Our Summary

This study compared two types of minimally invasive heart valve surgery: hemi-sternotomy (a small cut in the chest) and right anterolateral thoracotomy (a cut on the side of the chest). 90 patients who underwent these surgeries between 2019 and 2022 were studied.

The patients were divided into two groups: 36 had the hemi-sternotomy and 54 had the right anterolateral thoracotomy. There were no deaths or serious bleeding in the hemi-sternotomy group. However, in the other group, one patient died due to heart failure after the surgery and another suffered a leg artery injury.

The time taken for the surgery and time on heart-lung machine (a machine that takes over the function of the heart and lungs during surgery) were lower in the hemi-sternotomy group. However, recovery time, hospital stay and blood transfusion needs were similar for both groups.

The levels of certain heart-related proteins in the blood increased after surgery in both groups, but more so in the right anterolateral thoracotomy group. By the fifth day after surgery, these protein levels had dropped significantly in both groups.

The researchers concluded that both types of surgery are safe and effective, and that patients can benefit from these minimally invasive techniques. They also suggested that surgeons can easily learn these procedures.

FAQs

  1. What are the two types of minimally invasive heart valve surgeries compared in this study?
  2. How did the outcomes and recovery times for patients compare between the hemi-sternotomy and right anterolateral thoracotomy procedures?
  3. What did the researchers conclude about the safety and effectiveness of these two types of surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about sternotomy is to follow the post-operative care instructions carefully to promote proper healing and minimize the risk of complications. This may include avoiding certain activities that could put strain on the chest, taking prescribed medications as directed, attending follow-up appointments, and following a healthy lifestyle to support recovery. It is also important to communicate any concerns or symptoms to your healthcare provider promptly.

Suitable For

Patients who are typically recommended sternotomy are those who require heart valve surgery and are considered suitable candidates for minimally invasive techniques. These patients may include those with conditions such as valvular heart disease, aortic stenosis, mitral regurgitation, or other heart valve abnormalities. Patients who are at a lower risk for complications and have a good overall health status may also be considered for sternotomy. Additionally, patients who prefer a smaller incision and potentially faster recovery time may also be recommended for sternotomy.

Timeline

Before sternotomy:

  1. Patient undergoes preoperative evaluation and testing to determine the need for surgery.
  2. Patient is admitted to the hospital on the day of surgery.
  3. Patient is prepared for surgery, including anesthesia administration and placement of monitoring devices.
  4. Surgeon makes an incision along the sternum to access the heart.
  5. Surgery is performed to repair or replace the heart valve.
  6. Patient is taken off the heart-lung machine and sternum is closed.
  7. Patient is transferred to the intensive care unit for monitoring and recovery.

After sternotomy:

  1. Patient is monitored closely for any complications or adverse reactions.
  2. Patient is gradually weaned off mechanical ventilation and pain medication.
  3. Physical therapy and mobilization begin to prevent complications such as pneumonia or blood clots.
  4. Patient is discharged from the hospital once stable and able to care for themselves at home.
  5. Follow-up appointments are scheduled to monitor recovery and assess the success of the surgery.
  6. Patient may need cardiac rehabilitation to improve heart function and overall health.
  7. Long-term follow-up is necessary to monitor the heart valve and overall heart health.

What to Ask Your Doctor

  1. What is the difference between a hemi-sternotomy and a right anterolateral thoracotomy in terms of the surgical procedure and recovery process?

  2. What are the potential risks and complications associated with each type of surgery, particularly in relation to the heart and surrounding structures?

  3. How does the use of a heart-lung machine during surgery impact the overall outcome and recovery process for the patient?

  4. Are there any specific criteria or factors that make a patient a better candidate for one type of minimally invasive heart valve surgery over the other?

  5. How long can I expect to be in the hospital following either a hemi-sternotomy or a right anterolateral thoracotomy, and what is the typical recovery timeline for each procedure?

  6. What follow-up care or monitoring will be required after the surgery, and how often should I expect to see my healthcare provider for check-ups and evaluations?

  7. Are there any lifestyle changes or restrictions that I should be aware of following the surgery, and how soon can I expect to return to my normal daily activities?

  8. What are the long-term outcomes and success rates associated with both types of minimally invasive heart valve surgery, and what factors may affect these outcomes over time?

  9. Are there any ongoing research or advancements in minimally invasive heart valve surgery that I should be aware of, and how might these impact my treatment in the future?

  10. Can you provide me with any additional resources or information to help me better understand the benefits and risks of undergoing a hemi-sternotomy or a right anterolateral thoracotomy for my specific condition?

Reference

Authors: Zhang L, Pan Q, Huang S, Xu Z. Journal: Altern Ther Health Med. 2023 Nov;29(8):97-101. PMID: 37535923