The Mitroflow valve can be safely implanted in elderly patients undergoing advanced surgical procedures. Gradients were acceptably low even in the smallest valves.

Sternal instability after coronary artery bypass grafting (CABG) is a serious complication. Obese patients are at high risk for sternal instability after CABG. This study was conducted to assess the positive impact of double-wire sternal closure on sternal instability. A total of 200 obese patients with a body mass index ≥ 30 kg/m undergoing isolated CABG with left internal mammary artery (LIMA) graft were randomly assigned to sternal closure either by eight single wires ( = 100) or by a combination of four double wires and four single wires. There was a total of 21 cases with sternal instability: 5 cases (i.e., 5%) in the double-wire group versus 16 cases (16%) in the single-wire group ( = 0.019). Logistic regression analysis showed sternal closure via double wires as an independent protection factor (odds ratio [OR]: 0.276; = 0.029). Smoking (OR: 5.5; = 0.006) and postoperative delirium (OR: 3.5; = 0.033) turned out to be independent risk factors for the development of sternal instability. Double-wire sternal closure significantly reduces postoperative sternal instability in obese patients undergoing isolated CABG with LIMA graft.

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