Araştırma Makalesi
Sternal Komplikasyon Riski Yüksek Hastalarda İlk Sternotomi Kapamalarında Çelik Tel İle Sternal Kapatma Sistemlerinin Kombinasyonu: Termoreaktif Nitinol Klips Mi? Titanyum Sternal Kapatma Plağı Mı?
Öz
Bu çalışmada ilk sternotomilerin kapatılmasında kullanılan geleneksel çelik tel yöntemi, bu yöntem ile yüksek riskli hastalarda kombine edilen termoreaktif nitinol klips (TNK) veya titanyum sternal kapatma plağı (TSKP) kullanımı sonrası gelişebilecek sternal komplikasyon oranları gruplar arasında karşılaştırıldı. Mayıs 2018 – Ekim 2020 tarihleri arasında median sternotomi ile açık kalp cerrahisi uygulanan toplam 210 hasta (153 erkek, 57 kadın; ortalama yaş 62.87±10.21; dağılım 21-86 yıl) geriye dönük olarak incelendi. Hastalar sade çelik tel uygulanan (n=179), çelik tel ile TNK uygulanan (n=17) ve çelik tel ile TSKP uygulanan (n=14) olmak üzere üç gruba ayrıldı. Gruplar arasında demografik, klinik özelliklere ve postoperatif sternal komplikasyon oranları karşılaştırıldı. Sadece geleneksel çelik tel yöntemi ile sternotomisi kapatılan toplam 2 hastada (%1.1) sternal dehisens, toplam 2 hastada (%1.1) yüzeyel cilt enfeksiyonu gelişti. Çelik tel ile TSCP’nin kombine edildiği grupta ise 1 hastada (%7.1) yüzeyel cilt enfeksiyonu saptandı. TNK ve TSCP kullanılan gruplarda sternal dehisens izlenmedi. Her üç grup arasında sternal komplikasyonlar açısından istatistiksel bir fark saptanmadı. TNK ve TSKP kullanılan gruplarda diyabet oranı yüksek saptandı (p=0.002). Hastalar vücut kitle indekslerine (VKİ) göre dört gruba ayrıldı. Sadece geleneksel çelik tellemeye kıyasla TNK ve TSKP kullanılan hastalarda 35-39.9 ve >40 kg/m2 VKİ oranları anlamlı saptandı (p<0.001). TNK ve TSKP kullanımı üzerinde forward stepwise multinominal lojistik regresyon modeli oluşturularak kendi aralarında değerlendirldi. TNK için DM (OR=8.26), 30-34.9 kg/m2 VKİ (OR=14.28) anlamlı etkiye sahip bulundu. TSKP kullanımı üzerinde 30-34.9 (OR=41.66) ve 35-39.9 kg/m2 VKİ (OR=10.75) varlığı anlamlı etkiye sahip bulundu. TNK veya TSKP’nın özellikle sternal dehisens riski yüksek hastalarda ilk sternotomiyi kapatmakta geleneksel çelik tel ile kombine edilmesinin gelişebilecek sternal komplikasyonları azaltabileceği ve güvenle kullanılabileceği kanaatindeyizdir.
Anahtar Kelimeler
Destekleyen Kurum
yok
Proje Numarası
yok
Kaynakça
- 1. Kaul, P. Sternal reconstruction after post-sternotomy mediastinitis. J Cardiothorac Surg 2017; 12: 94.
- 2. Gummert JF, Barten MJ, Hans C, ve ark. Mediastinitis and cardiac surgery-an updated risk factor analysis in 10,373 consecutive adult patients. Thorac Cardiovasc Surg 2002; 50(2):87-91.
- 3. Casha AR, Yang L, Kay PH, ve ark. A biomechanical study of median sternotomy closure techniques, Eur J Cardiothorac Surg 1999; 15:365-9.
- 4. Hosseinrezaei H, Rafiei H, Amiri M. Incidence and risk factors of sternal wound infection at site of incision after open-heart surgery. J Wound Care. 2012;21:408–11.
