Our Summary

This research paper is a review of multiple studies that compare two methods for closing the sternum (breastbone) during heart surgery: the traditional wire cerclage (WC) method and the newer cable closure method. The researchers looked at four outcomes: deep infection in the wound, a condition where the wound reopens (sternal dehiscence), pain after the operation, and any infection in the wound.

The review found that patients who had their sternum closed with the cable closure method had significantly less chance of their wound reopening and experienced less pain after the operation compared to those with the WC method. However, there was no difference in deep wound infections between both methods.

The results suggest that the cable closure method could be a better option for closing the sternum during heart surgery. However, the authors point out that more high-quality studies are needed to confirm these findings, as there are still limited studies on this topic.

FAQs

  1. What are the two methods for closing the sternum during heart surgery discussed in the paper?
  2. What benefits does the cable closure method have over the traditional wire cerclage method according to the review?
  3. Are more studies needed to confirm the findings about the cable closure method for sternum closing during heart surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about sternotomy is to follow post-operative care instructions carefully to reduce the risk of complications such as wound infections or sternal dehiscence. Additionally, discussing with your surgeon the option of using the newer cable closure method for sternum closure during heart surgery may be beneficial based on current research findings.

Suitable For

Patients who are typically recommended sternotomy for heart surgery are those with conditions such as coronary artery disease, heart valve disease, heart failure, and congenital heart defects. These patients may require procedures such as coronary artery bypass surgery, valve repair or replacement, and heart transplant. Additionally, patients with aortic aneurysms, tumors in the heart, or certain types of arrhythmias may also undergo sternotomy for surgical treatment.

Timeline

Before sternotomy:

  • Patients undergo preoperative evaluations, including medical history, physical examination, and possibly imaging tests.
  • Patients may receive anesthesia before the procedure.
  • The surgeon marks the incision site on the chest.
  • The patient is positioned on the operating table and the surgical team prepares for the procedure.

During sternotomy:

  • The surgeon makes an incision in the chest, usually along the midline.
  • The breastbone (sternum) is divided using a surgical saw or other tools.
  • The chest cavity is opened, allowing access to the heart and other structures.
  • The necessary heart surgery, such as bypass surgery or valve repair, is performed.
  • The sternum is closed using either the wire cerclage (WC) method or the cable closure method.

After sternotomy:

  • The patient is transferred to the intensive care unit (ICU) for monitoring and recovery.
  • Pain management is provided to help with discomfort from the surgical incision.
  • Physical therapy may be initiated to help with breathing exercises and mobility.
  • The patient is monitored for any signs of complications, such as infection or sternal dehiscence.
  • Follow-up appointments are scheduled for postoperative care and rehabilitation.

Overall, the patient undergoes a series of preoperative preparations, the sternotomy procedure itself, and postoperative care to ensure a successful recovery from heart surgery.

What to Ask Your Doctor

  1. What are the potential risks and benefits of using the cable closure method for sternotomy compared to the traditional wire cerclage method?
  2. How does the cable closure method impact the likelihood of deep wound infections compared to the wire cerclage method?
  3. What is the recovery process like for patients who have undergone sternotomy with the cable closure method?
  4. Are there any specific factors or conditions that may make a patient a better candidate for the cable closure method over the wire cerclage method?
  5. How does the cable closure method affect long-term outcomes and complications compared to the wire cerclage method?
  6. Are there any additional precautions or considerations that need to be taken with the cable closure method post-surgery?
  7. What is the experience and expertise of the surgical team with using the cable closure method for sternotomy?
  8. Are there any alternative methods for closing the sternum during heart surgery that should be considered?
  9. How does the cost of using the cable closure method compare to the traditional wire cerclage method for sternotomy?
  10. Are there any ongoing research studies or clinical trials investigating the effectiveness of the cable closure method for sternotomy that I should be aware of?

Reference

Authors: Dixit A, Tam DY, Yu M, Yanagawa B, Gaudino M, Lam T, Fremes SE. Journal: Innovations (Phila). 2020 Jul/Aug;15(4):322-328. doi: 10.1177/1556984520938155. PMID: 32830573