:Bone Wires; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D004739:England / Q000453:epidemiology; D004867:Equipment Design; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects / Q000401:mortality; D013525:Surgical Instruments; D013529:Surgical Wound Dehiscence / Q000401:mortality / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000401:mortality / Q000517:prevention & control; D016896:Treatment Outcome; D058106:Wound Closure Techniques / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality
chemical_list: D000497:Alloys; C013616:nitinol