JBM  Vol.3 No.11 , November 2015
Resternotomy Following Sternal Bone Cement Implantation: A Great Challenge for Cardiac Surgeons
ABSTRACT
Background: Median sternotomy and resternotomy is the standard technique for coronary artery bypass grafting (CABG), valvular heart disease, and congenital heart disease. Despite ad-vances in many areas of cardiac surgical procedures, there is a lack of innovation in sternal closure techniques. Several studies have examined sternal closure techniques including wiring, interlocking, plate and screw, and bone cementation. However, none of them achieved widespread acceptability. On one hand, serious post-operative complications are associated with the use of wiring and plating techniques in high-risk patients. The aim of this study is showing challenges and difficulties with resternotomy in patient with a history of previous cardiac surgery and usage of biologic bone cements. Case Report: The case was a 56-year-old woman with a history of previous sternotomy for mitral and aortic valve replacement (mechanical sj. No. 29 and mechanical sj. No. 21, respectively) using biologic bone cement (Kryptonite TM, Doctors Research Group Inc.) for her osteopenic sternum. Four years after the mitral valve replacement (MVR), she was referred to emergency department with a thrombosis at the mitral valve. She under-went emergent cardiac surgery with a very difficult resternotomy under femoral cannulation support. Conclusion: Resternotomy in patients with previous sternotomy with Kryptonite bone cements or calcium phosphate cements (CPC) is safe and can be done similar to other cardiac reoperations. It seems that reoperation in this patients does not increase the risk of bleeding, morbidity, and mortality.

Cite this paper
Moeinipour, A. , Shamloo, A. , Moghadam, A. , Andalibi, M. , Zarifian, A. and Hoseinikhah, H. (2015) Resternotomy Following Sternal Bone Cement Implantation: A Great Challenge for Cardiac Surgeons. Journal of Biosciences and Medicines, 3, 77-81. doi: 10.4236/jbm.2015.311010.
References
[1]   Falor, W.H. and Traylor, R. (1982) Extended Indications for the Median Sternotomy Incision. American Surgon, 48, 582-583.

[2]   Dalton, M.L. and Connally, S.R. (1993) Median Sternotomy. Surgery, Gynecology & Obstetrics, 176, 615-624.

[3]   Bryan, C.S. and Yarbrough, W.M. (2013) Preventing Deep Wound Infection after Coronary Artery Bypass Grafting: A Review. Texas Heart Institute Journal, 40, 125-139.

[4]   Okutan, H., Tenekeci, C. and Kutsal, A. (2005) The Reinforced Sternal Closure System Is Reliable to Use in Elderly Patients. Journal of Cardiac Surgery, 20, 271-273.
http://dx.doi.org/10.1111/j.1540-8191.2005.200432.x

[5]   Song, D.H., Lohman, R.F., Renucci, J.D., Jeevanandam, V. and Raman, J. (2004) Primary Sternal Plating in High-Risk Patients Prevents Mediastinitis. European Journal of Cardio-Thoracic Surgery, 26, 367-372.
http://dx.doi.org/10.1016/j.ejcts.2004.04.038

[6]   Redzek, A., Mironicki, M., Gvozdenovic, A., Petrovic, M., cemerlic-Acic, N., Ilic, A. and Velicki, L. (2015) Predictors for Hospital Readmission after Cardiac Surgery. Journal of Cardiac Surgery, 30, 1-6.
http://dx.doi.org/10.1111/jocs.12441

[7]   Antohi, N., Stan, V., Huian, C. and Nae, S. (2014) Poststernotomy Wound Management by Debridement and Pedicle Flaps Reconstruction. Chirurgia (Bucur), 109, 670-677.

