Wire Cerclage Versus Cable Closure After Sternotomy for Dehiscence and DSWI: A Systematic Review and Meta-Analysis

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Surgical Innovation

Background:

• Traditional wire cerclage (WC) is a standard method for median sternotomy closure.
• Cable closure systems have emerged as a potential alternative to WC.
• Evaluating the comparative efficacy of cable closure is crucial for optimizing patient outcomes.

Purpose of the Study:

• To systematically review and meta-analyze existing literature comparing cable closure with traditional WC for median sternotomy.
• To assess the impact of cable closure on key patient outcomes, including sternal dehiscence, deep sternal wound infection (DSWI), and postoperative pain.

Main Methods:

• A comprehensive literature search was conducted using Ovid Medline, Embase, and Google Scholar.
• Seven studies involving 2,758 patients were included in the meta-analysis.
• Key outcomes analyzed were deep sternal wound infection, sternal dehiscence, and postoperative pain scores.

Main Results:

• Cable closure demonstrated a significantly lower incidence of sternal dehiscence compared to WC (RR 0.14, P < 0.01).
• No significant difference was observed in deep sternal wound infection rates between the two methods (RR 0.97, P = 0.95).
• Cable closure was associated with significantly lower postoperative pain scores (MD -1.04 points, P = 0.02).

Conclusions:

• Cable closure appears to be superior to WC in reducing sternal dehiscence and postoperative pain.
• The current evidence base is limited, necessitating further high-quality studies.
• Confirmation of these findings is required to establish cable closure as a preferred method for sternotomy closure.