An Evaluation of Rigid Sternal Fixation in Supporting Bone Healing and Improving Postoperative Recovery

NCT ID: NCT01783483

Last Updated: 2017-09-08

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

236 participants

Study Classification

INTERVENTIONAL

Study Start Date

2013-01-31

Study Completion Date

2016-12-31

Brief Summary

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The primary objective of this study is to evaluate sternal bone healing following a full median sternotomy versus standard of care for sternal closure with wire cerclage. Additional outcomes on post-operative pain and analgesic usage, patient function and quality of life, and complications will also be collected. A health economics study will also be conducted, in which cost and billing data will be collected from sites participating in this clinical study.

Detailed Description

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Rigid sternal fixation with the BIOMET SternaLock Blu Sternal Closure System may result in greater sternal stability that leads to superior sternal bone healing, less postoperative pain and narcotic usage, and improved functional outcomes compared to wire cerclage. The health economics analysis is an interesting component of this study, in which cost and billing data will be collected from participating sites and analyzed in terms of cost/effectiveness for patients and healthcare system.

Conditions

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Coronary Artery Disease Angina Pectoris Cardiac Valve Disease

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

SINGLE

Participants

Study Groups

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Suture Wire

The closure technique should be per surgeon and institutional preference, with documentation of the wiring technique including the wiring configuration and number of wires used. A minimum of 6 wires that cross the midline sternotomy should be used (e.g. 6 simple wires, 3 double wires, 3 figure of 8 wires, etc.).

Group Type ACTIVE_COMPARATOR

Suture Wire

Intervention Type DEVICE

Closure system wire-based used to approximate the two halfs of the sternum following a median sternotomy.

SternaLock Blu closure system

Patients will receive treatment option for sternal closure with the SternaLock Blue closure system at a minimum of 2 "X" plates on the sternal body and 1 "L" plate (or equivalent) on the manubrium. This technique is the standard configuration for this study, and is intended to ensure that at least 3 plates are used to achieve adequate fixation and stability, while allowing for variations in the plating configuration as a result of patient anatomy and surgeon preference. Various Sternal Blu plates may be used on the manubrium as described below, as can an additional plate on the sternal body.

Group Type EXPERIMENTAL

SternaLock Blue closure system

Intervention Type DEVICE

SternaLock Blue closure system is a primary closure system plate-based

Interventions

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SternaLock Blue closure system

SternaLock Blue closure system is a primary closure system plate-based

Intervention Type DEVICE

Suture Wire

Closure system wire-based used to approximate the two halfs of the sternum following a median sternotomy.

Intervention Type DEVICE

Other Intervention Names

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SternaLock, SternalBlu

Eligibility Criteria

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Inclusion Criteria

* Patients undergoing a full standard midline sternotomy as a result of a cardiac surgical procedure (i.e. coronary artery bypass graft (CABG) and/or valve replacement along with other cardiac surgical procedures)
* Patients admitted to the hospital the day of or the day before their scheduled surgical procedure
* Patients ≥ 18 years of age
* Patients with a BMI \< 40

Exclusion Criteria

Pre-operative

* Patients with endstage renal failure who are on dialysis
* Patients with severe chronic obstructive pulmonary disease (COPD) (FEV1 \< 50% or patients on on-home oxygen)
* Patients on prescribed pre-operative narcotics
* Patients taking chronic steroids, biologics acting as immunosuppressants (e.g. Enbrel (etanercept), Humira (adalimumab), Remicade (infliximab), or chemotherapeutics (iv or oral chemotherapeutics for cancer). Patients using a steroid inhaler for asthma should not be excluded.
* Patients with an active infection as defined by a positive culture
* Patients with foreign body sensitivity
* Patients with mental or neurologic conditions who are unwilling or incapable of following postoperative care instructions
* Patients defined within the New York Heart Association (NYHA) or Canadian Cardiovascular Society (CCS) functional Class IV for congestive heart failure: i.e., patients with cardiac disease resulting in inability to carry on any physical activity without discomfort (CCS ; NYHA)
* Patients presenting emergent/salvage cardiac acuity as defined per the Society of Thoracic Surgeons (STS) guidelines: i.e., patients undergoing cardiopulmonary resuscitation en route to the operating room or prior to induction of anesthesia (STS)
* Patients unwilling or unable to return for follow-up

