Background: Median sternotomy is the most performed procedure in cardiac surgery; however, sternal bleeding remains a problem. This study aimed to investigate whether sternal reconstruction using a sandwiched three-piece bioresorbable mesh plate can prevent postoperative bleeding more than a bioresorbable pin. Methods: Patients (n = 218) who underwent median sternotomy were classified according to whether a sandwiched three-piece bioresorbable mesh plate and wire cerclage (group M, n = 109) or a bioresorbable pin and wire cerclage (group P, n = 109) was used during sternal reconstruction. The causes of postoperative bleeding and computed tomography data were analyzed and compared between the groups. Results: The preoperative patient characteristics did not significantly differ between the groups. However, the amount of bleeding at 6 h postoperatively was lower in group M than in group P (235 ± 147 vs. 284 ± 175 mL, p = 0.0275). Chest reopening, intubation time, and length of intensive care unit and hospital stays did not differ between the groups. Evaluation for sternal and substernal hematoma on postoperative day 5 using computed tomography showed sternal displacement in 4 (4%) and 22 (20%) patients, and substernal hematoma in 9 (8%) and 22 (20%) patients in groups M and P, respectively; the difference was significant. The four-grade evaluation of substernal hematoma based on computed tomography yielded a significantly lower grade for group M than for group P, revealing that the mesh plate was an independent predictor of substernal hematoma prevention. Conclusion: Sternal fixation with a three-piece bioresorbable mesh plate could prevent postoperative bleeding and substernal hematoma more than sternal fixation with a pin.

Background and Aim of the Study: Ischemic mitral valve regurgitation (IMR) in patients undergoing coronary artery bypass grafting (CABG) is associated with worse long-term outcomes. The aim of this study was to assess the impact of mitral valve repair with CABG in patients with moderate IMR. Method: This observational study enrolled 3,215 consecutive patients from the Juntendo CABG registry with moderate IMR and multivessel coronary artery disease who underwent CABG between 2002 and 2017. The CABG alone and CABG with mitral valve surgery (MVs) groups were compared. The propensity score was calculated for each patient. Long-term all-cause death, cardiac death, and major adverse cardiac and cerebrovascular events (MACCEs) were compared between the two groups. Results: A total of 101 patients who underwent CABG had moderate IMR in our database. Propensity score matching selected 40 pairs for final analysis. MVs was associated with increased risks of postoperative atrial fibrillation, blood transfusion, and longer hospitalization. There were no differences between the two groups in long-term outcomes, including all-cause mortality, cardiac mortality, and the incidence of MACCEs. Conclusions: Surgical treatment of moderate IMR combined with CABG was as safe as CABG alone, with no differences in long-term outcomes. Further studies are needed to determine the effects of MVs in patients with moderate IMR and severe coronary artery disease.