• Thorac Cardiovasc Surg · Jun 2017

    Randomized Controlled Trial Comparative Study

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

    • Giorgi Loladze, Ralf Uwe Kuehnel, Thomas Claus, Martin Hartrumpf, Frank Kuepper, Manfred Pohl, and Johannes Maximilian Albes.
    • Department of Cardiovascular Surgery, Heart Center Brandenburg, Bernau, Germany.
    • Thorac Cardiovasc Surg. 2017 Jun 1; 65 (4): 332-337.

    AbstractBackground 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. Methods A total of 200 obese patients with a body mass index ≥ 30 kg/m2 undergoing 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. Results 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 (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. Conclusion Double-wire sternal closure significantly reduces postoperative sternal instability in obese patients undergoing isolated CABG with LIMA graft.Georg Thieme Verlag KG Stuttgart · New York.

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