Patients and Methods: In our study, included 10 adult patients (3 women, 7 men) which used secondary
Patients and Methods: In our study, included 10 adult patients (3 women, 7 men) which used secondary sterna closure with Nitinol thermo-reactive clips. Their ages ranged from 62 to 74 years (mean, 68.6). 9 patients showed sternal dehiscence following coronary artery bypass grafting (CABG), one patient following mitral valve replacement (MVR). Nitinol thermo-reactive clips were used 10 patients of them. Four patients had operated our institution and the other six patients had operated from other institutions by the same surgeon. Six patients had diagnosed and treated COPD, 2 patients had obesity, 3 patients had osteoporosis and 5 patients were NYHA class ¾ preoperatively. We calculated each patient’s body mass index (BMI) by dividing the patient’s weight in kilograms by the square of the patient’s height in meters. We defined obesity as a BMI more than 30.
Surgical Technique: Nitinol alloys contain more nickel than do stainless steels. Nitinol is metallurgical an inter-metallic mix and not an alloy, and the bonding force of nickel to titanium is much stronger in Nitinol than in alloy stainless steel components. The Nitinol clips are made of Nitinol alloy (Nitillium Research SRL, Napoli, Italy), with a special design for sternal closure (Figure 1) and, occur at the following temperatures: temperature manipulation less than 8 0C; temperature memory arise effect greater than 27 0C; and austenite ﬁnish temperature 35 0C. The clips are available in eight sizes between the from 22.5 mm to 40 mm. Sternal osteosynthesis may obtain with three Nitinol clips located at the second, ﬁfth, and sixth intercostal spaces. Electrocautery is used to create a hole through the intercostal space to store the clip, and attention should be used to avoid harming the internal thoracic arteries (Figure 2). To between the keep the sternum closed, loops are placed through intercostal spaces; otherwise, two Backaus forceps may be used. When the two parts of the sternum are put together, it is possible to measure the distance between intercostal spaces. This procedure is necessary to choose the clip size, which must be 7 to 8 mm smaller than the measured size (clip size range, 2.25 to 4 cm). The clip is then cooled with ice, and set on specific forceps of the patient. Cooling less 8 0C makes the clip highly malleable and easy to situate into the intercostal space (Figure 3). Finally, the clip is heated with warm water. If a new sternotomy is required, clips can easily be removed by cooling and by using specific forceps, as the Nitinol clip does not integrate in bone.
Results: The demographic profiles and risk factors were demonstrated in table 1. All patients presented non-infective sterna dehiscence and underwent secondary sternal closure procedure. Nitinol clips were used for sternal closure. Two major respiratory complications developed early postoperative period requiring prolonged intensive care unit and hospital stay. 3 patients with a single risk factor developed sternal dehiscence; 3 patients with 2 risk factors had sternal dehiscence; 4 patients with 3 risk factors had sternal dehiscence. Before the secondary sternal closure procedure, the average value FEV1 of the patients were 46,4±12,3 and after the procedure, the average value FEV1 56,6±11,3. FEV1 values of the patient were an improvement after surgery. Postoperatively 3 months follow-up period no recurrent sternal dehiscences were observed of all patients
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