Complications of cardiac surgery: sternal dehiscence after median sternotomy. Analysis of 14,171 cases operated on in years 1990–2009

Mariusz Listewnik, Arkadiusz Kazimierczak, Krzysztof Mokrzycki


Introduction: Dehiscence of the sternum is one of the most serious complications following cardiac surgery. It occurs after 0.2–5% of interventions with sternotomy access.

The aim of the study was the evaluation of factors that may influence the frequency of this complication.

Material and methods: A retrospective review of 14,171 patients undergoing median sternotomy for cardiac surgery between 1990 and 2009 at the Cardiac Surgery Department of the Pomeranian Medical University in Szczecin (Poland) was performed. The studied group consisted of 3,999 women (28.2%) and 10,172 men (71.8%) aged 11–87 years (59.8 years on average). We analysed cases with sternal dehiscence (SD), which occurred in 298 (2.1%) of the patients.

Results: The significant risk factors were: male sex (p = 0.0003), age (p < 0.00006), body mass (p < 0.00007), and use of both internal thoracic arteries (p < 0.00001). The risk of SD was also increased by coexisting diabetes and chronic obstructive lung disease (p < 0.012 and p < 0.02 respectively); however, discriminant analysis revealed that these variables were only linked to age. Apart from CABG, the type of surgical intervention had no influence on the frequency of SD. The total length of hospital stay in patients with SD was more than two times longer than in the rest of the patients (p < 0.00001). However, there were no significant differences in postoperative mortality between these two groups – 4.4% in the group with SD and 4.2% in the group without it.

Conclusions: Not being able to eliminate the influence of risk factors, since 2010 we decided to introduce changes in the method of sternum closure by increasing the number of wire loops from 6 to at least 8. For patients heavier than 80 kg, we assumed a ratio of one additional loop per every 10 kg of body mass, which should result in improved sternum stabilisation and reduce the risk of dehiscence.


sternum; risk factors; CABG; internal thoracic artery

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Robicsek F., Fokin A., Cook J., Bhatia D.: Sternal instability after midline sternotomy. Thorac Cardiovasc Surg. 2000, 48 (1), 1–8.

Losanoff J.E., Richman B.W., Jones J.W.: Disruption and infection of median sternotomy: a comprehensive review. Eur J Cardiothorac Surg. 2002, 21 (5), 831–839.

Harjula A., Jarvinen A.: Postoperative median sternotomy dehiscence. Scand J Thorac Cardiovasc Surg. 1983, 17 (3), 277–281.

Bitkover C.Y., Gardlund B.: Mediastinitis after cardiovascular operations: a case‑control study of risk factors. Ann Thorac Surg. 1998, 65 (1), 36–40.

Bitner M., Jaszewski R., Mussur M., Knopik J., Pawłowski W., Jegier B.: Całkowite rozejście się mostka po operacjach kardiochirurgicznych. Pol Przegl Chir. 1996, 68 (7), 641–645.

Zwoliński R., Zasłonka J., Jaszewski R., Banach M., Ostrowski S., Jegier B. et al.: Pierwotne i wtórne szycie mostka metodą Robicsek’a – doświadczenia własne. Kardiochir Torakochir Pol. 2004, 1 (2), 165–172.

Olbrecht V.A., Barreiro C.J., Bonde P.N., Williams J.A., Baumgartner W.A., Gott V.L. et al.: Clinical outcomes of noninfectious sternal dehiscence after median sternotomy. Ann Thorac Surg. 2006, 82 (3), 902–907.

Schimmer C., Reents W., Berneder S., Eigel P., Sezer O., Scheld H. et al.: Prevention

of sternal dehiscence and infection in high‑risk patients: a prospective randomized multicenter trial. Ann Thorac Surg. 2008, 86 (6), 1897–1904.

Julian O.C., Lopez‑Belio M., Dye W.S., Javid H., Grove W.J.: The median sternal incision in intracardiac surgery with extracorpore al circulation: a general evaluation of its use in heart surgery. Surgery. 1957, 42 (4), 753–761.

Shumacker H.B., Mandelbaum I.: Continuous antibiotic irrigation in the treatment of infection. Arch Surg. 1963, 86 (3), 384–387.

Milano C.A., Kesler K., Archibald N., Sexton D.J., Jones R.H.: Mediastinitis after coronary artery bypass graft surgery. Risk factors and long‑term survival. Circulation. 1995, 92 (8), 2245–2251.

Zalewska‑Adamiec M., Bachórzewska‑Gajewska H., Tomaszuk‑Kazberuk A., Trzciński R., Prokopczuk P., Hirnle T. et al.: Wpływ otyłości na rokowanie i ryzyko powikłań u pacjentów z chorobą pnia lewej tętnicy wieńcowej leczonych kardiochirurgicznie. Pol Przegl Kardiol. 2012, 14 (1), 29–36.

Shafir R., Weiss J., Herman O., Cohen N., Stern D., Igra Y.: Faulty sternotomy and complications after median sternotomy. J Thorac Cardiovasc Surg. 1988, 96 (2), 310–313.

Bitner M., Jaszewski R.: Rozejścia mostka po operacjach w krążeniu pozaustrojowym w umiarkowanej hipotermii (lata 1987–1994) i w normotermii ogólnej (lata 1995–2000). Clin Exp Med Lett. 2005, 46 (3), 47–50.

Gualis J., Flórez S., Tamayo E., Alvarez F.J., Castrodeza J., Castaño M.: Risk factors for mediastinitis and endocarditis after cardiac surgery. Asian Cardiovasc Thorac Ann. 2009, 17 (6), 612–616.

Wouters R., Wellens F., Vanermen H., De Geest R., Degrieck I., De Meerleer F.: Sternitis and mediastinitis after coronary artery bypass grafting. Analysis of risk factors. Tex Heart Inst J. 1994, 21 (3), 183–188.

Abid Q., Podila S.R., Kendall S.: Sternal dehiscence after cardiac surgery and ACE type I inhibition. Eur J Cardiothorac Surg. 2001, 20 (1), 203–204.

El Oakley R.M., Wright J.E.: Postoperative mediastinitis: classification and management. Ann Thorac Surg. 1996, 61 (3), 1030–1036.

Bottio T., Rizzoli G., Vida V., Casarotto D., Gerosa G.: Double crisscross sternal wiring and chest wound infections: a prospective randomized study. J Thorac Cardiovasc Surg. 2003, 126 (5), 1352–1356.

Furnary A.P., Gao G., Grunkemeier G.L., Wu Y., Zerr K.J., Bookin S.O. et al.: Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2003, 125 (5), 1007–1021.


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