Download PDF
Thorac Cardiovasc Surg 2024; 72(01): 077-083
DOI: 10.1055/s-0043-1768967
Original Thoracic

Sternal Pin Used to Close Sternum in Infants after Cardiac Surgery

Wen-Peng Xie
1   Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
,
Xiu-Hua Chen
1   Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
,
Si-Jia Zhou
1   Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
,
Qiang Chen 
1   Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
,
Hua Cao
1   Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
› Author Affiliations
› Further Information
    Permissions and Reprints All articles of this category

Abstract

Objective A retrospective study was conducted to explore the efficacy of bioabsorbable poly-L-lactic acid sternal pins in sternal closure in infants after cardiac surgery.

Methods A total of 170 infantile patients who underwent cardiac surgery were divided into the steel wire group (group A), the PDS cord group (group B), and the steel wire + sternal pin group (group C). The occurrence of the thoracic deformity was evaluated by vertebral index (VI), frontosagittal index (FSI), and Haller index (HI) values; the stability of the sternum was evaluated by detecting sternal dehiscence and displacement.

Results By comparing the absolute values of the differences in VI, FSI, and HI in the three groups, it was found that the difference values of VI and HI in group C were significantly lower than those in group B (p = 0.028 and 0.005). For the highest deformation index, the deformation rate of infants in group C before discharge and during the 1-year follow-up was lower than that in group A and group B (p = 0.009 and 0.002, respectively). The incidence of sternal displacement in group C was also significantly lower than that in groups A and B (p = 0.009 and 0.009). During the 1-year follow-up, there was no sternal dehiscence, and the sternum healed completely in the three groups.

Conclusion The use of “steel wire + sternal pin” for sternal closure in infants after cardiac surgery can reduce the occurrence of sternal deformity, reduce anterior and posterior displacement of the sternum, and improve sternal stability.

Keywords

congenital heart disease - outcomes - sternum - surgery/incisions - surgical equipment

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.


Authors' Contribution

W.-P.X. and H.C. designed the study, performed the statistical analysis, participated in the operation, and drafted the manuscript. X.-H.C, S.-J.Z. and Q.C. collected the clinical data. All authors read and approved the final manuscript.




