Sekiz şeklinde kapama ve çift halka (FÜZYON) sternal kapama tekniklerinin sonuçlarının analizi

Abstract

Amaç: Bu çalışmanın amacı, koroner arter baypas greftleme (KABG) ameliyatı geçiren obez hastalarda modifiye edilmiş bir sternal kapama yöntemi olan Figure-of-eight and doUble-loop Sternal-closure (FUSION) tekniğinin, geleneksel sekiz figürlü telleme (Figure-of-eight wiring, FEW) tekniğine kıyasla sternal instabiliteyi azaltmadaki etkinliğini değerlendirmektir. Gereç ve Yöntemler: Ocak 2023 ile Ocak 2024 tarihleri arasında Ankara Bilkent Şehir Hastanesi’nde median sternotomi ile elektif izole KABG uygulanan, vücut kitle indeksi ≥30 kg/m² olan 90 obez hasta retrospektif olarak analiz edildi. Hastalar uygulanan sternal kapama tekniğine göre iki gruba ayrıldı: 48 hasta FEW grubunda, 42 hasta ise FUSION grubunda yer aldı. Postoperatif iki ay içinde klinik takipler gerçekleştirildi; gerekli durumlarda klinik muayene, akciğer grafisi ve toraks BT ile sternal instabilite değerlendirildi. İstatistiksel analizlerde Mann-Whitney U testi, ki-kare testi, Fisher’s exact testi ve çok değişkenli lojistik regresyon kullanıldı. Bulgular: Gruplar arasında demografik ve perioperatif değişkenler benzerdi. Sternal instabilite, FEW grubundaki hastalarda (%10,4) FUSION grubuna kıyasla (%2,3) daha sık görüldü (p = 0,001). Çok değişkenli analizde; FEW tekniği (OR: 3,5; %95 GA: 2,4-5,3; p = 0,001), KOAH (OR: 3,5; %95 GA: 2,2-4,4; p = 0,05), diyabet (OR: 2,3; %95 GA: 1,3-4,1; p = 0,05), postoperatif delirium (OR: 3,2; %95 GA: 2,1-4,8; p = 0,01) ve kadın cinsiyet (OR: 2,4; %95 GA: 1,8-5,5; p = 0,02) sternal instabilite için bağımsız risk faktörleri olarak belirlendi. Sonuç: FÜZYON tekniği, obez hastalarda FEW tekniğine kıyasla sternal instabiliteyi anlamlı düzeyde azaltmıştır. Bu yöntem, yüksek riskli popülasyonlar için etkili bir koruyucu yaklaşım olabilir.

Keywords

• sternal kapama
• obezite
• koroner arter baypas greftleme
• sternal instabilite

Analysis of the outcomes of figure-of-eight and double-loop sternal-closure (FUSION) techniques

Abstract

Aim: To assess the benefit of a modified sternal closure (Figure-of-eight and double-loop sternal-closure, FUSION) versus conventional figure-of-eight wiring (FEW) technique in reducing sternal instability in obese patients undergoing coronary artery bypass grafting (CABG). Material and Methods: We retrospectively analyzed 90 obese (body mass index ≥30 kg/m²) patients who underwent elective isolated CABG under median sternotomy between January 2023 and January 2024 at the Ankara Bilkent City Hospital. Patients were divided into two groups based on the sternal closure technique employed: 48 patients in the FEW groups and 42 patients in the FUSION group. Clinical follow-ups were conducted for two months postoperatively, and sternal instability was assessed through clinical examination, chest X-rays, and thoracic CT scans when necessary. Results: Demographic and perioperative variables were similar among groups. Sternal instability occurred more frequently in patients in the FEW group (10.4%) than in those in the FUSION group (2.3%; p =0.001). Multivariate analysis showed that FEW technique (OR: 3.5; 95% CI: 2.4-5.3; p = 0.001), COPD (OR: 3.5; 95% CI: 2.2-4.4; p = 0.05), DM (OR: 2.3; 95% CI: 1.3-4.1; p = 0.05), postoperative delirium (3.2; 95% CI: 2.1-4.8; p = 0.01) and female gender (OR: 2.4; 95% CI: 1.8-5.5; p = 0.02) were all independent factors for sternal instability. Conclusion: The FUSION technique significantly reduced sternal instability in obese patients compared to the FEW techniques, indicating its potential as an effective preventive measure for high-risk populations.

