Double-Wire versus Single-Wire Sternal Closure in Obese Patients: a Randomized Prospective Study

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Surgical Complications

Background:

• Sternal instability is a significant complication following coronary artery bypass grafting (CABG).
• Obese patients undergoing CABG face a higher risk of sternal instability.
• The left internal mammary artery (LIMA) is frequently used in CABG procedures.

Purpose of the Study:

• To evaluate the effectiveness of double-wire sternal closure in reducing sternal instability.
• To compare the incidence of sternal instability between double-wire and single-wire closure techniques in obese CABG patients.

Main Methods:

• A randomized controlled trial involving 200 obese patients (BMI ≥ 30 kg/m²) undergoing isolated CABG with LIMA graft.
• Patients were assigned to either single-wire (n=100) or double-wire (n=100) sternal closure.
• Sternal instability was assessed postoperatively.

Main Results:

• The incidence of sternal instability was significantly lower in the double-wire group (5%) compared to the single-wire group (16%) (p=0.019).
• Double-wire closure was identified as an independent protective factor against sternal instability (OR: 0.276; p=0.029).
• Smoking and postoperative delirium were independent risk factors for sternal instability.

Conclusions:

• Double-wire sternal closure is a superior technique for reducing postoperative sternal instability in obese patients undergoing CABG with LIMA graft.
• This method enhances sternal wound healing and minimizes complications in high-risk patient populations.