Mitigating Sternal Risks Using Primary Sternal Plating for Morbidly Obese Patients

Background: Morbidly obese patients (body mass index [BMI] ≥ 35 kg/m2) who undergo cardiac surgery involving median sternotomy have a higher-than-normal risk of sternal dehiscence. We hypothesize that the utility of... [ view full abstract ]

Background: Morbidly obese patients (body mass index [BMI] ≥ 35 kg/m²) who undergo cardiac surgery involving median sternotomy have a higher-than-normal risk of sternal dehiscence. We hypothesize that the utility of transverse sternal plating for primary sternal closure in morbidly obese cardiac surgical patients can be a solution to mitigate the risk of sternal dihiscence.

Methods: We retrospectively reviewed data from cardiac surgical patients who underwent single primary xiphoid transverse titanium plate reinforcement for primary sternal closure from August 2009 to July 2010 (n=8).  We compared their outcomes with those of patients with BMI ≥35 kg/m² who underwent cardiac surgery without sternal plate reinforcement from April 2008 to July 2009 (n=14).  All cases were performed by the same surgeon.

Results: The 2 groups of patients had similar demographics and comorbidities (p>0.05 for all). All patients with sternal plate reinforcement reported sternal stability at last follow-up (median of 27 months postoperatively; range, 8.4-49.3 months), whereas 1 patient (7.1%) who underwent standard closure developed sterile sternal dehiscence (p=0.4). Postoperative patient-controlled analgesia (PCA) morphine usage was significantly higher for patients without sternal plate reinforcement than for patients who had sternal plate reinforcement (3.6 mg/h vs 1.3 mg/h, p=0.008). No patient in the sternal plate group had wound seromas or perioperative complications attributable to sternal closure technique.

Conclusion: Single xiphoid transverse plate reinforcement for primary sternal closure is a feasible option for morbidly obese patients, who are otherwise at high risk of developing sternal dehiscence. Using this technique may decrease postoperative narcotics usage.