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.