Factors influencing sternal healing and comparison of different sternal closure methods: a retrospective analysis

Background We determined the factors affecting sternum healing after a median sternotomy based on a retrospective analysis; additionally, we compared the stability of different sternal closure techniques. Methods We collected information involving patients who underwent a median sternotomy in Changzhou First People's Hospital from 2014–2019 and who had chest CT examinations at 1–24 months post-operation. The main outcome included the average sternal healing score at the five specific anatomic levels and adverse events of transverse displacement of the sternum. Results In the short-term healing group, the sternal score was only correlated with postoperative time (HR = 0.18, 95% CI: 0.135–0.225, p < 0.001). In the long-term healing group, older people had a higher risk of poor sternal healing than young people (age, HR=-0.028, 95% CI: -0.05–0.006, p = 0.013). Patients with left internal mammary artery dissociation (LIMA-d) had a high risk of poor sternal healing (HR=-0.444, 95% CI: -0.869-0.019, p = 0.045). The binary logistic regression showed that steel wire fixation was a favorable factor for preventing transverse displacement of the sternum (HR = 0.122, 95% CI: 0.007–0.651, p = 0.047). Conclusion In summary, advanced age and internal mammary artery interception are risk factors that affect sternal healing, based on the imaging findings. This new method of sternal closure provides an effective way of ensuring sternal stability of both sternal plates and reduces the risk for complications after cardiac surgery in high-risk patients.