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Bone cement-enhanced sternal closure technique in cardiac surgery: effects on sternal union, pain and life quality.

Bayramoglu Z, Durak Y, Bayram M, Ulusoy OL, Caynak B, Sagbas E, Akpınar B - J Cardiothorac Surg (2013)

Bottom Line: Although this incision technique is associated with relatively lower complication rates, certain complications such as the sternal dehiscence may pose serious health consequences.Kryptonite bone cement, when combined with a standard wire cerclage, enhances mechanical strength, prevents sternal dehiscence, reduces postoperative pain and improves quality of life after conventional cardiac surgery.Long-term studies are warranted to better define the role of kryptonite bone cement in the prevention of sternal dehiscence.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Background: Median sternotomy provides excellent access to all mediastinal structures in patients undergoing conventional cardiovascular surgery. Although this incision technique is associated with relatively lower complication rates, certain complications such as the sternal dehiscence may pose serious health consequences. In this regard, considerable effort has been paid to develop techniques aiming to improve sternal healing and to enhance postoperative recovery after conventional cardiac surgery. Among these, kryptonite bone cement, a biocompatible polymer with improved mechanical properties when combined with a standard wire cerclage, represents a promising novel approach that may help prevent sternal dehiscence. In this study, the effects of this particular type of bone cement on sternal healing, postoperative pain, and quality of life have been evaluated.

Methods: Kryptonite bone cement enhanced sternal closure was employed in a total of 100 patients undergoing conventional cardiac surgery between November 2009 and June 2012. Of these patients, 50 expressed their willingness to participate in this study. Each participant underwent a computerized tomography imaging for the radiological assessment of sternal healing. Pain and life quality of these patients have been evaluated by Wong-Baker faces pain scale and SF-36 health survey questionnaire, respectively.

Results: Mean duration of follow-up was 20.14 ± 7.36 months (range: 10-32). Mean age and body mass index were 71.32 ± 7.23 years (range: 55-85) and 28.34 ± 2.62 (21-34) kg/m2, respectively. Elderly patients (≥70), females and those with chronic obstructive pulmonary disease (COPD) comprised 64%, 26% and 40% of the study population, respectively. No patients had findings suggestive of dehiscence on CT images. No patients reported severe pain (i.e. all patients had a Wong-Baker faces pain scale score <4). Elderly (≥ 70 yr) subjects had better quality of life scores as compared to the remaining group of patients (< 70 yr) according to SF-36 Health Survey results. Vitality and emotional role scores were lower (63.5 ± 25.5, p = 0.018 and 41.7 ± 23.3, p = 0.001, respectively) in female patients. Patients with COPD had lower quality of life scores than those without COPD, particularly with respect to general health scores (73.3 ± 18.5; p = 0.012).

Conclusions: Kryptonite bone cement, when combined with a standard wire cerclage, enhances mechanical strength, prevents sternal dehiscence, reduces postoperative pain and improves quality of life after conventional cardiac surgery. Long-term studies are warranted to better define the role of kryptonite bone cement in the prevention of sternal dehiscence.

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Severely osteoporotic sternum (A); application of Kryptonite bone cement (B).
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Figure 1: Severely osteoporotic sternum (A); application of Kryptonite bone cement (B).

Mentions: Following standard cardiopulmonary bypass, sternal closure was performed in all patients using 7-wire interrupted cerclage with (No:6) 18-gauge stainless steel. Then, trabecular bone was cleansed with a sterile brush and irrigated with saline solution to expose the bone trabecular interface. The Kryptonite bone adhesive was mixed for 5 minutes, and then 5 ml of it was applied as a thin layer to each hemisternum. It is an injectable liquid for up to 8 minutes after mixing three components, then, transitions into a highly adhesive taffy state 8–15 minutes after mixing. Through polymerization, it attains bone-like rigidity and strength (Figure 1). The sternum was closed before the cement completely set. Excess cement under the sternum was removed by a gauze prior to closing. Similarly, excess cement on the sternum was removed by a wet gauze. The material was used as a bone filler, as well as for bleeding control. Other hemostatic agents including bone wax were not used. Importantly, the adhesive can be easily divided with a sternal saw to facilitate rapid chest reentry if re-exploration is needed.


