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Dehiscence of the sternum is one of the mostserious complications following cardiac surgery. It occurs after0.2–5% of interventions with sternotomy access.The aim of the study was the evaluation of factors that mayinfluence the frequency of this complication.Material and methodsA retrospective review of 14,171 patientsundergoing median sternotomy for cardiac surgery between 1990and 2009 at the Cardiac Surgery Department of the PomeranianMedical University in Szczecin (Poland) was performed. Thestudied group consisted of 3,999 women (28.2%) and 10,172men (71.8%) aged 11–87 years (59.8 years on average). We analysedcases with sternal dehiscence (SD), which occurred in 298(2.1%) of the patients.ResultsThe significant risk factors were: male sex (p = 0.0003),age (p < 0.00006), body mass (p < 0.00007), and use of bothinternal thoracic arteries (p < 0.00001). The risk of SD was alsoincreased by coexisting diabetes and chronic obstructive lungdisease (p < 0.012 and p < 0.02 respectively); however, discriminantanalysis revealed that these variables were only linkedto age. Apart from CABG, the type of surgical intervention hadno influence on the frequency of SD. The total length of hospitalstay in patients with SD was more than two times longer thanin the rest of the patients (p < 0.00001). However, there wereno significant differences in postoperative mortality betweenthese two groups – 4.4% in the group with SD and 4.2% in thegroup without it.ConclusionsNot being able to eliminate the influence of riskfactors, since 2010 we decided to introduce changes in themethod of sternum closure by increasing the number of wireloops from 6 to at least 8. For patients heavier than 80 kg, weassumed a ratio of one additional loop per every 10 kg of bodymass, which should result in improved sternum stabilisationand reduce the risk of dehiscence.

pomeranian journal of life sciences

Powikłania w kardiochirurgii: rozejścia mostka po pośrodkowej sternotomii. Analiza wyników 14 171 operacji kardiochirurgicznych wykonanych w latach 1990–2009