Improved sternal closure using steel bands: early experience with three-year follow-up.

Abstract

Use of stainless steel wires in median sternotomy closure is at times associated with serious complications. In view of this, the efficacy and safety of a stainless steel band designed for fixation and approximation of the sternum in cardiothoracic procedures was evaluated in a prospective, randomized study. Forty-eight patients undergoing open heart operations that involved a median sternotomy were studied. Group I (n = 21) was closed with four to six steel bands, and group II (n = 27) with six to eight standard stainless steel wires. The average age of the patients and the risk factors predisposing to dehiscence were similar in both groups. One postoperative death occurred in each group due to cardiac failure. In group I, the mean length of the postoperative hospital stay was 10.2 +/- 1.76 days (+/- 2 standard errors), whereas in group II the mean was 13.9 +/- 3.4 days (+/- 2 standard errors). Banded patients complained less of postoperative pain, although statistical significance was not achieved. No problems arose in either group during the 3-year follow-up. The steel bands, compared with wires, provided not only effective fixation, but a reduction in both postoperative pain and postoperative hospital stay. The band is now being studied in a larger group of patients to evaluate the incidence and type of complications associated with its use, as well as length of postoperative hospital stay.