What is the impact of a previously failed Robicsek repair in the
subsequent treatment of sternal dehiscence with thermoreactive nitinol
clips?
Abstract
Background: In this study, we conducted a retrospective review of
patients at our institution with noninfectious sternal dehiscence (NISD)
after median sternotomy who received thermoreactive nitinol clips (TRNC)
treatment during a 10-year period. We compared TRNC patients with and
without history of failed Robicsek repair. The purpose of the study was
to analyze the impact of previous Robicsek repair on the treatment of
sternal dehiscence with TRCN. Methods: Between December 2009 and January
2020, out of 283 patients with NISD who underwent refixation, we studied
34 cases who received TRNC treatment. We divided these 34 cases into two
groups: patients who had a previously failed Robicsek procedure before
TRNC treatment (group A, n=11) and patients who had been directly
referred to TRCN treatment (group B, n= 23). Results: Postoperative
complication rate was significantly higher in group A (p=0.026).
Hospitalization duration was significantly longer in group A due to the
higher complication rate (p=0.001). Operative time was significantly
shorter and blood loss was significantly lower in group B (p=0.001).
Conclusion: The Robicsek procedure is considered an effective method in
the treatment of NISD but, in case of its failure, subsequent TRNC
treatment might become cumbersome in high-risk patients. In our study, a
previously failed Robicsek procedure caused significantly higher
morbidity and additional operative risk in later TRNC treatment of
high-risk cases. Ultimately, we speculate that a direct TRNC treatment
for NISD is favorable in high-risk patients.