Indications and results of sternal allograft transplantation: learning from a worldwide experience

BACKGROUND: Reconstruction of the anterior chest wall defect after sternectomy is a challenge for cardiothoracic surgeons. In 2010 the Padua group published the first case of cadaveric sternum transplantation after sternectomy. This multi-center study reports the clinical indications, early and long-term results of sternal chondral allograft transplantation.METHODS: This is a retrospective multicentre-study from seven Academic-Centres. Demographic data, surgical indications, technical details, early postoperative results were collected. The complications, long-term stability and tolerance of the allografts were also analysed.RESULTS: Between January 2008 and December 2019 58-patients underwent sternectomy followed by reconstruction using cadaveric-cryopreserved sterno-chondral allografts. Thirty-two patients were males, with a median age of 63.5 years(IQR50-72). Indications for sternectomy were secondary sternal tumors(n=13), primary sternal tumors(n=15) and non-neoplastic disease(30). Thirty patients underwent total sternectomy, 16 lower-body sternectomy and 12 upper-body-manubrium resection. The 30-days mortality was 5%. The overall morbidity was 31%. Six early reoperations were necessary because of bleeding(n=1), titanium-plates dislocation(n=1) and re-suture of the skin in the lower part of the incision(n=4). Overall, the 5-year survival was 74%. The surviving patient's reconstructions are stable and free from mechanical or infective complications.CONCLUSIONS: The main indications for sternal allograft implantation were complex post sternotomy dehiscence followed by primary or secondary tumor involvement of the sternum. The collected results demonstrate that sterno-chondral allograft transplantation is a safe and effective method in reconstructing the anterior chest wall after sternectomy. Further studies to demonstrate the integration of the bone grafts into the patient's sternal wall will be made.