Reinforced sternal closures for prevention of sternal dehiscence in high risk patients

Background. Sternal dehiscence is still a frequent complication after cardi ac surgery procedures, performed through midline sternotomy. Its cumulative incidence has been reported to be around 2.5%, but several risk factors fo r increased incidence have also been identified. In past years several tech niques have been proposed to achieve reinforced sternal approximation, main ly considered for the treatment of sternal dehiscence, more than for its pr evention. The objective of this paper is the evaluation of the results, in terms of prevention of sternal dehiscence in highrisk patients, using reinf orced closure techniques compared to standard technique. Methods. Our study population included 212 patients who underwent cardiac s urgery procedure and presented at least one of the increased risk factor fo r sternal dehiscence. Fifty-six patients (26.4%) received a reinforced ster nal closure technique (RC group), 156 patients (73.6%) received a conventio nal sternal closure (CC group). Results. The cumulative incidence of sternal refixation, in this selected p opulation, was 5.6% with a statistically significant difference in favour o f the RC group. The results of this study clearly show that the appropriate utilisation and selection of one of the several techniques of reinforced s ternal closures can be effective in the reduction of sternal dehiscence in high risk patients. Conclusions. A reinforced technique should therefore be utilised in all pat ients undergoing cardiac surgery, presenting one or more risk factors for i ncreased incidence of sternal dehiscence.