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

Keith B. Allen, Vinod H. Thourani, Yoshifumi Naka, Kendra J. Grubb, John Grehan, Nirav Patel, T. Sloane Guy, Kevin Landolfo, Marc Gerdisch, Mark Bonnell, David J. Cohen

Research output: Contribution to journalArticle

32 Scopus citations

Abstract

Objective To evaluate sternal healing, complications, and costs after sternotomy closure with rigid plate fixation or wire cerclage. Methods This prospective, single-blinded, multicenter trial randomized 236 patients at 12 US centers at the time of sternal closure to either rigid plate fixation (n = 116) or wire cerclage (n = 120). The primary endpoint, sternal healing at 6 months, was evaluated by a core laboratory using computed tomography and a 6-point scale (greater scores represent greater healing). Secondary endpoints included sternal complications and costs from the time of sternal closure through 6 months. Results Rigid plate fixation resulted in better sternal healing scores at 3 (2.6 ± 1.1 vs 1.8 ± 1.0; P < .0001) and 6 months (3.8 ± 1.0 vs 3.3 ± 1.1; P = .0007) and greater sternal union rates at 3 (41% [42/103] vs 16% [16/102]; P < .0001) and 6 months (80% [81/101] vs 67% [67/100]; P = .03) compared with wire cerclage. There were fewer sternal complications through 6 months with rigid plate fixation (0% [0/116] vs 5% [6/120]; P = .03) and a trend towards fewer sternal wound infections (0% [0/116] vs 4.2% [5/120]; P = .06) compared with wire cerclage. Although rigid plate fixation was associated with a trend toward greater index hospitalization costs ($23,437 vs $20,574; P = .11), 6-month follow-up costs tended to be lower ($9002 vs $13,511; P = .14). As a result, total costs from randomization through 6 months were similar between groups ($32,439 vs $34,085; P = .61). Conclusions Sternotomy closure with rigid plate fixation resulted in significantly better sternal healing, fewer sternal complications, and no additional cost compared with wire cerclage at 6 months after surgery.

Original languageEnglish (US)
Pages (from-to)888-896
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume153
Issue number4
DOIs
StatePublished - Apr 1 2017

Keywords

  • cost effectiveness
  • rigid plate fixation
  • sternal closure
  • sternal complication
  • sternal healing
  • sternal wound infection
  • wire cerclage

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Randomized, multicenter trial comparing sternotomy closure with rigid plate fixation to wire cerclage'. Together they form a unique fingerprint.

  • Cite this

    Allen, K. B., Thourani, V. H., Naka, Y., Grubb, K. J., Grehan, J., Patel, N., Guy, T. S., Landolfo, K., Gerdisch, M., Bonnell, M., & Cohen, D. J. (2017). Randomized, multicenter trial comparing sternotomy closure with rigid plate fixation to wire cerclage. Journal of Thoracic and Cardiovascular Surgery, 153(4), 888-896. https://doi.org/10.1016/j.jtcvs.2016.10.093