{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T08:48:32Z","timestamp":1775810912252,"version":"3.50.1"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2024,3,26]],"date-time":"2024-03-26T00:00:00Z","timestamp":1711411200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p\/>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>Midline sternotomy is the main surgical access for cardiac surgeries. The most prominent complication of sternotomy is sternal wound infection (SWI). The use of a thorax support vest (TSV) that limits thorax movement and ensures sternal stability has been suggested to prevent postoperative SWI.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>We performed a meta-analysis to evaluate differences in clinical outcomes with and without the use of TSV after cardiac surgery in randomized trials. The primary outcome was deep SWI (DSWI). Secondary outcomes were superficial SWI, sternal wound dehiscence, and hospital length of stay (LOS). A trial sequential analysis was performed. Fixed (F) and random effects (R) models were calculated.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>A total of 4 studies (3820 patients) were included. Patients who wore the TSV had lower incidence of DSWI [odds ratio (OR) = F: 0.24, 95% confidence interval (CI), 0.13\u20130.43, P\u2009&amp;lt;\u20090.01; R: 0.24, 0.04\u20131.59, P\u2009=\u20090.08], sternal wound dehiscence (OR = F: 0.08, 95% CI, 0.02\u20130.27, P\u2009&amp;lt;\u20090.01; R: 0.10, 0.00\u20132.20, P\u2009=\u20090.08) and shorter hospital LOS (standardized mean difference = F: \u22120.30, \u22120.37 to \u22120.24, P\u2009&amp;lt;\u20090.01; R: \u22120.63, \u22121.29 to 0.02, P\u2009=\u20090.15). There was no difference regarding the incidence of superficial SWI (OR = F: 0.71, 95% CI, 0.34\u20131.47, P\u2009=\u20090.35; R: 0.64, 0.10, 4.26, P\u2009=\u20090.42). The trial sequential analysis, however, showed that the observed decrease in DSWI in the TSV arm cannot be considered conclusive based on the existing evidence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>This meta-analysis suggests that the use of a TSV after cardiac surgery could potentially be associated with a reduction in sternal wound complications. However, despite the significant treatment effect in the available studies, the evidence is not solid enough to provide strong practice recommendations.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/icvts\/ivae055","type":"journal-article","created":{"date-parts":[[2024,3,26]],"date-time":"2024-03-26T20:05:46Z","timestamp":1711483546000},"source":"Crossref","is-referenced-by-count":2,"title":["Thorax support vest to prevent sternal wound infections in cardiac surgery patients\u2014a systematic review and meta-analysis"],"prefix":"10.1093","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5697-2659","authenticated-orcid":false,"given":"Tulio","family":"Caldonazo","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University , Jena,","place":["Germany"]},{"name":"Department of Cardiothoracic Surgery, Weill Cornell Medicine , New York, NY,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michele","family":"Dell\u2019Aquila","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Weill Cornell Medicine , New York, NY,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianmarco","family":"Cancelli","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Weill Cornell Medicine , New York, NY,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1500-1308","authenticated-orcid":false,"given":"Lamia","family":"Harik","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Weill Cornell Medicine , New York, NY,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni Jr","family":"Soletti","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Weill Cornell Medicine , New York, NY,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes","family":"Fischer","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University , Jena,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hristo","family":"Kirov","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University , Jena,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed","family":"Rahouma","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Weill Cornell Medicine , New York, NY,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mudathir","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Maimonides Medical Center , Brooklyn, NY,","place":["USA"]},{"name":"Nuffield Department of Surgical Sciences, University of Oxford , Oxford,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4997-7707","authenticated-orcid":false,"given":"Michelle","family":"Demetres","sequence":"additional","affiliation":[{"name":"Samuel J. Wood Library & CV Starr Biomedical Information Center, Weill Cornell Medicine , New York, NY,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin R","family":"An","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Weill Cornell Medicine , New York, NY,","place":["USA"]},{"name":"Division of Cardiac Surgery, Department of Surgery, University of Toronto , Toronto, ON,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leonard","family":"Girardi","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Weill Cornell Medicine , New York, NY,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6411-909X","authenticated-orcid":false,"given":"Torsten","family":"Doenst","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University , Jena,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4680-0815","authenticated-orcid":false,"given":"Mario","family":"Gaudino","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Weill Cornell Medicine , New York, NY,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,3,26]]},"reference":[{"key":"2025030512153645800_ivae055-B1","doi-asserted-by":"crossref","first-page":"mmv017","DOI":"10.1093\/mmcts\/mmv017","article-title":"Median sternotomy","volume":"2015","author":"Reser","year":"2015","journal-title":"MMCTS"},{"key":"2025030512153645800_ivae055-B2","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.hrtlng.2022.04.013","article-title":"Risk factors for post sternotomy wound complications across the patient journey: a systematised review of the literature","volume":"55","author":"Morrell","year":"2022","journal-title":"Heart Lung"},{"key":"2025030512153645800_ivae055-B3","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.2214\/AJR.18.19782","article-title":"Poststernotomy complications: a multimodal review of normal and abnormal postoperative imaging findings","volume":"211","author":"Hota","year":"2018","journal-title":"AJR Am J Roentgenol"},{"key":"2025030512153645800_ivae055-B4","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1093\/icvts\/ivs554","article-title":"Wound complications after median sternotomy: a single-centre study","volume":"16","author":"Heilmann","year":"2013","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2025030512153645800_ivae055-B5","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1055\/s-0031-1275168","article-title":"Overview and management of sternal wound infection","volume":"25","author":"Singh","year":"2011","journal-title":"Semin Plast Surg"},{"key":"2025030512153645800_ivae055-B6","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1016\/j.jtcvs.2016.01.060","article-title":"Prevention and management of sternal wound infections","volume":"152","author":"Lazar","year":"2016","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025030512153645800_ivae055-B7","doi-asserted-by":"crossref","first-page":"291","DOI":"10.5999\/aps.2018.01151","article-title":"Deep sternal wound infections: evidence for prevention, treatment, and reconstructive surgery","volume":"46","author":"Schiraldi","year":"2019","journal-title":"Arch Plast Surg"},{"key":"2025030512153645800_ivae055-B8","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1086\/646436","article-title":"CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections","volume":"13","author":"Horan","year":"1992","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2025030512153645800_ivae055-B9","doi-asserted-by":"crossref","first-page":"383","DOI":"10.4097\/kja.21218","article-title":"Explanation of trial sequential analysis: using a post-hoc analysis of meta-analyses published in Korean Journal of Anesthesiology","volume":"74","author":"Cassai","year":"2021","journal-title":"Korean J Anesthesiol"},{"key":"2025030512153645800_ivae055-B10","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1093\/icvts\/ivw270","article-title":"Do external support devices reduce sternal wound complications after cardiac surgery?","volume":"23","author":"Tsang","year":"2016","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2025030512153645800_ivae055-B11","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1093\/icvts\/ivz088","article-title":"Total arterial myocardial revascularization using bilateral internal mammary arteries and the role of postoperative sternal stabilization to reduce wound infections in a large cohort study","volume":"29","author":"Albert","year":"2019","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2025030512153645800_ivae055-B12","doi-asserted-by":"crossref","first-page":"25","DOI":"10.5761\/atcs.oa.19-00293","article-title":"Prevention of sternal wound infections in women using an external sternum fixation corset","volume":"27","author":"Selten","year":"2021","journal-title":"Ann Thorac Cardiovasc Surg"},{"key":"2025030512153645800_ivae055-B13","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1007\/s12055-018-0686-3","article-title":"A review of the AATS guidelines for the prevention and management of sternal wound infections","volume":"34","author":"Lazar","year":"2018","journal-title":"Indian J Thorac Cardiovasc Surg"},{"key":"2025030512153645800_ivae055-B14","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1111\/iwj.13324","article-title":"Deep sternal wound infection following cardiac surgery: a comparison of the monolateral with the 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support vest (corset) in preventing mechanical complications of median sternotomy","volume":"6","author":"Caimmi","year":"2017","journal-title":"Cardiol Ther"},{"key":"2025030512153645800_ivae055-B21","doi-asserted-by":"crossref","first-page":"1398","DOI":"10.1016\/j.jtcvs.2011.01.042","article-title":"Sternal dehiscence in patients with moderate and severe chronic obstructive pulmonary disease undergoing cardiac surgery: the value of supportive thorax vests","volume":"141","author":"Celik","year":"2011","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025030512153645800_ivae055-B22","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1093\/icvts\/ivt240","article-title":"Prevention of sternal wound complications after sternotomy: results of a large prospective randomized multicentre trial","volume":"17","author":"Gorlitzer","year":"2013","journal-title":"Interact CardioVasc Thorac 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