Sternal Complications After Clamshell Surgery for (Heart-)Lung Transplantation-A Systematic Literature Review

Area of Science:

• Cardiothoracic Surgery
• Transplantation Medicine
• Surgical Complications

Background:

• Bilateral transverse thoracosternotomy, or clamshell surgery, is a standard approach for heart-lung transplantation.
• Postoperative sternal complications present a significant challenge in patients undergoing this procedure.

Purpose of the Study:

• To systematically review and evaluate the prevalence of sternal complications following clamshell surgery in heart-lung transplantation patients.

Main Methods:

• A systematic literature review of PubMed and Embase databases was performed.
• Eighteen studies including 828 patients were analyzed for sternal complication rates.
• Study quality was assessed using the NIH assessment tool; meta-analysis was not conducted due to heterogeneity.

Main Results:

• A total of 286 sternal complications were reported across 830 procedures (0.34 events per surgery).
• Sternal reoperations were conducted in 90 cases (0.14 reoperations per surgery).
• Prevalence rates varied significantly across individual studies.

Conclusions:

• This review underscores the high prevalence and clinical significance of sternal complications after clamshell surgery for heart-lung transplantation.
• Further research is needed on patient selection, risk stratification, and improved sternal closure techniques or alternative surgical approaches.