Randomized, multicenter trial comparing sternotomy closure with rigid plate fixation to wire cerclage

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Biomaterials and Medical Devices

Background:

• Sternotomy closure is critical for patient recovery after cardiac surgery.
• Traditional wire cerclage can lead to complications like non-union and infection.
• Novel fixation methods are being explored to improve sternal healing outcomes.

Purpose of the Study:

• To compare the efficacy of rigid plate fixation versus wire cerclage for sternotomy closure.
• To evaluate differences in sternal healing, complication rates, and associated costs.

Main Methods:

• A prospective, single-blinded, multicenter trial randomized 236 patients.
• Patients were assigned to either rigid plate fixation (n=116) or wire cerclage (n=120).
• Sternal healing was assessed via CT scan at 3 and 6 months; complications and costs were tracked for 6 months.

Main Results:

• Rigid plate fixation demonstrated significantly better sternal healing scores and union rates at both 3 and 6 months.
• Fewer sternal complications, including a trend towards reduced sternal wound infections, were observed with rigid plates.
• While initial hospitalization costs trended higher for plates, total 6-month costs were similar between groups.

Conclusions:

• Rigid plate fixation provides superior sternal healing and a lower complication rate compared to wire cerclage.
• This method achieves comparable overall costs at six months post-surgery.
• Rigid plate fixation represents an effective alternative for sternotomy closure.