Bone cement-enhanced sternal closure technique in cardiac surgery: effects on sternal union, pain and life quality.

Bayramoglu Z, Durak Y, Bayram M, Ulusoy OL, Caynak B, Sagbas E, Akpınar B - J Cardiothorac Surg (2013)

Severely osteoporotic sternum (A); application of Kryptonite bone cement (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750837&req=5

Figure 1: Severely osteoporotic sternum (A); application of Kryptonite bone cement (B).
Mentions: Following standard cardiopulmonary bypass, sternal closure was performed in all patients using 7-wire interrupted cerclage with (No:6) 18-gauge stainless steel. Then, trabecular bone was cleansed with a sterile brush and irrigated with saline solution to expose the bone trabecular interface. The Kryptonite bone adhesive was mixed for 5 minutes, and then 5 ml of it was applied as a thin layer to each hemisternum. It is an injectable liquid for up to 8 minutes after mixing three components, then, transitions into a highly adhesive taffy state 8–15 minutes after mixing. Through polymerization, it attains bone-like rigidity and strength (Figure 1). The sternum was closed before the cement completely set. Excess cement under the sternum was removed by a gauze prior to closing. Similarly, excess cement on the sternum was removed by a wet gauze. The material was used as a bone filler, as well as for bleeding control. Other hemostatic agents including bone wax were not used. Importantly, the adhesive can be easily divided with a sternal saw to facilitate rapid chest reentry if re-exploration is needed.

Bottom Line: Although this incision technique is associated with relatively lower complication rates, certain complications such as the sternal dehiscence may pose serious health consequences.Kryptonite bone cement, when combined with a standard wire cerclage, enhances mechanical strength, prevents sternal dehiscence, reduces postoperative pain and improves quality of life after conventional cardiac surgery.Long-term studies are warranted to better define the role of kryptonite bone cement in the prevention of sternal dehiscence.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Background: Median sternotomy provides excellent access to all mediastinal structures in patients undergoing conventional cardiovascular surgery. Although this incision technique is associated with relatively lower complication rates, certain complications such as the sternal dehiscence may pose serious health consequences. In this regard, considerable effort has been paid to develop techniques aiming to improve sternal healing and to enhance postoperative recovery after conventional cardiac surgery. Among these, kryptonite bone cement, a biocompatible polymer with improved mechanical properties when combined with a standard wire cerclage, represents a promising novel approach that may help prevent sternal dehiscence. In this study, the effects of this particular type of bone cement on sternal healing, postoperative pain, and quality of life have been evaluated.

Methods: Kryptonite bone cement enhanced sternal closure was employed in a total of 100 patients undergoing conventional cardiac surgery between November 2009 and June 2012. Of these patients, 50 expressed their willingness to participate in this study. Each participant underwent a computerized tomography imaging for the radiological assessment of sternal healing. Pain and life quality of these patients have been evaluated by Wong-Baker faces pain scale and SF-36 health survey questionnaire, respectively.

Results: Mean duration of follow-up was 20.14 ± 7.36 months (range: 10-32). Mean age and body mass index were 71.32 ± 7.23 years (range: 55-85) and 28.34 ± 2.62 (21-34) kg/m2, respectively. Elderly patients (≥70), females and those with chronic obstructive pulmonary disease (COPD) comprised 64%, 26% and 40% of the study population, respectively. No patients had findings suggestive of dehiscence on CT images. No patients reported severe pain (i.e. all patients had a Wong-Baker faces pain scale score <4). Elderly (≥ 70 yr) subjects had better quality of life scores as compared to the remaining group of patients (< 70 yr) according to SF-36 Health Survey results. Vitality and emotional role scores were lower (63.5 ± 25.5, p = 0.018 and 41.7 ± 23.3, p = 0.001, respectively) in female patients. Patients with COPD had lower quality of life scores than those without COPD, particularly with respect to general health scores (73.3 ± 18.5; p = 0.012).

Conclusions: Kryptonite bone cement, when combined with a standard wire cerclage, enhances mechanical strength, prevents sternal dehiscence, reduces postoperative pain and improves quality of life after conventional cardiac surgery. Long-term studies are warranted to better define the role of kryptonite bone cement in the prevention of sternal dehiscence.

Show MeSH
Related in: MedlinePlus