Operative

* Patients requiring delayed sternotomy closure
* Patients with an off-midline sternotomy reducing the bony margin between a SternaLock screw body and an osteotomy to within 2mm or less
* Patients presenting intra-operative conditions that in the opinion of the treating surgeon would require or preclude the use of either wire cerclage or rigid fixation, or who are not able to be plated or wired per the protocol (e.g. patients who in the opinion of the surgeon have insufficient quantity of quality of sternal bone; redo sternotomy with excessive fibrous tissue)
* Use of non resorbable (beeswax) bonewax
* Intraoperative death prior to device placement
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Zimmer Biomet

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Keith B Allen, M.D.

Role: PRINCIPAL_INVESTIGATOR

St Luke's Mid America and Vascular Institute

Locations

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Mayo Clinic Jacksonville

Jacksonville, Florida, United States

Site Status

Florida Hospital

Orlando, Florida, United States

Site Status

Emory University

Atlanta, Georgia, United States

Site Status

Franciscan St. Francis Health

Indianapolis, Indiana, United States

Site Status

University of Louisville

Louisville, Kentucky, United States

Site Status

United Heart & Vascular Clinic, United Hospital, part of Allina Health

Saint Paul, Minnesota, United States

Site Status

Saint Luke's Mid America Heart and Vascular Institute

Kansas City, Missouri, United States

Site Status

Columbia University Medical Center

New York, New York, United States

Site Status

Lenox Hill Hospital

New York, New York, United States

Site Status

University of Toledo

Toledo, Ohio, United States

Site Status

Temple University Hospital

Philadelphia, Pennsylvania, United States

Site Status

Scott & White Memorial Hospital

Temple, Texas, United States

Site Status

Countries

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United States

References

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Bennett-Guerrero E, Phillips-Bute B, Waweru PM, Gaca JG, Spann JC, Milano CA. Pilot study of sternal plating for primary closure of the sternum in cardiac surgical patients. Innovations (Phila). 2011 Nov;6(6):382-8. doi: 10.1097/IMI.0b013e318248fbda.

Reference Type BACKGROUND
PMID: 22436774 (View on PubMed)

Casha AR, Yang L, Kay PH, Saleh M, Cooper GJ. A biomechanical study of median sternotomy closure techniques. Eur J Cardiothorac Surg. 1999 Mar;15(3):365-9. doi: 10.1016/s1010-7940(99)00014-7.

Reference Type BACKGROUND
PMID: 10333037 (View on PubMed)

Chou SS, Sena MJ, Wong MS. Use of SternaLock plating system in acute treatment of unstable traumatic sternal fractures. Ann Thorac Surg. 2011 Feb;91(2):597-9. doi: 10.1016/j.athoracsur.2010.07.083.

Reference Type BACKGROUND
PMID: 21256325 (View on PubMed)

Raman J, Lehmann S, Zehr K, De Guzman BJ, Aklog L, Garrett HE, MacMahon H, Hatcher BM, Wong MS. Sternal closure with rigid plate fixation versus wire closure: a randomized controlled multicenter trial. Ann Thorac Surg. 2012 Dec;94(6):1854-61. doi: 10.1016/j.athoracsur.2012.07.085. Epub 2012 Oct 25.

Reference Type BACKGROUND
PMID: 23103010 (View on PubMed)

Hirose H, Yamane K, Youdelman BA, Bogar L, Diehl JT. Rigid sternal fixation improves postoperative recovery. Open Cardiovasc Med J. 2011;5:148-52. doi: 10.2174/1874192401105010148. Epub 2011 Jul 4.

