SynthesisEuropean journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery2025
Sternal Complications After Clamshell Surgery for (Heart-)Lung Transplantation-A Systematic Literature Review.
Synthesis in European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesBilateral transverse thoracosternotomy ("clamshell") is widely used for (heart-)lung transplantations, but postoperative sternal complications are a significant challenge. The primary objective of this systematic review was to evaluate the prevalence of sternal complications after clamshell surgery in (heart-)lung transplantation patients.
methodsA systematic literature review was conducted. On April 4, 2025, PubMed and Embase databases were searched. Original studies reporting sternal complications after clamshell surgery in adults for bilateral lung or heart-lung transplantation were included. Studies including <10 patients were excluded. Study quality was assessed using the National Institutes of Health assessment tool. The total and range of sternal complication prevalence was provided. Meta-analysis of sternal complication prevalence was not performed due to significant heterogeneity across studies.
resultsThe database searches yielded 945 eligible articles. Eighteen studies were included, including 828 patients who underwent a total of 830 bilateral lung or heart-lung transplantations through clamshell surgery. All included studies were cohort studies with poor (n = 15), fair (n = 1), or good (n = 2) quality. In total, 286 sternal complications were reported (0.34 event per clamshell surgery; range 0.02 to 1.35 in individual studies) and 90 sternal reoperations were conducted (0.14 reoperation per clamshell surgery; range 0.02 to 0.29 in individual studies).
conclusionsDespite limitations in study quality and heterogeneity, this review highlights the high prevalence and relevance of sternal complications following clamshell surgery for (heart-)lung transplantation. Future studies should focus on patient selection, risk stratification, development of modified sternal closure techniques, and implementation of alternative surgical approaches to (heart-)lung transplantation.
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