Thorac Cardiovasc Surg 2018; 66(06): 517-522
DOI: 10.1055/s-0037-1607217
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Sternal Anomalies in Asymptomatic Patients after Median Sternotomy and Potential Influencing Factors

Hector Rodriguez Cetina Biefer
1  University Hospital Zurich, Division of Cardiovascular Surgery, Zurich, Switzerland
,
Simon H. Sündermann
2  Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
,
Hatem Alkadhi
3  Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
,
Michele Genoni
1  University Hospital Zurich, Division of Cardiovascular Surgery, Zurich, Switzerland
,
Francesco Maisano
1  University Hospital Zurich, Division of Cardiovascular Surgery, Zurich, Switzerland
,
Maximilian Y. Emmert
1  University Hospital Zurich, Division of Cardiovascular Surgery, Zurich, Switzerland
,
André Plass
1  University Hospital Zurich, Division of Cardiovascular Surgery, Zurich, Switzerland
› Author Affiliations
Further Information

Publication History

08 March 2017

29 August 2017

Publication Date:
07 October 2017 (online)

Abstract

Background We aimed to assess asymptomatic patients who had open-heart surgery with median sternotomy for potential sternal anomalies (SA), their related patient-specific risk factors, and treatment options for the prevention of SA.

Methods Multiplanar CT scans (CTs) from 131 asymptomatic consecutive patients were analyzed retrospectively. Of these, 83 underwent CABG (63.4%), and 48 had aortic valve (AV) procedures via median sternotomy. Sternal bone healing was analyzed for SA and their exact location.

Results In total, 49 SA were identified in 42 (32.1%) patients; 65% SA were found in the manubrium (n = 32). Five hundred thirty-two wires were implanted (4.2 ± 0.5 wires/patient), out of which 96.1% (n = 511) were figure 8 wires. There was no difference between normal and abnormal sterna with regard to the number of wires used for sternal closure (4.2 ± 0.5 vs. 4.3 ± 0.6, p = ns). The distance between wire placement to the proximal edge of the manubrium in normal and abnormal sterna was comparable (11.2 ± 4.2 vs. 10.9 ± 4.8 mm, p = ns). Patients who underwent CABG had a significantly higher risk for SA (OR = 2.4, p ≤ 0.05, 95% CI [1.2–4.9]). The use of BIMA (OR = 4.4, p ≤ 0.05, 95% CI [1.1–17.9]) and body mass index (BMI) > 31 kg/m2 (OR = 3.4, p ≤ 0.01, 95% CI [1.4–8.3]) significantly increased the risk of SA.

Conclusion At least 30% of patients were at an increased risk for SA after receiving a median sternotomy. CABG, use of BIMA, and a BMI > 30 kg/m2 were potential risk factors for the development of SA and warrant close clinical follow-up. Sternal plate fixation, particularly in the manubrium, could be beneficial in such patients.

Paper Presentation

This study was presented at the Oral Sessions of the Joint Annual Meeting of the Swiss Society of Cardiology, Swiss Society of Cardiac and Thoracic Vascular Surgery, and the Swiss Society of Pneumology, Lausanne, Switzerland from June 15 to 17, 2016.[30]