A Randomized Trial to Assess the Contribution of a Novel Thorax Support Vest (Corset) in Preventing Mechanical Complications of Median Sternotomy

Abstract

ObjectivesMechanical complications of median sternotomy may cause significant morbidity and mortality in cardiac surgical patients. This study was aimed at assessing the role of Posthorax support vest (Epple, Inc., Vienna, Austria) in the prevention of sternal complications and the improvement of anatomical healing in patients at high risk for mechanical sternal dehiscence after cardiac surgery by mean of median sternotomy.MethodsA prospective, randomized, study was performed and 310 patients with predisposing factors for sternal dehiscence after sternotomy for cardiac surgery were included. The patients were divided into two groups: patients who received the Posthorax support vest after surgery, and patients who did not. Primary variables assessed included the incidence of mechanical sternal complications, the quality of sternal healing, the rate of re-operation, the duration of hospitalization, rate and duration of hospital, re-admission for sternal complications. Secondary variables assessed were the post-operative pain, the number of requests for supplemental analgesia and the quality of life measured by means of the EQ-5D format.ResultsPatients using vest demonstrated a lower incidence of mechanical sternal complications, a better anatomical sternum healing, lower hospital stay, no re-operations for sternal dehiscence before discharge and lower re-admissions for mechanical sternal complication. In addition, patients using a vest reported a better quality of life with better freedom from limitations in mobility, self-care, and pain.ConclusionsOur findings demonstrate that the use of the Posthorax vest reduces post-sternotomy mechanical complications and improves the healing of the sternotomy, the clinical course, and the post-operative quality of life.

Analysis of sternal healing after median sternotomy in low risk patients at midterm follow-up: retrospective cohort study from two centres

“…For low risk patients, the sternal plate did not present values in hospital stay, cost, and incidence of sternal complications [18]. In addition, a thoracic support vest was beneficial for healing the sternum, and also reduced mechanical sternal complications and shortened the hospital stay [19].…”

Prevention of Sternal Wound Infections in Women Using an External Sternum Fixation Corset

“…Some of them tend to be useful in preventing instability and infection of the sternum and should reduce postoperative pain, thereby improving the clinical course and the postoperative quality of life. [5][6][7] Using the external supportive sternal Stern-E-Fix (Fendel & Keuchen GmbH, Aachen, Germany) corset is shown to yield a significantly better and effective prevention against development of sternal dehiscence and secondary sternal wound infection (SWI) in high-risk poststernotomy male patients. 6) The aim of this study is to assess the prevention of SWI, DSWI, and mediastinitis after median sternotomy in high-risk female patients using the Stern-E-Fix corset.…”

“…Some of them tend to be useful in preventing instability and infection of the sternum and should reduce postoperative pain, thereby improving the clinical course and the postoperative quality of life. 5 - 7) …”

Guidelines for enhanced recovery after cardiac surgery. Consensus document of Spanish Societies of Anesthesia (SEDAR), Cardiovascular Surgery (SECCE) and Perfusionists (AEP)

“…Con el objetivo de reducir la incidencia de dehiscencia esternal y el dolor en el proceso de rehabilitación tras la intervención, se pueden usar chalecos o corsés especialmente diseñados para los pacientes en el postoperatorio de cirugía cardiaca con esternotomía. Su uso en pacientes de alto riesgo está especialmente indicado [487][488][489][490] .…”