Mechanical Complications - Sternum Instability After Open Heart Surgery


The sternum is a bone that moves with every breath. During open heart surgery it was cut in half - and is now an open fracture. How do you stabilise it ?


Title: A Randomized Trial to Assess the Contribution of a Novel Thorax Support Vest (Corset) in Preventing Mechanical Complications of Median Sternotomy

Authors: Philippe P Caimmi, Maurizio Sabbatini, Emmanouil I Kapetanakis, Silvia Cantone, Marcus V Ferraz, Mario Cannas, Ugo F Tesler

Affiliations:

  1. Department of Cardiac Surgery, University Hospital of Novara "Maggiore della Carità", Novara, Italy.
  2. Department of Science Health, UPO University, Novara, Italy.
  3. "Policlinico di Monza" Hospital Group, Department Cardiac Surgery, San Gaudenzio Clinic, Novara, Italy.
  4. Department of Science and Innovation Technology, UPO University, Alessandria, Italy.
  5. Department of Thoracic Surgery, "Sotiria" Chest Diseases Hospital of Athens, Athens, Greece.
  6. "Policlinico di Monza" Health Care Group, Department Cardiac Anaesthesiology, San Gaudenzio Clinic, Novara, Italy.
  7. Department of Cardiac Surgery, Beneficencia Portouguesa Hospital, Piracicaba, Brazil.

PMID: 27995554 PMCID: PMC5446811 DOI: 10.1007/s40119-016-0078-y

Abstract: The study aims to assess the role of the Posthorax support vest in preventing mechanical complications of median sternotomy and improving anatomical healing in patients at high risk for sternal dehiscence after cardiac surgery.

Methods: A prospective, randomized study was conducted, involving 310 patients with predisposing factors for sternal dehiscence after sternotomy. The patients were divided into two groups: those who received the Posthorax support vest after surgery, and those who did not. The primary variables assessed included the incidence of mechanical sternal complications, quality of sternal healing, rate of re-operation, duration of hospitalization, rate and duration of hospital re-admission for sternal complications. Secondary variables assessed were post-operative pain, number of requests for supplemental analgesia, and quality of life measured using the EQ-5D format.

Results: Patients who used the Posthorax vest demonstrated a lower incidence of mechanical sternal complications, better anatomical sternum healing, shorter hospital stay, no re-operations for sternal dehiscence before discharge, and lower re-admissions for mechanical sternal complications. Additionally, patients using the vest reported a better quality of life with fewer limitations in mobility, self-care, and pain.

Conclusions: The findings of the study suggest that the use of the Posthorax vest can reduce post-sternotomy mechanical complications, improve sternotomy healing, clinical course, and post-operative quality of life.

Keywords: Dehiscence, Postoperative care, Quality of life, Sternum, Surgery complications, Wound healing.