[8]   Nazerali, R.S., Hinchcliff, K. and Wong, M.S. (2014) Rigid Fixation for the Prevention and Treatment of Sternal Complications. Annals of Plastic Surgery, 72, S27-S30.
http://dx.doi.org/10.1097/SAP.0000000000000155

[9]   Song, D.H., Lohman, R.F., Renucci, J.D., Jeevanandam, V. and Raman, J. (2004) Primary Sternal Plating in High-Risk Patients Prevents Mediastinitis. European Journal of Cardio-Thoracic Surgery, 26, 367-372.
http://dx.doi.org/10.1016/j.ejcts.2004.04.038

[10]   Hashim, S., Chin, L.Y., Krishnasamy, S., Sthaneswar, P. and Raja Mokhtar, R.A. (2015) Effect of Sternal Closure with Biological Bone Adhesive on Pain Visual Analogue Score and Serum Cytokine. Journal of Cardio-Thoracic Surgery, 17, 32.
http://dx.doi.org/10.1186/s13019-015-0230-0

[11]   Collaud, S., Pfofe, D., Decurtins, M. and Gelpke, H. (2012) Mesh-Bone Cement Sandwich for Sternal and Sternoclavicular Joint Reconstruction. European Journal of Cardio-Thoracic Surgery, 43.

[12]   Bayramoglu, Z., Durak, Y., Bayram, M., Ulusoy, O.L., Caynak, B., Sagbas, E. and Akpinar, B. (2013) Bone Cement- Enhanced Sternal Closure Technique in Cardiac Surgery: Effects on Sternal Union, Pain and Life Quality. Journal of Cardio-Thoracic Surgery, 7, 182.
http://dx.doi.org/10.1186/1749-8090-8-182

[13]   Fedak, P.W., Kieser, T.M., Maitland, A.M., Holland, M., Kasatkin, A., Leblanc, P., Kim, J.K. and King, K.M. (2011) Adhesive-Enhanced Sternal Closure to Improve Postoperative Functional Recovery: A Pilot, Randomized Controlled Trial. Annals of Thoracic Surgery, 92, 1444-1450.
http://dx.doi.org/10.1016/j.athoracsur.2011.05.014

[14]   Alhalawani, A.M., Curran, D.J., Pingguan-Murphy, B., Boyd, D. and Towler, M.R. (2013) A Novel Glass Polyalkenoate Cement for Fixation and Stabilisation of the Ribcage, Post Sternotomy Surgery: An Ex-Vivo Study. Journal of Functional Biomaterials, 4, 329-357.
http://dx.doi.org/10.3390/jfb4040329

[15]   Vaishya, R., Chauhan, M. and Vaish, A. (2013) Bone Cement. Journal of Clinical Orthopaedics and Trauma, 4, 157-163.
http://dx.doi.org/10.1016/j.jcot.2013.11.005

[16]   Alhalawani, A.M. and Towler, M.R. (2013) A Review of Sternal Closure Techniques. Journal of Biomaterials Applications, 28, 483-497.
http://dx.doi.org/10.1177/0885328213495426

[17]   Alhalawani, A.M., Rodriguez, O., Curran, D.J., Co, R., Kieran, S., Arshad, S., Keenan, T.J., Wren, A.W., Crasto, G., Peel, S.A. and Towler, M.R. (2015) A Glass Polyalkenoate Cement Carrier for Bone Morphogenetic Proteins. Journal of Materials Science: Materials in Medicine, 26, 151.
http://dx.doi.org/10.1007/s10856-015-5494-3

[18]   O’Riordan, M. (2010) Surgical Kryptonite: Bone Cement Improves QoL and Physical Disability in CABG Patients. Heartwire from Medscape.
http://www.medscape.com/viewarticle/731256

[19]   Graf, K., Sohr, D., Haverich, A., Kühn, C., Gastmeier, P. and Chaberny, I.F. (2009) Decrease of Deep Sternal Surgical Site Infection Rates after Cardiac Surgery by a Comprehensive Infection Control Program. Interactive Cardiovascular and Thoracic Surgery, 9, 282-286.
http://dx.doi.org/10.1510/icvts.2009.205286

 
 
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