FLEXIGRIPNew insights in primary

sternal closure : preliminary experience with Nitinol

thermreactive clips

Dr P. Van Ruyssevelt, Department of Cardiovascular and Thoracic Surgery, Centre Hospitalier de Jolimont, Belgium

2nd Thoracic Workshop on Human Cadavers, University of Mons, January 23

Scientific Publications : update

The Use of Nitinol Clips for Primary Sternal Closure in Cardiac SurgeryN. Nikolaidis, D. Karangelis, K. Mattam, G. Tsang and S. OhriAnnals of Thoracic Cardiovascular Surgery. 2013; 19(4):330-4

Nitinol Flexigrip Sternal Closure System and Chest Wound Infections : Insight from A Comparative Analysis of Complications and CostsJ. Bejko, V. Tarzia, M. De Franceschi, R. Bianco, M. Castoro, T. Bottio, G. GerosaAnnals of Thoracic Surgery. 2012; 94:1848-53

2nd Thoracic Workshop on Human Cadavers, University of Mons, January 23

Flexigrip® sternal closure system

2nd Thoracic Workshop on Human Cadavers, University of Mons, January 23

Flexigrip® sternal closure system

2nd Thoracic Workshop on Human Cadavers, University of Mons, January 23

Flexigrip® sternal closure system

Thermoreactive alloy of Ni and Ti with memory effect

Becomes malleable at < 100 C Recover its shape when placed at >

250 C

2nd Thoracic Workshop on Human Cadavers, University of Mons, January 23

Flexigrip® : availabe sizes9 available size ranging from 20 mm to 40 mm

2nd Thoracic Workshop on Human Cadavers, University of Mons, January 23

Implantation technique1. Create holes in the 1st, 2nd, 3rd and 4th

intercostal spaces with electrocautery2. Place wires to the manubrium and the

xyphoid process3. At < 100 C the clip becomes

malleable4. Place staples in the 1st, 2nd, 3rd and 4th

intercostal spaces5. Application of warm > 450 C solution

accelerates shape return and sternal edges approximation2nd Thoracic Workshop on Human Cadavers, University of Mons, January 23

Patients2015 N = 12

Median age 68 y ( range 52-82 )

Male gender 75 %

Diabetes 42 %

CABG alone 42 %

Valve alone 42 %

CABG and valve 16 %

2nd Thoracic Workshop on Human Cadavers, University of Mons, January 23

Post-operative X-rays

Post-operative X-rays

Lessons learntMake sure holes are to the periosteumPay attention to bracing of 1st

intercostal spaceDo not cute wires until Flexigrip sizedEmergency resternotomy is not a

problem

2nd Thoracic Workshop on Human Cadavers, University of Mons, January 23

SummaryExternal to sternum : « not-through-

the-bone device »Enhanced ( 4 x ) surface area : lower

stress per mm2

Open « C » design : preserving flexibility and avoiding ischemia

MRI compatible

2nd Thoracic Workshop on Human Cadavers, University of Mons, January 23

Thank you !