Sternal Komplikasyon Riski Yüksek Hastalarda İlk Sternotomi Kapamalarında Çelik Tel İle Sternal Kapatma Sistemlerinin Kombinasyonu: Termoreaktif Nitinol Klips Mi? Titanyum Sternal Kapatma Plağı Mı?

Year 2022, Volume: 9 Issue: 2, 130 - 136, 24.08.2022

Ersin Çelik , Ahmet Çora , Şenol Gülmen

https://doi.org/10.47572/muskutd.857635

Abstract

Bu çalışmada ilk sternotomilerin kapatılmasında kullanılan geleneksel çelik tel yöntemi, bu yöntem ile yüksek riskli hastalarda kombine edilen termoreaktif nitinol klips (TNK) veya titanyum sternal kapatma plağı (TSKP) kullanımı sonrası gelişebilecek sternal komplikasyon oranları gruplar arasında karşılaştırıldı. Mayıs 2018 – Ekim 2020 tarihleri arasında median sternotomi ile açık kalp cerrahisi uygulanan toplam 210 hasta (153 erkek, 57 kadın; ortalama yaş 62.87±10.21; dağılım 21-86 yıl) geriye dönük olarak incelendi. Hastalar sade çelik tel uygulanan (n=179), çelik tel ile TNK uygulanan (n=17) ve çelik tel ile TSKP uygulanan (n=14) olmak üzere üç gruba ayrıldı. Gruplar arasında demografik, klinik özelliklere ve postoperatif sternal komplikasyon oranları karşılaştırıldı. Sadece geleneksel çelik tel yöntemi ile sternotomisi kapatılan toplam 2 hastada (%1.1) sternal dehisens, toplam 2 hastada (%1.1) yüzeyel cilt enfeksiyonu gelişti. Çelik tel ile TSCP’nin kombine edildiği grupta ise 1 hastada (%7.1) yüzeyel cilt enfeksiyonu saptandı. TNK ve TSCP kullanılan gruplarda sternal dehisens izlenmedi. Her üç grup arasında sternal komplikasyonlar açısından istatistiksel bir fark saptanmadı. TNK ve TSKP kullanılan gruplarda diyabet oranı yüksek saptandı (p=0.002). Hastalar vücut kitle indekslerine (VKİ) göre dört gruba ayrıldı. Sadece geleneksel çelik tellemeye kıyasla TNK ve TSKP kullanılan hastalarda 35-39.9 ve >40 kg/m2 VKİ oranları anlamlı saptandı (p<0.001). TNK ve TSKP kullanımı üzerinde forward stepwise multinominal lojistik regresyon modeli oluşturularak kendi aralarında değerlendirldi. TNK için DM (OR=8.26), 30-34.9 kg/m2 VKİ (OR=14.28) anlamlı etkiye sahip bulundu. TSKP kullanımı üzerinde 30-34.9 (OR=41.66) ve 35-39.9 kg/m2 VKİ (OR=10.75) varlığı anlamlı etkiye sahip bulundu. TNK veya TSKP’nın özellikle sternal dehisens riski yüksek hastalarda ilk sternotomiyi kapatmakta geleneksel çelik tel ile kombine edilmesinin gelişebilecek sternal komplikasyonları azaltabileceği ve güvenle kullanılabileceği kanaatindeyizdir. 

Keywords

Nitinol Klips, Sternal Dehisens, Titanyum Plak

Supporting Institution

yok

Project Number

yok

Sternal Steel Wire Combined with Sternal Closure Systems for The First Sternotomy Closures in Patients with High Risk for Sternal Complications; Thermoractive Nitinol Clips or Titanium Sternal Closure Plate?

Abstract

In this study, we aimed to compare the sternal complication rates of traditional steel wire closure, steel wire combined with thermoreactive nitinol clips (TRC) or steel wire combined with titanium sternal closure plate (TSCP) methods used in first sternotomy closures in high risk patients. 210 patients (153 males, 57 females, mean age 62.87±10.21, distribution 21-86 years) that underwent open heart surgery via median sternotomy between May 2018-October 2020 were studied retrospectively. The patients were divided into three groups according to the methods used for sternal closure as; steel wire only (n=179), steel wire combined with TRC (n=17) and steel wire combined with TSCP (n=14). The groups were compared in terms of demographic changes, clinical specifications, and sternal complication rates. Sternal dehiscence was evaluated in 2 patients (1.1%) whose sternums were closed with only steel wire, and among all the patients included in the study, superficial wound infection was seen in these 2 patients (1.1%). Superficial wound infection was seen in 1 patient (7.1%) in the group where TSCP combined steel wire was used. No sternal dehiscence was seen in patient groups in which TSCP and TRC were used. There was no statistical significance observed regarding sternal complications among three group. DM ratio was higher among the TRC and TSCP groups (p=0.002). The patients were divided into four groups according to their body mass indexes (BMI). The BMI rates of 35-39.9 and> 40 kg/m2 were found to be significant in the patients for whom TRC and TSCP used (p <0.001) in comparison with the BMI rates of the patients to whom conventional steel wiring was applied. A forward stepwise multinomial logistic regression model was created to evaluate the use of TRC and TSCP. DM (OR=8.26) and 30-34.9 kg/m2 BMI (OR=14.28) were found significantly effective for TRC. 30-34.9 kg/m2 and 35-39.9 kg/m2 BMI (OR=10.75) were found significantly effective for TSCP. We believe that using reinforced stell wire with TSCP and TRC for closure of first sternotomies was safe and could prevent further possible sternal complications among the patients that have high risks of sternal dehiscence.

Keywords

Nitinol Clips, Sternal Dehiscence, Titanium Plaque

Project Number

yok

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