Comparison of three different sternal closure techniques after cardiac surgery in elderly patients

Öz

Aim: To identify the effectivity of stainless steel wires (SSW), Robicsek technique (RT) and thermoreactive nitinol clips (TNC) for sternal closure in elderly patients.

Methods: We conducted a prospective randomized study to compare SSW, RT and TNC in the sternal closure between January 2015 and January 2017. Patients over 60 years old who required sternal closure following cardiac surgery were enrolled into the study. Preoperative characteristics, operative parameters and EuroSCORE were recorded for each patient. In postoperative period, duration of intensive care unit stay and hospitalization, complications and mortality rates were analyzed. All patients evaluated according to the Visual analogue scale score (VAS) on 1st, 3rd and 5th day after the operation.

Results: 96 patients (32 patients with SSW, 32 patients with RT and 32 patients with TNC) required sternal closure. Patients in which sternal closure was performed with TNC, achieved significantly shorter hospitalization period (p=0.014) and no any dehiscence (p= 0.014). We achieved significantly better VAS scores in patients with TNC (p<0.001, p<0.001 and p<0.001, respectively). In multivariate regression analysis, superficial sternal wound infection (SSWI) and DSWI were the only predictive factors for sternal dehiscence (p=0.029 and p=0.015, respectively).

Conclusion: Our study showed that using TNC decreased the hospitalization duration, DSWI, sternal dehiscence development and postoperative pain intensity. SSWI and DSWI were found to be the only predictive factors for sternal dehiscence in multivariate regression analysis.

Anahtar Kelimeler

• Nitinol clips,Sternotomy,Sternal closure,Stainless steel wires,Robicsek technique

Yaşlı hastalarda kardiyak cerrahisi sonrası üç farklı sternum kapatma tekniğinin karşılaştırılması

Öz

Amaç: Yaşlı hastalarda sternal kapanma için paslanmaz çelik tellerin (PÇT), Robicsek tekniğinin (RT) ve termoreaktif nitinol klipslerinin (TNK) etkinliğini saptamak.

Yöntemler: Ocak 2015 ile Ocak 2017 yılları arasındaki sternal kapamada PÇT, RT ve TNK'yi karşılaştırmak için prospektif randomize çalışma yaptık. Ameliyat öncesi veriler, operasyon parametreleri ve EuroSCORE değerleri her hasta için kaydedildi. Ameliyat sonrası dönemde yoğun bakım ünitesinde kalış süresi, hastanede yatış günü, komplikasyonlar ve mortalite oranları analiz edildi. Tüm hastalara operasyondan 1., 3. ve 5. günden sonra vizuel analog skala (VAS) ile skorlama yapıldı.

Bulgular: Çalışma protokolü sırasında 96 hastaya (PÇT'li 32 hasta, RT'li 32 hasta ve TNK'li 32 hasta) sternal kapama uygulandı. TNK ile sternal kapatma yapılan hastalarda hastanede yatış süresi önemli ölçüde kısaydı (p=0.014). Sternum ayrılması PÇT uygulanan hastalardan altısında, RT uygulanan hastaların dördünde gelişirken, TNK ile sternal kapama yapılan hastalarda açılma gelişmedi (p=0.014). TNK'li hastalarda anlamlı olarak daha iyi VAS skorları elde edildi (sırasıyla p<0.001, p<0.001 ve p<0.001). Çok değişkenli regresyon analizinde derin sternal yara enfeksiyonu (DSYE) ve yüzeyel sternal yara enfeksiyonu (YSYE)  sternal dehisens için tek prediktif faktör olarak saptandı  (sırasıyla p=0.029 ve p=0.015).

Sonuç: Çalışmamız TNK'nin sternal kapanış sonrasında hastaneye yatma süresi, DSYE, sternal ayrılma gelişimi ve postoperatif ağrı stresini azalttığını göstermiştir. Çok değişkenli regresyon analizinde YSYE ve DSYE sternal ayrılma için tek prediktif faktör olarak bulunmuştur.

Anahtar Kelimeler

• Sternotomi,Sternal kapatma,Paslanmaz çelik tel,Nitinol klipsler,Robicsek tekniği

Kaynakça

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