Publication History

Received: 21 November 2022

Accepted: 11 April 2023

Article published online:
25 May 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Julian OC, Lopez-Belio M, Dye WS, Javid H, Grove WJ. The median sternal incision in intracardiac surgery with extracorporeal circulation; a general evaluation of its use in heart surgery. Surgery 1957; 42 (04) 753-761
    PubMedGoogle Scholar
  • 2 Sirivella S, Zikria EA, Ford WB, Samadani SR, Miller WH, Sullivan ME. Improved technique for closure of median sternotomy incision. Mersilene tapes versus standard wire closure. J Thorac Cardiovasc Surg 1987; 94 (04) 591-595
    CrossrefPubMedGoogle Scholar
  • 3 Dalton ML, Connally SR, Sealy WC. Julian's reintroduction of Milton's operation. Ann Thorac Surg 1992; 53 (03) 532-533
    CrossrefPubMedGoogle Scholar
  • 4 Fan C, Tang M, Wu S, Yuan S, Borovjagin AV, Yang J. Reabsorbable pins can reinforce an early sternal stability after median sternotomy in young children with congenital heart disease. Pediatr Cardiol 2019; 40 (08) 1728-1734
    CrossrefPubMedGoogle Scholar
  • 5 Subramaniam T, Keita L, Veerasingam D. Sternal Talon, a novel repair for sternal dehiscence. Kardiochir Torakochirurgia Pol 2015; 12 (02) 153-154
    PubMedGoogle Scholar
  • 6 Hu CX, Tan J, Chen S, Ding H, Xu ZW. Comparison of clinical outcomes and postoperative recovery between two open heart surgeries: minimally invasive right subaxillary vertical thoracomy and traditional median sternotomy. Asian Pac J Trop Med 2014; 7 (08) 625-629
    CrossrefPubMedGoogle Scholar
  • 7 Shih CC, Shih CM, Su YY, Lin SJ. Potential risk of sternal wires. Eur J Cardiothorac Surg 2004; 25 (05) 812-818
    CrossrefPubMedGoogle Scholar
  • 8 Ozaki W, Buchman SR, Iannettoni MD, Frankenburg EP. Biomechanical study of sternal closure using rigid fixation techniques in human cadavers. Ann Thorac Surg 1998; 65 (06) 1660-1665
    CrossrefPubMedGoogle Scholar
  • 9 Koshiyama H, Yamazaki K. Absorbable sternal pins improve sternal closure stability within a small deviation. Gen Thorac Cardiovasc Surg 2015; 63 (06) 331-334
    CrossrefPubMedGoogle Scholar
  • 10 Cohen DJ, Griffin LV. A biomechanical comparison of three sternotomy closure techniques. Ann Thorac Surg 2002; 73 (02) 563-568
    CrossrefPubMedGoogle Scholar
  • 11 Saito T, Iguchi A, Sakurai M, Tabayashi K. Biomechanical study of a poly-L-lactide (PLLA) sternal pin in sternal closure after cardiothoracic surgery. Ann Thorac Surg 2004; 77 (02) 684-687
    CrossrefPubMedGoogle Scholar
  • 12 Tanaka T, Okawa Y, Ishida N, Toyama M, Hashimoto M, Matsumoto K. Clinical studies of bioabsorbable poly-L-lactide sternal coaptation pins. J Cardiovasc Surg (Torino) 2001; 42 (06) 749-751
    PubMedGoogle Scholar
  • 13 Hamaji M, Sakaguchi Y, Matsuda M, Kono S. Reinforced closure of the sternum with absorbable pins for high-risk patients. Interact Cardiovasc Thorac Surg 2009; 9 (04) 559-561
    CrossrefPubMedGoogle Scholar
  • 14 Fu XM, Oshima H, Araki Y. et al. A comparative study of two types of sternal pins used for sternal closure: poly-L-lactide sternal pins versus uncalcined hydroxyapatite poly-L-lactide sternal pins. J Artif Organs 2013; 16 (04) 458-463
    CrossrefPubMedGoogle Scholar
  • 15 Fowler Jr VG, O'Brien SM, Muhlbaier LH, Corey GR, Ferguson TB, Peterson ED. Clinical predictors of major infections after cardiac surgery. Circulation 2005; 112 (9, Suppl): I358-I365
    PubMedGoogle Scholar
  • 16 Kilda A, Basevicius A, Barauskas V, Lukosevicius S, Ragaisis D. Radiological assessment of children with pectus excavatum. Indian J Pediatr 2007; 74 (02) 143-147
    CrossrefPubMedGoogle Scholar
  • 17 Ohno K, Morotomi Y, Nakahira M. et al. Indications for surgical repair of funnel chest based on indices of chest wall deformity and psychological state. Surg Today 2003; 33 (09) 662-665
    CrossrefPubMedGoogle Scholar
  • 18 Safa N, Wei S, Saran N, Guadagno E, Laberge JM, Emil S. Musculoskeletal deformities after thoracic surgery in children: an observational long-term follow-up study. J Pediatr Surg 2021; 56 (01) 136-141
    CrossrefPubMedGoogle Scholar
  • 19 Oiwa H, Ishida R, Sudo K. Sternal closure with reabsorbable pin and cord in pediatric-less invasive cardiac surgery. Ann Thorac Surg 2004; 78 (01) 358-359
    CrossrefPubMedGoogle Scholar
  • 20 Nørgaard MA, Andersen TC, Lavrsen MJ, Borgeskov S. The outcome of sternal wire removal on persistent anterior chest wall pain after median sternotomy. Eur J Cardiothorac Surg 2006; 29 (06) 920-924
    CrossrefPubMedGoogle Scholar
  • 21 Kawashima M, Sano A, Tanaka M. Sternal closure with absorbable pins and cords in general thoracic surgery. Surg Today 2015; 45 (07) 929-931
    CrossrefPubMedGoogle Scholar
  • 22 Shuhaiber H, Chugh T, Burns G. In vitro adherence of bacteria to sutures in cardiac surgery. J Cardiovasc Surg (Torino) 1989; 30 (05) 749-753
    PubMedGoogle Scholar
  • 23 Vanscheidt W, Eschenbruch E, Hofherr R, Schmuziger M. Thoracic closure following open heart surgery with a coated polyester suture. Report of experiences in over 2,437 cases [in German]. Chirurg 1986; 57 (02) 105-106
    PubMedGoogle Scholar