OBJECTIVES: To determine the difference in sternal infection and other 
infectious events between conventional wire and cable-tie-based closure 
techniques post-sternotomy in a collective of patients after cardiac surgery.
METHODS: The sternal ZipFix™ (ZF) system consists of a biocompatible 
poly-ether-ether-ketone (PEEK) cable-tie that surrounds the sternum through the 
intercostal space and provides a large implant-to-bone contact. Between 1 
February 2011 and 31 January 2012, 680 cardiac operations were performed via 
sternotomy at our institution. After the exclusion of operations for active 
endocarditis and early mortality within 7 days, 95 patients were exclusively 
closed with ZF and could be compared with 498 who were closed with conventional 
wires (CWs) during the same period. A multivariable logistic regression 
analysis, including body mass index, renal impairment and emergency as suspected 
confounders and inverse propensity weights was performed on the infection rate.
RESULTS: Total infection rate was 6.1%, with a total of 36 diagnosed sternal 
infections (5 in ZF and 31 in CW). Comparing ZF with CW with regard to sternal 
infection, there is no statistically significant difference related to the 
device (odds ratio: 0.067, confidence interval: 0.04-9.16, P=0.72). The 
propensity modelling provided excellent overlap and the mean propensity was 
almost the same in both groups. Thus, we have observed no difference in 
receiving either ZF or CW. No sternal instability was observed with the ZF 
device, unlike 4/31 patients in the CW group. The overall operation time is 
reduced by 11 min in the ZF group with identical perfusion and clamping times.
CONCLUSIONS: Our study underlines a neutral effect of the sternal ZipFix™ system 
in patients regarding sternal infection. Postoperative complications are similar 
in both sternal closure methods. The cable-tie-based system is fast, easy to 
use, reliable and safe.