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were implemented.
Results: All patients survived the procedure, no major complications occurred and no blood transfusion
was administered. The Cell-saver system (transfused volume: 474±101ml) and synthetic plasma substitutes
(Ringer’s Lactate, 873±367ml and Voluven 700±388ml) were used routinely as well as hemostaticas
such as Bone-Wax (100%) fibrin-glue Tissucol DuoS (21%) and Tabotamp Nu-Knit(29%).
Mean pre-discharge Hk and Hb were 32.2±3.2% and 10.6±1.2g/dl. The decrease of Hk and Hb
appeared to be the lowest after off-pump surgery when compared to all other procedures requiring
cardio-pulmonary bypass (20±6% vs. 33±6%;p=0.01 and 22±9% vs. 34±6%;p=0.04). Similarly, the
decrease of platelets was significantly lower after off-pump surgery (21±12% vs. 45±14%;p=0.01)
and even did not drop below the normal range. Follow-up was completed for all patients with a mean
time of 52±34months. Within this period, only one patient had died for a non-cardiac reason, whereas
all others were alive, in good clinical condition and did not have major adverse cardiac events (MACE)
or recurrent symptoms requiring redo surgery or re-intervention.
Conclusion: Modern peri-operative management leads to excellent short and long-term outcomes in
JW patients. Combined efforts in regard to preoperative haematological parameter optimization, senior
surgical staff, effective intraoperative volume-management and modern surgical techniques make
this possible but raise the cautionary note why this is only possible in JW patients.
23.3
Serious complication with sternal destruction in high risk patients after DSS implantation
B. Winkler, M. Grapow, P. Matt, F. Rueter, F. Eckstein (Basel)
Objective: Sternal instability after median sternotomy occurs infrequently but can be challenging to
repair. DSS( sternal synthesis device), a novel fixation system provided for high risk patients as a primarily
prophylactic device, was evaluated in our clinic according to clinical utilization and postoperative
sternum stability.
Methods: 17 high risk patients undergoing cardiac surgery with multiple known risk factors such as
diabetes, COPD, osteoporosis and obesity with BMI over 35 were treated after median sternotomy by
the novel DSS ( Mikai Spa, Vincenza Italy) system in addition to wires. The DSS consists of separate
Titanium clips sliding into each other for length adjustment, the single vertical arms are placed in the
intercostal space. Finally this system is surrounded by stainless steel wires for reapproximation.
Results: 13 patients (BMI mean 30) showed an uneventful postoperative course. Unfortunately 4 Patients
with extensive obesity (BMI mean 34) presented with a complete traumatic rupture of the sternal
bone at the level of the costal cartilage insertions after coughing. Extensive reconstruction required the
use of a transverse plate refixation system in 3 patients and a musculocutaneous flap in one patient.
Hospitalisation time was significantly prolonged in this cohort (p24hours (12.0% vs.
7.5%;p