title: A new cable-tie-based sternal closure device: infectious considerations.
abstract: OBJECTIVE
  To determine the difference in sternal infection and other infectious events between conventional wire and cable-tie-based closure techniques post-sternotomy in a collective of patients after cardiac surgery.
  
  
  METHODS
  The sternal ZipFix™ (ZF) system consists of a biocompatible poly-ether-ether-ketone (PEEK) cable-tie that surrounds the sternum through the intercostal space and provides a large implant-to-bone contact. Between 1 February 2011 and 31 January 2012, 680 cardiac operations were performed via sternotomy at our institution. After the exclusion of operations for active endocarditis and early mortality within 7 days, 95 patients were exclusively closed with ZF and could be compared with 498 who were closed with conventional wires (CWs) during the same period. A multivariable logistic regression analysis, including body mass index, renal impairment and emergency as suspected confounders and inverse propensity weights was performed on the infection rate.
  
  
  RESULTS
  Total infection rate was 6.1%, with a total of 36 diagnosed sternal infections (5 in ZF and 31 in CW). Comparing ZF with CW with regard to sternal infection, there is no statistically significant difference related to the device (odds ratio: 0.067, confidence interval: 0.04-9.16, P=0.72). The propensity modelling provided excellent overlap and the mean propensity was almost the same in both groups. Thus, we have observed no difference in receiving either ZF or CW. No sternal instability was observed with the ZF device, unlike 4/31 patients in the CW group. The overall operation time is reduced by 11 min in the ZF group with identical perfusion and clamping times.
  
  
  CONCLUSIONS
  Our study underlines a neutral effect of the sternal ZipFix™ system in patients regarding sternal infection. Postoperative complications are similar in both sternal closure methods. The cable-tie-based system is fast, easy to use, reliable and safe.
authors.affiliation: Clinic for Cardiac Surgery, University Hospital Basel, Basel, Switzerland. Ludovic.Melly@usb.ch
authors.forename: Ludovic
authors.initials: L
authors.lastname: Melly
authors.forename: Brigitta
authors.initials: B
authors.lastname: Gahl
authors.forename: Ruth
authors.initials: R
authors.lastname: Meinke
authors.forename: Florian
authors.initials: F
authors.lastname: Rueter
authors.forename: Peter
authors.initials: P
authors.lastname: Matt
authors.forename: Oliver
authors.initials: O
authors.lastname: Reuthebuch
authors.forename: Friedrich S
authors.initials: FS
authors.lastname: Eckstein
authors.forename: Martin T R
authors.initials: MT
authors.lastname: Grapow
mesh_terms: D000368:Aged; D001577:Benzophenones; D001672:Biocompatible Materials; D001864:Bone Wires; D004867:Equipment Design; D005260:Female; D006801:Humans; D007659:Ketones; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011092:Polyethylene Glycols; D011108:Polymers; D012189:Retrospective Studies; D012307:Risk Factors; D056346:Sternotomy; D013530:Surgical Wound Infection / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome; D058106:Wound Closure Techniques / Q000009:adverse effects* / Q000295:instrumentation*
chemical_list: D001577:Benzophenones; D001672:Biocompatible Materials; D007659:Ketones; D011108:Polymers; C063834:polyetheretherketone; D011092:Polyethylene Glycols
keywords: Cardiac surgery; Poly-ether-ether-ketone; Sternal closure device; Sternal infection