Thermoreactive nitinol clips: Propensity score comparison with Robicsek technique

To compare the use of thermoreactive nitinol clips with the classic Robicsek technique for treatment of sternal dehiscence after cardiac surgery.

Eighty-two (2.3%) of 3564 open heart surgery patients underwent reoperation for sternal dehiscence between October 2011 and 2012. Prospectively collected data from 26 (31%) consecutive patients who underwent reoperation using thermoreactive nitinol clips were compared with those of a retrospective cohort of 42 (51.2%) who were treated with the classic Robicsek technique. To overcome baseline and operative variations, we constructed a propensity model using logistic regression.

Overall mortality occurred in 3 (5%) patients and a second revision was performed in 2 (7.7%) in the nitinol clip group and 2 (6.3%) in the control group (p > 0.05). Postoperative results were similar except for the mean time of operation which was significantly shorter in the nitinol clip group, and patients in this group required substernal dissection slightly less frequently than those in the control group.

Thermoreactive nitinol clips allow the surgeon to perform a rapid and less challenging technique for sternal reoperations, without additional complications. Using this technique in an identical group with a finite sample size, we accomplished similar early results to those of the classic Robicsek technique.