Cable Closure Versus Conventional Wire Cerclage For Sternotomy After Cardiac Surgery: A Systematic Review And Meta-analysis
Derrick Tam, Apurva Dixit, Monica Yu, Tiffany Lam, Stephen Fremes.
University of Toronto, Toronto, ON, Canada.
Objective: The median sternotomy is one the most commonly performed osteotomies globally, allowing for quick access and excellent exposure to the mediastinum. There are some studies to suggest that a cable closure technique may be superior to conventional wire cerclage (WC) in providing a stable sternal closure. Individual studies may be underpowered to detect for differences in important clinical endpoints. Thus, a study level meta-analysis compared CC to WC is necessary to determine the potential benefits of this novel technique in sternal closure.
Methods: A systematic review of the literature for all studies comparing CC to WC was performed. The primary outcome was sternal wound infection, the secondary outcomes were mortality, dehiscence, deep sternal wound infection (DSWI), post-operative pain scores, and hospital length of stay. Crude event rates were aggregated. Binary outcomes and continuous outcomes were analyzed as risk ratios (RR) and mean differences (MD) respectively in a random-effects meta-analysis.
Results: From 387 unique citations found, six studies were included (n=2702). There were three randomized clinical trials (RCTs, n=716), one adjusted (n=784) and two unadjusted (n=1202) observational studies. There was no difference in the primary outcome between CC and WC (3.9% vs 4.1%, RR: 0.83, 95% confidence interval (95%CI): 0.48, 1.46, p=0.28). The rate of dehiscence was decreased with CC (0.2% vs 2.6%, RR: 0.12, 95%CI: 0.02, 0.66, p=0.01). There was no difference in DSWI or mortality between the two groups (Table). Mean pain score was reduced with CC compared to WC (MD: -1.04, 95%CI: -1.89, -0.19, p=0.02) while total hospital length of stay was similar between the two groups.
Conclusions: Individual studies comparing CC to WC were underpowered to detect for differences in key clinical outcomes. Our analysis shows that the use of CC may reduce the risk of sternal dehiscence and reduce post-operative pain. Further work in the form of large multi-centered RCTs are required to confirm these findings.
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