Objectives: To explore the personalized treatment strategy of sternal fixation and closure of sternal median incision in open cardiac surgery. Methods: A total of 293 patients who underwent open-heart surgery with a median sternal incision at Peking Union Medical College Hospital from January 2019 to March 2021 were divided into two groups, according to the timing and type of treatment. The first 169 patients received single-wire fixation and closure (control group), while the subsequent 124

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... ients received double-wire fixation and closure (study group). The patients were followed up for three months to observe the duration of pain, sternal instability, and occurrence of chest wound infection. Results: The average age was 53±30 years in the control group and 55±34 years in the study group (P = 0.594). There were no significant differences in baseline data between the two groups (P > 0.05). Compared with the control group, the study group had a shorter duration of pain (P < 0.05), smaller drainage volume within three days postoperatively (650 ml vs. 770 ml, P < 0.05), lower incidence of superficial sternal wound infection (2.4% vs. 8.9%, P = 0.042), and lower incidence of sternal instability (1.6% vs. 8.3%, P = 0.026). Deep sternal wound infection occurred in two patients in the control group and none in the study group; however, this difference was not significant. No surgery-related deaths occurred. Conclusions: Selecting the appropriate sternal fixation and closure method, according to the characteristics of patients, can reduce the incidence of sternal incision complications. We proposed a personalized selection strategy for sternal fixation and closure, which requires verification in clinical studies.