Reference Type BACKGROUND
PMID: 21760857 (View on PubMed)

Neaman KC, Blount AL, Kim JA, Renucci JD, Hooker RL. Prophylactic sternal plating with pectoralis advancement flaps after sternotomy in patients with a history of chest irradiation. Interact Cardiovasc Thorac Surg. 2011 Mar;12(3):355-8. doi: 10.1510/icvts.2010.247262. Epub 2010 Dec 7.

Reference Type BACKGROUND
PMID: 21138917 (View on PubMed)

Snyder CW, Graham LA, Byers RE, Holman WL. Primary sternal plating to prevent sternal wound complications after cardiac surgery: early experience and patterns of failure. Interact Cardiovasc Thorac Surg. 2009 Nov;9(5):763-6. doi: 10.1510/icvts.2009.214023. Epub 2009 Aug 26.

Reference Type BACKGROUND
PMID: 19710069 (View on PubMed)

Lee JC, Raman J, Song DH. Primary sternal closure with titanium plate fixation: plastic surgery effecting a paradigm shift. Plast Reconstr Surg. 2010 Jun;125(6):1720-1724. doi: 10.1097/PRS.0b013e3181d51292.

Reference Type BACKGROUND
PMID: 20517097 (View on PubMed)

Shifrin DA, Sohn SM, Stouffer CW, Hooker RL, Renucci JD. Sternal salvage with rigid fixation in the setting of a massive mediastinal aortic pseudoaneurysm: a case report and review of the literature. J Plast Reconstr Aesthet Surg. 2008 Oct;61(10):e17-20. doi: 10.1016/j.bjps.2007.09.022. Epub 2007 Nov 26.

Reference Type BACKGROUND
PMID: 18033747 (View on PubMed)

Raman J, Straus D, Song DH. Rigid plate fixation of the sternum. Ann Thorac Surg. 2007 Sep;84(3):1056-8. doi: 10.1016/j.athoracsur.2006.11.045.

Reference Type BACKGROUND
PMID: 17720442 (View on PubMed)

Raman J, Song DH, Bolotin G, Jeevanandam V. Sternal closure with titanium plate fixation--a paradigm shift in preventing mediastinitis. Interact Cardiovasc Thorac Surg. 2006 Aug;5(4):336-9. doi: 10.1510/icvts.2005.121863. Epub 2006 Apr 25.

Reference Type BACKGROUND
PMID: 17670585 (View on PubMed)

Dickie SR, Dorafshar AH, Song DH. Definitive closure of the infected median sternotomy wound: a treatment algorithm utilizing vacuum-assisted closure followed by rigid plate fixation. Ann Plast Surg. 2006 Jun;56(6):680-5. doi: 10.1097/01.sap.0000202825.41069.c3.

Reference Type BACKGROUND
PMID: 16721085 (View on PubMed)

Song DH, Lohman RF, Renucci JD, Jeevanandam V, Raman J. Primary sternal plating in high-risk patients prevents mediastinitis. Eur J Cardiothorac Surg. 2004 Aug;26(2):367-72. doi: 10.1016/j.ejcts.2004.04.038.

Reference Type BACKGROUND
PMID: 15296898 (View on PubMed)

Song DH, Agarwal JP, Jeevanandam V. Rigid sternal fixation in the cardiac transplant population. J Thorac Cardiovasc Surg. 2003 Sep;126(3):896-7. doi: 10.1016/s0022-5223(03)00605-6. No abstract available.

Reference Type BACKGROUND
PMID: 14502187 (View on PubMed)

Pai S, Gunja NJ, Dupak EL, McMahon NL, Roth TP, Lalikos JF, Dunn RM, Francalancia N, Pins GD, Billiar KL. In vitro comparison of wire and plate fixation for midline sternotomies. Ann Thorac Surg. 2005 Sep;80(3):962-8. doi: 10.1016/j.athoracsur.2005.03.089.

Reference Type BACKGROUND
PMID: 16122464 (View on PubMed)

Related Links

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Other Identifiers

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SLBlu

Identifier Type: OTHER

Identifier Source: secondary_id

0712

Identifier Type: -

Identifier Source: org_study_id

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