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Sternal reconstruction after post-sternotomy dehiscence and mediastinitis

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Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Purpose

Post-sternotomy dehiscence and mediastinitis remains a serious complication in cardiothoracic surgery. The aim of this work is to report our experience over a period of 8 years in the surgical treatment and risk factor analyses of post-sternotomy dehiscence and mediastinitis.

Methods

All patients treated for post-sternotomy dehiscence at our Thoracic Surgery Unit in the last 8 years were retrospectively collected. We identified 237 patients with post-sternotomy dehiscence/mediastinitis. Forty-two patients had simple fractures of the metal steel wires, 61 had an asymmetric sternotomy with multiple sternal fractures, 113 had a symmetric sternotomy with multiple sternal fractures, 14 had a failed Robicsek procedure, and 7 had sternal dehiscence with mediastinal abscess.

Results

Different surgical techniques and materials were used to repair the sternum. In 21 patients, the first revision failed and a second reoperation was required. At multivariate analyses, we have identified risk factors for revision failure and in-hospital mortality. Mortality rate was significantly higher in patients who underwent more than one surgical revision (8% vs 19%, p < 0.001).

Conclusions

Patients with sternal dehiscence are very fragile due to multiple preoperative comorbidities as reflected by postoperative morbidity and risk factors for in-hospital mortality. A correct evaluation of the characteristics of sternal dehiscence is important to guide the most appropriate repair strategy. Patients who need repeated sternal revisions had a higher mortality. Further randomized studies are needed to evaluate different techniques and medical devices to define the gold standard procedure to reduce significantly sternal wound complications in high-risk patients as defined by well-known risk factors.

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Funding

We declare no external financial support.

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Authors and Affiliations

  1. Department of Cardio-Thoracic Surgery, S. Orsola Malpighi University Hospital, Via Massarenti 9, Bologna, BO, Italy

    Andrea Dell’Amore, Stefano Congiu, Alessio Campisi, Sara Mazzarra, Silvia Zanoni & Domenica Giunta

Authors
  1. Andrea Dell’Amore
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  2. Stefano Congiu
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  3. Alessio Campisi
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  4. Sara Mazzarra
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  5. Silvia Zanoni
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  6. Domenica Giunta
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Contributions

Conception and design: ADA and DG

Administrative support: SZ and SM

Provision of study materials: SC and AC

Collection and assembly of data: SM, SC, and SZ

Data analysis and interpretation: ADA and DG

Manuscript writing: all Authors

Final approval of the manuscript: all authors

Corresponding author

Correspondence to Andrea Dell’Amore.

Ethics declarations

This retrospective multicenter study was approved by the Institutional Review Board of S. Orsola Malpighi University Hospital in Bologna, and the study has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Dell’Amore, A., Congiu, S., Campisi, A. et al. Sternal reconstruction after post-sternotomy dehiscence and mediastinitis. Indian J Thorac Cardiovasc Surg 36, 388–396 (2020). https://doi.org/10.1007/s12055-019-00880-5

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  • DOI: https://doi.org/10.1007/s12055-019-00880-5

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