TITLE:
Prevention of Sternal Dehiscence Following Use of Bilateral Internal Mammary Arteries in OPCAB
AUTHORS:
Sandeep Singh, Sarju Ralhan, Aparesh Sanyal, Frankleena Parage, Varun Sisodia, S. S. Lohchab
KEYWORDS:
Robiscek Repair, Interlocking Figure of Eight Wires, Sternal Dehiscence, Bilateral Internal Mammary Arteries
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.10 No.12,
December
16,
2020
ABSTRACT: Purpose: We harvested bilateral Internal Mammary Arteries and
made LIMA-RIMA Y in all the patients undergoing OPCAB at our center irrespective
of the presence or absence of various risk factors for sternal dehiscence. The
purpose of this study was to find an effective way of sternal closure in
patients undergoing OPCAB with both the Internal Mammary Arteries harvested for
grafting. Method: The patients who did not have any risk factors were
placed in group I and all of them had a standard six wire closure of
sternotomy. The patients having any risk factors were placed in group II. The
patients in group II were randomized by including every alternate patient from group
II to subgroup II A and every other alternate patient from group II to subgroup
II B. Patients in subgroup II A again had a standard closure of sternotomy
while in patients of subgroup II B bilateral Robiscek repair and four-five
interlocking figure of eight wires were used for closure of sternotomy. Results: The patients who had risk factors for sternal dehiscence had higher risk
for sternal dehiscence as compared to patients without any risk factors if
bilateral Internal Mammary Arteries were harvested for OPCAB. But if we used
bilateral Robiscek repair with four to five interlocking figure of eight wires
for sternal closure then the rate of sternal complications in the patients with
risk factors for sternal dehiscence was not more than the patients without risk
factors. Conclusion: We can harvest bilateral Internal Mammary Arteries
for OPCAB without fear of sternal complications even in patients with high risk
for sternal dehiscence if we use bilateral Robiscek repair with four to five
interlocking figure of eight wires for sternal closure.