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

Öz

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.

Anahtar Kelimeler

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

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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