Our Summary

This research paper is about the comparison of two surgical procedures for the treatment of a heart condition called hypertrophic obstructive cardiomyopathy, in which the heart muscles become abnormally thick, making it harder for the heart to pump blood. The standard treatment is a surgery called septal myectomy, usually performed by cutting open the chest (full sternotomy). However, this study looked at a less invasive version of the surgery (ministernotomy), where the incision is smaller, and compared its results with the standard approach.

The researchers looked at the medical records of 120 patients who had the surgery from 1999 to 2016. 34 of them had the standard surgery, and 86 had the minimally invasive surgery. They compared different factors before and after the surgery, such as symptoms and heart function, and also looked at the duration of the surgery and any complications.

The results showed that both types of surgery were effective in reducing the symptoms of heart failure. There was no significant difference in the improvement of heart function or in the occurrence of major complications between the two groups. The minimally invasive surgery took about the same amount of time as the standard surgery, though the time the heart was clamped (stopped) was slightly longer.

In conclusion, the study suggests that the minimally invasive version of the surgery is just as effective as the standard version and could be a good option for patients who haven’t responded to medications.

FAQs

  1. What is hypertrophic obstructive cardiomyopathy and how is it typically treated?
  2. What is the difference between a full sternotomy and a ministernotomy?
  3. Did the study reveal any significant difference in results between the traditional septal myectomy and the minimally invasive version?

Doctor’s Tip

A doctor might tell a patient undergoing sternotomy to follow their post-operative care instructions carefully, including proper wound care and avoiding heavy lifting or strenuous activity for a certain period of time. They may also advise the patient to attend follow-up appointments to monitor their recovery progress and address any concerns or complications promptly. Additionally, the doctor may recommend engaging in cardiac rehabilitation to help improve heart function and overall health post-surgery.

Suitable For

Typically, patients who are recommended sternotomy are those who have a heart condition that requires open-heart surgery, such as coronary artery bypass grafting, valve replacement, or repair, as well as patients with certain congenital heart defects. Patients with severe heart disease or conditions that cannot be treated with less invasive procedures may also be recommended sternotomy.

Timeline

Before the surgery, the patient would have undergone various tests and consultations to determine the best course of treatment. This would include imaging tests to assess the condition of the heart and its function, as well as discussions with the surgical team about the risks and benefits of the procedure.

During the surgery, the patient would be placed under general anesthesia, and the surgeon would make an incision in the chest to access the heart. In a full sternotomy, the breastbone is cut open to provide full access to the heart. In a ministernotomy, a smaller incision is made, usually between the ribs, to access the heart.

After the surgery, the patient would be closely monitored in the intensive care unit for a period of time to ensure proper recovery. Pain management and rehabilitation would also be provided to help the patient recover and regain strength. Follow-up appointments would be scheduled to monitor the patient’s progress and make any necessary adjustments to their treatment plan.

What to Ask Your Doctor

  1. What are the potential benefits of a minimally invasive sternotomy compared to a full sternotomy for my specific condition?
  2. What are the potential risks or complications associated with each type of sternotomy surgery?
  3. How experienced are you and your surgical team in performing minimally invasive sternotomy procedures?
  4. How long is the recovery time expected to be for a minimally invasive sternotomy compared to a full sternotomy?
  5. Will I have a higher risk of needing a repeat surgery in the future if I choose the minimally invasive sternotomy over the standard procedure?
  6. Are there any specific factors about my health or anatomy that may make me a better candidate for one type of sternotomy over the other?
  7. What is the success rate of the minimally invasive sternotomy procedure for patients with hypertrophic obstructive cardiomyopathy compared to the standard surgery?
  8. How will the incision size and scarring differ between a minimally invasive sternotomy and a full sternotomy?
  9. Will I need any additional tests or evaluations before deciding on the type of sternotomy surgery that is best for me?
  10. What follow-up care will be needed after the surgery, and how will it differ between the two types of sternotomy procedures?

Reference

Authors: Musharbash FN, Schill MR, Hansalia VH, Schuessler RB, Leidenfrost JE, Melby SJ, Damiano RJ Jr. Journal: Innovations (Phila). 2018 Jul/Aug;13(4):261-266. doi: 10.1097/IMI.0000000000000536. PMID: 30138243