Sternal closure with sandwiched three-piece bioresorbable mesh reduces postoperative hemorrhage: a retrospective study

Abstract

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.