Our Summary

The research paper discusses a new method of performing a heart transplant. This approach is particularly useful when the patient had previously undergone a specific type of minimally invasive surgery to insert a device (left ventricular assist device) that helps the heart pump blood. The technique involves a unique T-shaped cut on the chest, sparing the upper bone of the sternum, known as the manubrium. The heart-lung machine, which temporarily takes over the function of the heart and lungs during surgery, is connected via arteries and veins in the right armpit, neck, and thigh. The previously inserted device is then carefully removed through an incision on the left side of the chest. The heart transplant is performed using standard techniques, and the paper reports excellent visibility during surgery and positive outcomes for the patient.

FAQs

  1. What is a manubrium-sparing sternotomy and how is it performed?
  2. How is cardiopulmonary bypass established during this technique of heart transplantation?
  3. What is the outcome of heart transplantation performed by manubrium-sparing sternotomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about sternotomy is to follow all post-operative care instructions carefully to ensure proper healing and minimize the risk of complications. This may include avoiding activities that could put strain on the chest, taking prescribed medications as directed, and attending follow-up appointments with the medical team. It is important to communicate any concerns or changes in symptoms to the doctor promptly.

Suitable For

Patients who may be recommended for sternotomy include those undergoing heart transplantation, reoperation after minimally invasive left ventricular assist device insertion, and other complex cardiac procedures requiring a more extensive surgical approach.

Timeline

Before sternotomy:

  1. Patient undergoes minimally invasive left ventricular assist device insertion.
  2. Patient experiences complications or challenges that require re-entry for heart transplantation.

After sternotomy:

  1. T-shaped, manubrium-sparing sternotomy performed using an oscillating saw up to the first intercostal space.
  2. Cardiopulmonary bypass established via right axillary artery and percutaneous venous cannulation of right jugular and femoral vein.
  3. Outflow graft ligated and divided via left thoracotomy.
  4. All anastomoses performed with standard technique.
  5. Excellent exposure and outcome achieved.

What to Ask Your Doctor

  1. Can a manubrium-sparing sternotomy be performed in my case, and what are the potential benefits compared to a traditional sternotomy?
  2. How will the manubrium-sparing sternotomy affect my recovery time and post-operative pain?
  3. What are the risks and potential complications associated with a manubrium-sparing sternotomy?
  4. How experienced are you in performing manubrium-sparing sternotomies for heart transplant surgeries?
  5. Are there any alternative surgical approaches that could be considered in my case?
  6. What is the success rate of heart transplant surgeries performed using a manubrium-sparing sternotomy?
  7. Will I require any additional follow-up or special care due to the use of a manubrium-sparing sternotomy?
  8. How long can I expect to stay in the hospital after undergoing a heart transplant with a manubrium-sparing sternotomy?
  9. Are there any specific lifestyle changes or restrictions I should be aware of following this type of surgery?
  10. Can you provide me with any additional information or resources about manubrium-sparing sternotomies and their use in heart transplant surgeries?

Reference

Authors: Ohira S, Spielvogel D, Lanier GM, Kai M. Journal: J Card Surg. 2022 Dec;37(12):5643-5645. doi: 10.1111/jocs.17071. Epub 2022 Oct 31. PMID: 36316823