eComment. Is the sternal closure technique using titanium hooks and wires cost-effective?

The publication by Kilian et al. proposes a new technique for sternal closure in patients with secondary or additional stabilization [1]. They successfully performed the new technique using titanium hooks and wires in 15 patients and revealed very satisfactory results. The most striking feature was the possible avoidance of substernal dissection in redo cases with sternal instability, thereby decreasing the risk of graft or myocardial/pulmonary injury. We congratulate the authors for their effort and successful results.

We believe that there is one more topic to be emphasized on this subject. It is very well known that substernal dissection in redo cardiac surgery including sternal repair may lead to injury in adjacent structures. In this context, the use of thermoreactive nitinol clips was reported recently by our group [2]. We documented the ease of the technique due to the nature of the material and the parasternal application procedure. Moreover, we also reported the cost-effectiveness of the method. From the early years of cardiac surgery, various reports documenting sternal re-closure techniques have been published. The most frequently employed technique is still the Robicsek weave [3]. It is simple, cheap and objectively effective. The only drawback is the need for substernal re-dissection. In our study, we also compared the costs of sternal re-closure methods avoiding substernal re-dissection. The cost for thermoreactive nitinol clip implantation was $550; $700-1400 for rigid-plate fixation and $8500 for the transverse sternal-plating system. We concluded that thermoreactive nitinol clip implantation was more advantageous. We think that the authors should also have done a cost analysis to provide readers with a possible comparison between the mentioned techniques.

Conflict of interest: none declared.