- 5. Schimmer C, Reents W, Berneder S, ve ark. Prevention of sternal dehiscence and infection in high-risk patients: a prospective randomized multicenter trial. Ann Thorac Surg. 2008;86:1897–904.
- 6. Cohen DJ, Griffin LV. A biomechanical comparison of three sternotomy closure techniques. Ann Thorac Surg 2002;73:563-8.
- 7. Orhan SN, Özyazıcıoğlu MH, Çolak A. Experimental comparison of efficiency of four different sternum closure techniques. Turk Gogus Kalp Dama. 2017;25(4):535-42.
- 8. Robicsek F, Fokin A, Cook J, ve ark. Sternal instability after midline sternotomy. Thorac Cardiovasc Surg 2000;48:1–8.
- 9. Alhalawani AM, Towler MR. A review of sternal closure techniques. J Biomater Appl. 2013;28(4):483-97.
- 10. El Oakley RM, Wright JE. Postoperative mediastinitis: classification and management. Ann Thorac Surg. 1996;61(3):1030-6.
- 11. Hollenbeak CS, Murphy DM, Koenig S, ve ark. The clinical and economic impact of deep chest surgical site infections following coronary artery bypass graft surgery. Chest. 2000;118(2):397-402.
- 12. Molina JE, Lew RS, Hyland KJ. Postoperative sternal dehiscence in obese patients: incidence and prevention. Ann Thorac Surg. 2004;78(3):912-7.
- 13. Kiessling AH, Isgro F, Weisse U, ve ark. Advanced sternal closure to prevent dehiscence in obese patients. Ann Thorac Surg. 2005;80(4):1537-9.
- 14. Dell’Amore A, Congiu S, Campisi A, ve ark. Sternal reconstruction after post-sternotomy dehiscense and mediastinitis. Indian J Thorac Cardiovasc Surg. 2020;36:388-96.
- 15. Björntorp P. International Textbook of Obesity. John Wiley & Sons: Chichester, 2001.
- 16. Marasco SF, Fuller L, Zimmet A, ve ark. Prospective, randomized controlled trial of polymer cable ties versus standard wire closure of midline sternotomy. J Thorac Cardiovasc Surg. 2018;156:1589–95.
- 17. Peigh G, Kumar J, Unai S, ve ark. Randomized trial of sternal closure for low risk patients: rigid fixation versus wire closure. Heart Surg Forum. 2017;20:E164–9.
- 18. Tam DY, Nedadur R, Yu M, ve ark. Rigid plate fixation versus wire cerclage for sternotomy after cardiac surgery: a meta analysis. Ann Thorac Surg. 2018;106:298–304.
- 19. Losanoff JE, Jones JW, Richman BW. Primary closure of median sternotomy: techniques and principles. Cardiovasc Surg. 2002;10(2):102-10.
- 20. Fawzy H, Alhodaib N, Mazer CD, ve ark. Sternal plating for primary and secondary sternal closure; can it improve sternal stability? J Cardiothorac Surg. 2009;4:19.
- 21. Liao JM, Chan P, Cornwell L, ve ark. Feasibility of primary sternal plating for morbidly obese patients after cardiac surgery. J Cardiothorac Surg. 2019;14(1):25.
- 22. Kilian E, Mair H, Reichart B, ve ark. Sternal closure after median sternotomy: a new technique using titanium hooks and wires applied parasternally. Interact CardioVasc Thorac Surg 2013;16:721–4.
- 23. Nikolaidis N, Karangelis D, Mattam K, ve ark. The use of Nitinol clips for primary sternal closure in cardiac surgery. Ann Thorac Cardiovasc Surg. 2013;19:330-4.
- 24. Bejko J, Bottio T, Tarzia V, ve ark. Nitinol flexigrip sternal closure system and standard sternal steel wiring: insight from a matched comparative analysis. Cardiovasc Med 2015;16:134-8.