Keywords

• sternal closure
• obesity
• coronary artery bypass grafting
• sternal instability

References

1. Reser D, Caliskan E, Tolboom H, Guidotti A, Maisano F. Median sternotomy. Multimed Man Cardiothorac Surg. 2015;2015.
2. Alhalawani AM, Towler MR. A review of sternal closure techniques. J Biomater Appl. 2013;28(4):483-97.
3. Nenna A, Nappi F, Dougal J, Satriano U, Chello C, Mastroianni C, et al. Sternal wound closure in the current era: the need of a tailored approach. Gen Thorac Cardiovasc Surg. 2019;67(11):907-16.
4. Balachandran S, Lee A, Denehy L, Lin KY, Royse A, Royse C, et al. Risk Factors for Sternal Complications After Cardiac Operations: A Systematic Review. Ann Thorac Surg. 2016;102(6):2109-17.
5. Borger MA, Rao V, Weisel RD, Ivanov J, Cohen G, Scully HE, et al. Deep sternal wound infection: risk factors and outcomes. Ann Thorac Surg. 1998;65(4):1050-6.
6. Kiessling A-H, Isgro F, Weisse U, Möltner A, Saggau W, Boldt J. Advanced Sternal Closure to Prevent Dehiscence in Obese Patients. The Annals of Thoracic Surgery. 2005;80(4):1537-9.
7. Saxena P, Konstantinov IE, Newman MA. Use of double wires in sternal closure: a useful technique. Tex Heart Inst J. 2006;33(4):540-1.
8. Shafi AMA, Abuelgasim E, Abuelgasim B, Iddawela S, Harky A. Sternal closure with single compared with double or figure of 8 wires in obese patients following cardiac surgery: A systematic review and meta-analysis. J Card Surg. 2021;36(3):1072-82.

9. Losanoff JE, Jones JW, Richman BW. Primary closure of median sternotomy: techniques and principles. Cardiovasc Surg. 2002;10(2):102-10.
10. Wilkinson GA, Clarke DB. Median sternotomy dehiscence: a modified wire suture closure technique. Eur J Cardiothorac Surg. 1988;2(4):287-90.
11. Jidéus L, Liss A, Ståhle E. Patients with sternal wound infection after cardiac surgery do not improve their quality of life. Scand Cardiovasc J. 2009;43(3):194-200.
12. Lafci G, Yasar E, Cicek OF, Irdem A, Uzun A, Yalcinkaya A. A novel modified Robicsek technique for sternal closure: "Double-check". Asian Cardiovasc Thorac Ann. 2014;22(6):758-60.
13. Molina JE, Lew RS, Hyland KJ. Postoperative sternal dehiscence in obese patients: incidence and prevention. Ann Thorac Surg. 2004;78(3):912-7; discussion -7.
14. Loladze G, Kuehnel RU, Claus T, Hartrumpf M, Kuepper F, Pohl M, et al. Double-Wire versus Single-Wire Sternal Closure in Obese Patients: a Randomized Prospective Study. Thorac Cardiovasc Surg. 2017;65(4):332-7.
15. Losanoff JE, Basson MD, Gruber SA, Huff H, Hsieh F-h. Single Wire Versus Double Wire Loops for Median Sternotomy Closure: Experimental Biomechanical Study Using a Human Cadaveric Model. The Annals of Thoracic Surgery. 2007;84(4):1288-93.