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. 2024 Dec 16;11(12):1280.
doi: 10.3390/bioengineering11121280.

First Report on Rigid Plate Fixation for Enhanced Sternal Closure in Minimally Invasive Cardiac Surgery: Safety and Outcomes

Jules Miazza  1 , Benedikt Reuthebuch  1 , Florian Bruehlmeier  1 , Ulisse Camponovo  1 , Rory Maguire  1 , Luca Koechlin  1 , Ion Vasiloi  1 , Brigitta Gahl  1 , Luise Vöhringer  1 , Oliver Reuthebuch  1   2 , Friedrich Eckstein  1   2 , David Santer  1   2   3
Affiliations

First Report on Rigid Plate Fixation for Enhanced Sternal Closure in Minimally Invasive Cardiac Surgery: Safety and Outcomes

Jules Miazza et al. Bioengineering (Basel). .

Abstract

Introduction: This study reports of the use of a rigid-plate fixation (RPF) system designed for sternal closure after minimally invasive cardiac surgery (MICS).

Methods: This retrospective analysis included all patients undergoing MICS with RPF (Zimmer Biomet, Jacksonville, FL, USA) at our institution. We analyzed in-hospital complications, as well as sternal complications and sternal pain at discharge and at follow-up 7 to 14 months after surgery.

Results: Between June and December 2023, 12 patients underwent RPF during MICS, of which 9 patients were included in the study. The median (IQR) age was 64 years (63 to 71) and two patients (22%) were female. All patients underwent aortic valve replacement, with two patients (22%) undergoing concomitant aortic surgery. RPF was successfully performed in all patients. ICU and in-hospital stay were 1 day (1 to 1) and 9 days (7 to 13), respectively. Patients were first mobilized in the standing position on postoperative day 2 (2 to 2). Four patients (44%) required opiates on the general ward. In-hospital mortality was 0%. At discharge, rates of sternal pain, sternal instability or infection were 0%. After a follow-up time of 343.6 days (217 to 433), median pain intensity using the Visual Analog Scale was 0 (0 to 2). Forty-four percent (n = 4) of patients reported pain at rest. No sternal complications (sternal dehiscence, sternal mal-union, sternal instability, superficial wound infections and deep sternal wound infections) were reported.

Conclusions: In the evolving landscape of cardiac therapies with incentives to reduce surgical burden, RPF showed safety and feasibility. It might become an important tool for sternal closure in minimally invasive cardiac surgery.

Keywords: aortic valve replacement; cardiac surgery; enhanced sternal closure; ministernotomy; partial upper hemisternotomy; rigid plate fixation; sternal wound infection.

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Conflict of interest statement

D.S. has received speaker honoraria and educational grants from Abbott Medical, Zurich, Switzerland, and Medtronic, Muenchenbuchsee, Switzerland, as well as speaker honoraria from Abiomed, Aachen, Germany; Nycomed GmbH, Vienna, Austria; and Zimmer GmbH, Zug, Switzerland. The other authors declare no financial interests or relationships that may be considered as competing interests.

Figures

Figure 1
Figure 1
SternaLock Blu MICS system. (A) MICS osteosynthesis plate; (B) hexagonal plate; (C) skin retraction tool.
Figure 2
Figure 2
Surgical access in MICS. Surgical planning for MICS: (A,B) envisioned sternum section plane using multiplane CT scan; (C) J-shaped ministernotomy (created with BioRender.com).
Figure 3
Figure 3
Sternal closure using rigid plate fixation. Rigid plate fixation after minimally invasive cardiac surgery. In all intraoperative images, the cranial is to the left and the caudal is to the right. (A) Measurement of screw length using a specific designed tool (blue arrow) prior to rigid plate fixation to avoid loose screws or perforation or dorsal bone cortex. (B) Fixation of the caudal plate with a holding tool and pre-measured screws. The MICS plate is mounted on the skin retractor to help with plate positioning. (C) Completed rigid plate fixation. A conventional sternal wire is used to optimize approximation (green arrow).
Figure 4
Figure 4
Postoperative CT scan after rigid plate fixation. Postoperative CT scan showing ossification and correct plate position of the rigid plate fixation system at the level of (A,C) the manubrium and (B,C) the corpus sterni.
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