Stabilizing the Sternum in High-Risk Patients
At Sanger Heart & Vascular Institute, we’re seeing more and more patients who face an increased risk that their sternum won’t heal properly after surgery because of risk factors like smoking, obesity, diabetes and pulmonary disease.
We’re also seeing a lot of patients from across the region who come to us when their chest wounds need to be repaired because it didn’t heal properly after their original surgery.
That’s why Jeko Madjarov, MD, and his colleagues spent six years developing a new device – called longitudinal sternal stabilization (LSS) – that uses polymer plates and wire to stabilize the sternum and improve quality of life.
Which Patients Can LSS Help?
The standard of care is to wire the sternum closed after open heart surgery, often via the “Robicsek weave” technique developed at Sanger more than 30 years ago. But traditional wire closure doesn’t always work because risk factors like smoking, obesity, diabetes and pulmonary disease can weaken bone. This makes it easier for the wire to cut through the sternum as it’s subjected to everyday forces like breathing, coughing and lifting.
Dr. Madjarov designed LSS to solve this problem so high-risk patients can heal properly after their first surgery. LSS can also help patients who had surgery months – or years – ago and need to have their sternum repaired and stabilized.
Our team is also applying LSS to more difficult clinical scenarios. Dr. Madjarov and his colleagues are using the device to repair sternal dehiscence in the presence of infection. And they just started using LSS in patients with traumatically fractured sternums – potentially accelerating recoveries and significantly reducing the need for pain medications.
How LSS Improves Outcomes
The groundbreaking device reinforces each side of the sternum with plates made of PEEK – an extremely strong polymer that flexes and bends like bone. Surgeons screw these plates into the sternum and then wrap them in wire, with help from specially-designed grooves that lock the wire in place. Then the wire disperses force onto the plates and screws, instead of onto the bone.
This lets surgeons use more force to pull the sternum back together, which promotes healing and helps keep the sternum stable. And the polymer plates prevent the wire from cutting through the bone over time.
Dr. Madjarov was the first to implant the device, which was approved by the FDA in 2016, and has trained surgeons from across the country on how to use it.
“LSS has been used in more than 2,000 patients at centers nationwide, and we’re seeing that it successfully stabilizes the sternum, prevents bone fragmentation and significantly improves quality of life,” he says.
Unique Expertise in Sternal Repair
Because Sanger has some of the region’s highest volumes, our surgeons have extensive experience with high-risk patients. We understand their needs and can develop a plan that gives them the best chance at a good outcome – while minimizing risk of sternal nonunion.
We also have decades of experience repairing chest wounds and have treated more than 100 patients with LSS. These patients come to us from across the region when their sternum doesn’t heal after a previous surgery. We can help them achieve the best possible outcome – even when their bone is weak and prior reconstructions have failed.
To refer a patient, call 704-446-2145.