Modified Sternum-Closing Procedure with Titanium Cable and a Poly-Lactic Acid (PLA) Mesh Plate—For Improving QOL after Cardiac Surgery in Patient with Sternotomy

<p>Background: Unstable sternal fixation following sternotomy is one of the risk factors that affects postoperative outcomes in cardio-thoracic surgery and is associated with increased risk of infection, bleeding and delayed rehabilitation due to pain associated with sternal movement. Sternal plate systems, which help stabilize fixation, has been limited in use due to patients' comorbidities, such as diabetes mellitus (DM) and obesity. The conventional wire sternal-fixation procedure, which depend on years of physician' experience, raise concerns such as unstable sternal fixation due to uncompleted wire twisting. Therefore, a novel sternal-fixation procedure using both titanium cable and a PLA mesh plate was investigated as a potential improvement for sternal closure. We compared the ability of this new sternum fixation procedure (group N) against the conventional sternal fixation procedure using only a wire (group O) to achieve more stable postoperative sternal fixation. Methods and Results: Among adult open-heart surgeries performed between August 2020 and April 2023, 155 patients who underwent postoperative CT were included, with group N being the combined group and group O being the group using conventional metal wires: group N (86 patients: M 65, F 21) and group O (69 patients: M 50, F 19). Preoperative factors included age at surgery (group N: group O)=68.4±10.6 : 69.6±11.5 years (p=0.25)), BMI (group N: group O=23.0±3.7 : 24.1±7.7 (p=0.16)) and HbA1c (group N: group O=6.3±1.1 : 8.0±10.3% (p=0.10), and no factors were significantly different between the two groups. The CT analysis at the point of hospital discharge after surgery measured postoperative sternal deviation in the third rib position. Transverse displacement was significantly reduced (group N: group O=0.22±0.73: 0.83±1.08 mm (p=0.005)), and longitudinal displacement also showed an improvement but the difference was not statistically significant (group N: group O=0.53±0.86: 0.72±1.14 mm (p=0.13). Conclusion: A novel sternum closing technique using a tension-anchored titanium cable and a PLA mesh plate demonstrated improved postoperative sternal fixation in a controlled study with 155 patients. This new procedure also enables standardized stable sternal closure with a constant force without relying on conventional empirical sensation and without suppressing sternal cutting, thus contributing to the improvement of postoperative quality of life and prevention of complications.</p>