Analysis of the outcomes of figure-of-eight and double-loop sternal-closure (FUSION) techniques

Aim: To assess the benefit of a modified sternal closure (Figure-of-eight and double-loop sternal-closure, FUSION) versus conventional figure-of-eight wiring (FEW) technique in reducing sternal instability in obese patients undergoing coronary artery bypass grafting (CABG). Material and Methods: We retrospectively analyzed 90 obese (body mass index ≥30 kg/m²) patients who underwent elective isolated CABG under median sternotomy between January 2023 and January 2024 at the Ankara Bilkent City Hospital. Patients were divided into two groups based on the sternal closure technique employed: 48 patients in the FEW groups and 42 patients in the FUSION group. Clinical follow-ups were conducted for two months postoperatively, and sternal instability was assessed through clinical examination, chest X-rays, and thoracic CT scans when necessary. Results: Demographic and perioperative variables were similar among groups. Sternal instability occurred more frequently in patients in the FEW group (10.4%) than in those in the FUSION group (2.3%; p =0.001). Multivariate analysis showed that FEW technique (OR: 3.5; 95% CI: 2.4-5.3; p = 0.001), COPD (OR: 3.5; 95% CI: 2.2-4.4; p = 0.05), DM (OR: 2.3; 95% CI: 1.3-4.1; p = 0.05), postoperative delirium (3.2; 95% CI: 2.1-4.8; p = 0.01) and female gender (OR: 2.4; 95% CI: 1.8-5.5; p = 0.02) were all independent factors for sternal instability. Conclusion: The FUSION technique significantly reduced sternal instability in obese patients compared to the FEW techniques, indicating its potential as an effective preventive measure for high-risk populations.