Our Summary

This research paper compares two surgical procedures for aortic root and arch surgery: partial upper sternotomy (a less invasive technique) and full sternotomy (a more invasive technique). The study looked at 100 patients who underwent these surgeries between 2013 and 2020, with 73 of them having the less invasive procedure.

The researchers found no significant difference between the two procedures in terms of complications such as kidney failure, stroke, heart attack, and bleeding. However, the less invasive procedure had several advantages. Patients who had partial upper sternotomy needed fewer blood transfusions, had less post-surgery drainage, spent less time on a ventilator, had fewer cases of sepsis, spent less time in intensive care, and had shorter hospital stays. There was one case of a patient having to be converted to the more invasive procedure due to heavy bleeding.

In summary, the less invasive partial upper sternotomy is a safe and feasible option for aortic root and arch surgery. It has similar risk levels to the full sternotomy, but offers several advantages such as less blood loss, faster recovery times, and shorter hospital stays.

FAQs

  1. What are the key differences between partial upper sternotomy and full sternotomy procedures for aortic root and arch surgery?
  2. What are the advantages of the less invasive partial upper sternotomy compared to the full sternotomy?
  3. Were there any significant complications found in the study between the two procedures?

Doctor’s Tip

A helpful tip a doctor might give a patient about sternotomy is to discuss with them the possibility of undergoing a less invasive partial upper sternotomy for aortic root and arch surgery. This procedure has been shown to have similar risk levels as a full sternotomy but offers advantages such as less blood loss, faster recovery times, and shorter hospital stays. It is important for patients to be informed about their options and discuss with their healthcare provider what may be the best choice for their individual situation.

Suitable For

Patients who are typically recommended for a partial upper sternotomy procedure are those who require aortic root and arch surgery but are considered to be at lower risk for complications. These may include patients with conditions such as aortic aneurysms, aortic dissection, aortic valve disease, or other structural heart problems. Patients who are younger, have fewer comorbidities, and are in overall good health may also be good candidates for this less invasive approach. Additionally, patients who have a preference for a smaller incision and faster recovery times may also be more inclined towards a partial upper sternotomy procedure.

Timeline

Before sternotomy:

  1. Patient undergoes preoperative assessments including medical history, physical examination, and diagnostic tests.
  2. Patient receives anesthesia before the surgery.
  3. Surgical team prepares the patient for the procedure, including positioning and sterilizing the surgical site.
  4. Incision is made on the chest to access the heart and surrounding structures.

After sternotomy:

  1. Surgical team performs the necessary procedure on the heart or aortic root/arch.
  2. Chest is closed and patient is taken to the recovery room.
  3. Patient is monitored closely for any complications such as bleeding, infection, or breathing difficulties.
  4. Patient may require pain medication to manage discomfort.
  5. Patient begins rehabilitation and recovery process, including physical therapy and gradual return to normal activities.
  6. Patient is discharged from the hospital once stable and able to manage self-care at home.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a sternotomy procedure?
  2. How does a partial upper sternotomy compare to a full sternotomy in terms of recovery time and post-surgery complications?
  3. What criteria determine whether a patient is a candidate for a less invasive sternotomy procedure?
  4. How experienced are you in performing partial upper sternotomy procedures compared to full sternotomy procedures?
  5. Are there any specific precautions or special care instructions I should follow after undergoing a sternotomy procedure?
  6. How soon can I expect to resume normal activities after undergoing a sternotomy procedure?
  7. Are there any long-term effects or considerations I should be aware of after having a sternotomy procedure?
  8. What follow-up appointments or monitoring will be necessary after the surgery?
  9. Can you explain the decision-making process for choosing between a partial upper sternotomy and a full sternotomy for my specific case?
  10. Are there any alternative treatment options or surgical approaches that I should consider for my condition?

Reference

Authors: Boudart A, Yilmaz A, Kaya A. Journal: Acta Chir Belg. 2022 Apr;122(2):144-149. doi: 10.1080/00015458.2022.2050979. Epub 2022 Mar 10. PMID: 35255771