Thorac Cardiovasc Surg 2017; 65(04): 332-337
DOI: 10.1055/s-0036-1582257
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Double-Wire versus Single-Wire Sternal Closure in Obese Patients: a Randomized Prospective Study

Giorgi Loladze
1  Department of Cardiovascular Surgery, Heart Center Brandenburg, Bernau, Germany
,
Ralf Uwe Kuehnel
1  Department of Cardiovascular Surgery, Heart Center Brandenburg, Bernau, Germany
,
Thomas Claus
1  Department of Cardiovascular Surgery, Heart Center Brandenburg, Bernau, Germany
,
Martin Hartrumpf
1  Department of Cardiovascular Surgery, Heart Center Brandenburg, Bernau, Germany
,
Frank Kuepper
1  Department of Cardiovascular Surgery, Heart Center Brandenburg, Bernau, Germany
,
Manfred Pohl
2  Institute of Medical Physics and Biophysics, University Hospital Charité, Berlin, Germany
,
Johannes Maximilian Albes
1  Department of Cardiovascular Surgery, Heart Center Brandenburg, Bernau, Germany
› Author Affiliations
Further Information

Publication History

27 November 2015

02 January 2016

Publication Date:
18 April 2016 (online)

Abstract

Background Sternal instability after coronary artery bypass grafting (CABG) is a serious complication. Obese patients are at high risk for sternal instability after CABG. This study was conducted to assess the positive impact of double-wire sternal closure on sternal instability.

Methods A total of 200 obese patients with a body mass index ≥ 30 kg/m2 undergoing isolated CABG with left internal mammary artery (LIMA) graft were randomly assigned to sternal closure either by eight single wires (n = 100) or by a combination of four double wires and four single wires.

Results There was a total of 21 cases with sternal instability: 5 cases (i.e., 5%) in the double-wire group versus 16 cases (16%) in the single-wire group (p = 0.019). Logistic regression analysis showed sternal closure via double wires as an independent protection factor (odds ratio [OR]: 0.276; p = 0.029). Smoking (OR: 5.5; p = 0.006) and postoperative delirium (OR: 3.5; p = 0.033) turned out to be independent risk factors for the development of sternal instability.

Conclusion Double-wire sternal closure significantly reduces postoperative sternal instability in obese patients undergoing isolated CABG with LIMA graft.