- 25. Tulugan CI, Spindel SM, Bansal AD, ve ark. Does elective sternal plating in morbidly obese patients reduce sternal complication rates? Ann Thorac Surg 2020;110:1898-903.
- 26. Allen KB, Icke KJ, Thourani VH, ve ark. Sternotomy closure using rigit plate fixation: a paradigm shift from wire cerclage. Ann Cardiothorac Surg 2018;7(5):611-20.
Sternal Steel Wire Combined with Sternal Closure Systems for The First Sternotomy Closures in Patients with High Risk for Sternal Complications; Thermoractive Nitinol Clips or Titanium Sternal Closure Plate?
Öz
In this study, we aimed to compare the sternal complication rates of traditional steel wire closure, steel wire combined with thermoreactive nitinol clips (TRC) or steel wire combined with titanium sternal closure plate (TSCP) methods used in first sternotomy closures in high risk patients. 210 patients (153 males, 57 females, mean age 62.87±10.21, distribution 21-86 years) that underwent open heart surgery via median sternotomy between May 2018-October 2020 were studied retrospectively. The patients were divided into three groups according to the methods used for sternal closure as; steel wire only (n=179), steel wire combined with TRC (n=17) and steel wire combined with TSCP (n=14). The groups were compared in terms of demographic changes, clinical specifications, and sternal complication rates. Sternal dehiscence was evaluated in 2 patients (1.1%) whose sternums were closed with only steel wire, and among all the patients included in the study, superficial wound infection was seen in these 2 patients (1.1%). Superficial wound infection was seen in 1 patient (7.1%) in the group where TSCP combined steel wire was used. No sternal dehiscence was seen in patient groups in which TSCP and TRC were used. There was no statistical significance observed regarding sternal complications among three group. DM ratio was higher among the TRC and TSCP groups (p=0.002). The patients were divided into four groups according to their body mass indexes (BMI). The BMI rates of 35-39.9 and> 40 kg/m2 were found to be significant in the patients for whom TRC and TSCP used (p <0.001) in comparison with the BMI rates of the patients to whom conventional steel wiring was applied. A forward stepwise multinomial logistic regression model was created to evaluate the use of TRC and TSCP. DM (OR=8.26) and 30-34.9 kg/m2 BMI (OR=14.28) were found significantly effective for TRC. 30-34.9 kg/m2 and 35-39.9 kg/m2 BMI (OR=10.75) were found significantly effective for TSCP. We believe that using reinforced stell wire with TSCP and TRC for closure of first sternotomies was safe and could prevent further possible sternal complications among the patients that have high risks of sternal dehiscence.
Anahtar Kelimeler
Proje Numarası
yok
Kaynakça
- 1. Kaul, P. Sternal reconstruction after post-sternotomy mediastinitis. J Cardiothorac Surg 2017; 12: 94.
- 2. Gummert JF, Barten MJ, Hans C, ve ark. Mediastinitis and cardiac surgery-an updated risk factor analysis in 10,373 consecutive adult patients. Thorac Cardiovasc Surg 2002; 50(2):87-91.
- 3. Casha AR, Yang L, Kay PH, ve ark. A biomechanical study of median sternotomy closure techniques, Eur J Cardiothorac Surg 1999; 15:365-9.
- 4. Hosseinrezaei H, Rafiei H, Amiri M. Incidence and risk factors of sternal wound infection at site of incision after open-heart surgery. J Wound Care. 2012;21:408–11.
- 5. Schimmer C, Reents W, Berneder S, ve ark. Prevention of sternal dehiscence and infection in high-risk patients: a prospective randomized multicenter trial. Ann Thorac Surg. 2008;86:1897–904.
- 6. Cohen DJ, Griffin LV. A biomechanical comparison of three sternotomy closure techniques. Ann Thorac Surg 2002;73:563-8.
- 7. Orhan SN, Özyazıcıoğlu MH, Çolak A. Experimental comparison of efficiency of four different sternum closure techniques. Turk Gogus Kalp Dama. 2017;25(4):535-42.
