ZipFix sternal closure system – single-centre experience in 20 patients and how to use it

Objectives: Median sternotomy is still the main access for cardiac surgery. Despite the “gold” standard of closing the sternum using single steel wires, there are tremendous different sternum closure systems available (“clips”, “screws and plates”, etc.). We present our experience with the ZipFix sternal closure system (Synthes) for primary sternal closure and a video how to use it. The ZipFix system is a biocompatible zip tie (polyetheretherketon) with a large area of contact between the zip and the sternum with an increase of carrying capacity and sternal stability. The technique for sternal closure is almost similar to using single steel wires. Methods: Between May 2011 and September 2011 twenty consecutive patients were operated on CABG (coronary artery bypass grafting) and CABG combined with AVR (aortic valve replacement) using the ZipFix sternal closure system (Synthes). Results: All primary sternal closures were successful using the ZipFix sternal closure system (Synthes) (figure 1). Eleven patients received only the ZipFix sternal closure system while in nine patients additional steel wires were used for the manubrium sterni. The mean age was 78.0 years for eight female patients with a mean BMI of 28.5 and 70.5 years for twelve male patients with a mean BMI of 28.7, respectively. Only one patient received a superficial site wound infection postoperatively. The sternal closure time was slightly extended by approximately 5 minutes compared to standard technique. The costs for this new sternal closure device are twofold compared to steel wires. Conclusions: The ZipFix system (Synthes) is a new, safe and easy to use sternal closure system with a large area of contact between the zip and the sternum to increase sternal stability. A combination of steel wires and the ZipFix system is possible for sternal closure. In future, we will use the ZipFix system for primary sternal closure in high risk patients for postoperative sternal wound complications.