title: Double-Wire versus Single-Wire Sternal Closure in Obese Patients: a Randomized Prospective Study.
abstract: BackgroundSternal 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.MethodsA total of 200 obese patients with a body mass index ≥ 30 kg/m2undergoing isolated CABG with left internal mammary artery (LIMA) graft were randomly assigned to sternal closure either by eight single wires (n= 100) or by a combination of four double wires and four single wires.ResultsThere 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 (p= 0.019). Logistic regression analysis showed sternal closure via double wires as an independent protection factor (odds ratio [OR]: 0.276;p= 0.029). Smoking (OR: 5.5;p= 0.006) and postoperative delirium (OR: 3.5;p= 0.033) turned out to be independent risk factors for the development of sternal instability.ConclusionDouble-wire sternal closure significantly reduces postoperative sternal instability in obese patients undergoing isolated CABG with LIMA graft.
authors.affiliation: Department of Cardiovascular Surgery, Heart Center Brandenburg, Bernau, Germany.
authors.forename: Giorgi
authors.initials: G
authors.lastname: Loladze
authors.affiliation: Department of Cardiovascular Surgery, Heart Center Brandenburg, Bernau, Germany.
authors.forename: Ralf Uwe
authors.initials: RU
authors.lastname: Kuehnel
authors.affiliation: Department of Cardiovascular Surgery, Heart Center Brandenburg, Bernau, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Claus
authors.affiliation: Department of Cardiovascular Surgery, Heart Center Brandenburg, Bernau, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Hartrumpf
authors.affiliation: Department of Cardiovascular Surgery, Heart Center Brandenburg, Bernau, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Kuepper
authors.affiliation: Institute of Medical Physics and Biophysics, University Hospital Charité, Berlin, Germany.
authors.forename: Manfred
authors.initials: M
authors.lastname: Pohl
authors.affiliation: Department of Cardiovascular Surgery, Heart Center Brandenburg, Bernau, Germany.
authors.forename: Johannes Maximilian
authors.initials: JM
authors.lastname: Albes
mesh_terms: D000368:Aged; D015992:Body Mass Index; D001864:Bone Wires; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005858:Germany; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications* / Q000175:diagnosis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects; D013249:Sternum / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D058106:Wound Closure Techniques / Q000009:adverse effects / Q000295:instrumentation*; D014945:Wound Healing