IMPROVED STERNAL CLOSURE USING STEEL BANDS - EARLY EXPERIENCE WITH 3-YEAR FOLLOW-UP

Background. Use of stainless steel wires in median sternotomy closure is at times associated with serious complications. In view of this, th e efficacy and safety of a stainless steel band designed for fixation and approximation of the sternum in cardiothoracic procedures was eval uated in a prospective, randomized study. Methods. Forty-eight patient s undergoing open heart operations that involved a median sternotomy w ere studied. Group I (n = 21) was closed with four to six steel bands, and group II (n = 27) with six to eight standard stainless steel wire s. The average age of the patients and the risk factors predisposing t o dehiscence were similar in both groups. Results. One postoperative d eath occurred in each group due to cardiac failure. In group I, the me an length of the postoperative hospital stay was 10.2 +/- 1.76 days (/-2 standard errors), whereas in group II the mean was 13.9 +/- 3.4 da ys (+/-2 standard errors). Banded patients complained less of postoper ative pain, although statistical significance was not achieved. No pro blems arose in either group during the 3-year fellow-up. Conclusions. The steel bands, compared with wires, provided not only effective fixa tion, but a reduction in both postoperative pain and postoperative hos pital stay. The band is now being studied in a larger group of patient s to evaluate the incidence and type of complications associated with its use, as well as length of postoperative hospital stay.