- 8. Robicsek F, Fokin A, Cook J, ve ark. Sternal instability after midline sternotomy. Thorac Cardiovasc Surg 2000;48:1–8.
- 9. Alhalawani AM, Towler MR. A review of sternal closure techniques. J Biomater Appl. 2013;28(4):483-97.
- 10. El Oakley RM, Wright JE. Postoperative mediastinitis: classification and management. Ann Thorac Surg. 1996;61(3):1030-6.
- 11. Hollenbeak CS, Murphy DM, Koenig S, ve ark. The clinical and economic impact of deep chest surgical site infections following coronary artery bypass graft surgery. Chest. 2000;118(2):397-402.
- 12. Molina JE, Lew RS, Hyland KJ. Postoperative sternal dehiscence in obese patients: incidence and prevention. Ann Thorac Surg. 2004;78(3):912-7.
- 13. Kiessling AH, Isgro F, Weisse U, ve ark. Advanced sternal closure to prevent dehiscence in obese patients. Ann Thorac Surg. 2005;80(4):1537-9.
- 14. Dell’Amore A, Congiu S, Campisi A, ve ark. Sternal reconstruction after post-sternotomy dehiscense and mediastinitis. Indian J Thorac Cardiovasc Surg. 2020;36:388-96.
- 15. Björntorp P. International Textbook of Obesity. John Wiley & Sons: Chichester, 2001.
- 16. Marasco SF, Fuller L, Zimmet A, ve ark. Prospective, randomized controlled trial of polymer cable ties versus standard wire closure of midline sternotomy. J Thorac Cardiovasc Surg. 2018;156:1589–95.
- 17. Peigh G, Kumar J, Unai S, ve ark. Randomized trial of sternal closure for low risk patients: rigid fixation versus wire closure. Heart Surg Forum. 2017;20:E164–9.
- 18. Tam DY, Nedadur R, Yu M, ve ark. Rigid plate fixation versus wire cerclage for sternotomy after cardiac surgery: a meta analysis. Ann Thorac Surg. 2018;106:298–304.
- 19. Losanoff JE, Jones JW, Richman BW. Primary closure of median sternotomy: techniques and principles. Cardiovasc Surg. 2002;10(2):102-10.
- 20. Fawzy H, Alhodaib N, Mazer CD, ve ark. Sternal plating for primary and secondary sternal closure; can it improve sternal stability? J Cardiothorac Surg. 2009;4:19.
- 21. Liao JM, Chan P, Cornwell L, ve ark. Feasibility of primary sternal plating for morbidly obese patients after cardiac surgery. J Cardiothorac Surg. 2019;14(1):25.
- 22. Kilian E, Mair H, Reichart B, ve ark. Sternal closure after median sternotomy: a new technique using titanium hooks and wires applied parasternally. Interact CardioVasc Thorac Surg 2013;16:721–4.
- 23. Nikolaidis N, Karangelis D, Mattam K, ve ark. The use of Nitinol clips for primary sternal closure in cardiac surgery. Ann Thorac Cardiovasc Surg. 2013;19:330-4.
- 24. Bejko J, Bottio T, Tarzia V, ve ark. Nitinol flexigrip sternal closure system and standard sternal steel wiring: insight from a matched comparative analysis. Cardiovasc Med 2015;16:134-8.
- 25. Tulugan CI, Spindel SM, Bansal AD, ve ark. Does elective sternal plating in morbidly obese patients reduce sternal complication rates? Ann Thorac Surg 2020;110:1898-903.
- 26. Allen KB, Icke KJ, Thourani VH, ve ark. Sternotomy closure using rigit plate fixation: a paradigm shift from wire cerclage. Ann Cardiothorac Surg 2018;7(5):611-20.
Toplam 26 adet kaynakça vardır.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Cerrahi |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Proje Numarası | yok |
| Yayımlanma Tarihi | 24 Ağustos 2022 |
| Gönderilme Tarihi | 10 Ocak 2021 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 9 Sayı: 2 |
