Results:
The retrospective cohort included 283 patients who underwent refixation
due to NSID after median sternotomy. The patients had a mean age of
58.5±13.4 years (range, 33–82 years) at reoperation and a male (n=176)
to female (n=107) ratio of 1.64. The mean interval between the initial
operation and the sternal reoperation was 49.4±9.5 days (range, 42–78
days).
Our study mainly consisted of 34 patients who were treated with the TRNC
method due to NISD after median sternotomy. Demographic, preoperative,
intraoperative, and postoperative variables of patients who had a
previous failed Robicsek procedure before the TRNC method (group A,
n=11), and patients who underwent the TRNC method immediately (group B,
n= 23), are presented in Table 1. The mean interval between failed
Robicsek procedures and TRNC treatment was 18.4±2.6 days (range, 14–26
days) in group A (n=11).
Initial procedures included: 58.8% coronary artery bypass grafting
(20/34), 11.7% valve replacement (4/34), 5.8% repair of ascending
aorta (2/34), and 23.5% combination of procedures (8/34). There was no
significant difference in terms of initial procedure requiring median
sternotomy between the analyzed groups.
The mean hospitalization time after TRNC treatment was 9.3±3.2 days
(range, 5–24 days). The mean operative time was 56.4±8.4 minutes
(range, 40–95 minutes) and the mean blood loss was 312.4±76.6 ml
(range, 150–1000 ml).
There was no significant difference between the groups in terms of
comorbidity rates or surgical complications. Risk distribution according
to group A and B, including comorbidities and surgical complications, is
presented in Table 2. Both groups consisted of high-risk patients.
Postoperative complications included: chronic ventilator dependence or
intubation for more than 7 days (2.9%, 1/34), pneumonia (5.8%, 2/34),
hematoma (8.8%, 3/34), seroma (14.7%, 5/34), pleural effusion (8.8%,
3/34), delirium (11.8%, 4/34), atrial fibrillation (8.8%, 3/34), and
severe limitations of physical activity due to excess sternal pain
(26.4%, 9/34). Postoperative superficial sternal infection was seen in
5.8% of TRNC patients (2/34), but none of the superficial infections
progressed into the mediastinum. No mortality was reported. A detailed
comparison of post-operative complications between the analyzed groups
is presented in Table 3. Postoperative complication rate was
significantly higher in group A (p=0.026). Hospitalization duration was
significantly longer in group A, due to the higher complication rate
(p=0.001). Operative time was significantly shorter and blood loss was
significantly lower in group B (p=0.001).
After TRNC treatment, sternal stability at hospital discharge was
reached in 94.1% of the patients (32/34). Two cases in group A still
had sternal dehiscence (2/11), whereas all patients in group B had
sternal stability at the time of discharge (p=0.035).
In addition, we compared the results of group B and group C. High-risk
patient frequency was significantly higher in TRCN group (group B)
compared to Robicsek group (group C) (100% vs 6.5%) (p=0.001). Overall
success rate of Robicsek repair was 93.8% (244/260) and TRCN was 100%
(p>0.05) but the success rate of the Robicsek repair in
high-risk patients with NISD (n=17) was 35.3% (6/17). TRCN treatment
was significantly more effective in high-risk NISD patients compared to
Robicsek repair with a success rate of 100% (p=0.01). Lastly, operative
time was significantly shorter in group B compared to group C (47.3±7.6
vs 75.3±4.8) (p=0.01). There was no significant difference between the
groups in terms of age, gender, blood loss, complication rate, ICU stay
or hospital stay (p>0.05).