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OBJECTIVE: Cerclage wire fixation is standard technique of sternal fixation after median sternotomy in cardiovascular surgery. Although, the efficacy of plate fixation is coming to be reported these days. We evaluated the early outcome of plate fixation in off pump coronary artery bypass grafting (OPCAB), and we compared the outcome with that of wire fixation.
METHODS: A retrospective study about patients who underwent rigid sternal fixation with plate and cerclage wire fixation in OPCAB between June 2014 and March 2015 at Chiba-Nishi General Hospital was performed. Outcomes including surgical site infection, sternal instability, postoperative drain output, the day of the chest drain removal, the postoperative day and the distance of the first walk after surgery were assessed. We performed plate fixation in patients with bilateral internal thoracic artery use, insulin dependent diabetes mellitus, chronic hemodialysis, and the patients without these history underwent wire fixation. The all plating system was Sternalock Blu (Biomet, Warsaw, IN, USA)
RESULTS: Seventy three patients(M:F= 59:14, age 67.8+/-11.1 y.o.) were engaged. In 41 patients(M:F=35:6 , age 75.0+/-10.4 y.o.), plate fixation was performed(P group). In 32 patients(M:F=24:8, age 70.3+/-11.3 y.o.), wire fixation was performed(W group). There was significant difference in the number of the grafts(W:P=2.6+/-0.7:3.4+/-0.9, p<0.001) and intraoperative bleeding(W:P=1069 +/- 594:1517+/-881 mL, p=0.019). Drain output in postoperative day 1(W:P=255 +/- 240:148 +/-108 mL, p=0.013), 2(W:P=127 +/- 180:27.6+/-55.3 mL, p=0.001) and total drain output was significantly less in P group. The day of walk for first time after operation did not show significant difference(P:W=2.6+/-2.0:2.1+/-1.2 postoperative day, p=0.201) but the distance of walk in the day was significantly longer in P group (P:W= 57.1+/-29.5:42.5+/-30.0 m, p=0.041). The intensive care unit stay length and hospital stay length was almost the same. We observed surgical site infection in 1 patients in each group.
CONCLUSIONS: Plate fixation with Sternalock Blu was effective in OPCAB. The difference can be caused by the better reduction of sternum in plate fixation. It also can be a reason that fewer wire penetrate the sternum in plate fixation.