Our Summary

This research paper discusses the growing use of minimally invasive methods in heart surgery. Traditional heart surgeries involve a large cut in the chest, but this paper argues that smaller cuts (like upper hemisternotomy and right anterolateral thoracotomy) can give surgeons enough access to the heart. The benefits of these minimally invasive techniques include less pain after surgery, lower need for blood transfusions, fewer breathing problems, and shorter hospital stays. The paper also emphasizes that these less invasive surgeries are as safe as the traditional ones. Furthermore, it explains that the upper hemisternotomy method is easier to learn and offers versatile access to structures above the heart. The paper also provides step-by-step instructions for performing a safe upper hemisternotomy.

FAQs

  1. What are the advantages of minimally invasive approaches compared to conventional sternotomy in cardiac surgical procedures?
  2. What are the differences between upper hemisternotomy and right anterolateral thoracotomy?
  3. How does a hemisternotomy provide versatile access to supra-cardiac structures?

Doctor’s Tip

One helpful tip a doctor might tell a patient about sternotomy is to follow post-operative care instructions carefully to ensure proper healing and minimize the risk of complications. This may include avoiding certain activities, taking prescribed medications as directed, and attending follow-up appointments with your healthcare provider. By following these recommendations, patients can support their recovery and achieve the best possible outcomes after undergoing sternotomy surgery.

Suitable For

Patients who may be recommended for sternotomy include those requiring access to the aortic valve and proximal thoracic aorta, such as those undergoing aortic valve replacement or repair, aortic root surgery, or coronary artery bypass grafting. Additionally, patients with complex cardiac conditions or those who may benefit from a more extensive exposure of the heart and surrounding structures may also be recommended for sternotomy. It is important for the surgical team to carefully evaluate each patient’s individual case and determine the most appropriate approach for their specific needs.

Timeline

  • Before sternotomy: A patient typically undergoes preoperative evaluation, including imaging tests and blood work. They may also receive instructions on preoperative care and medications to take before surgery.

  • Day of surgery: The patient is brought into the operating room and given anesthesia. The surgical team prepares the patient for the procedure, which may include placement of monitoring devices and catheters.

  • During sternotomy: The surgeon makes an incision in the chest, typically along the midline, to access the heart and surrounding structures. The breastbone (sternum) is divided to provide access to the heart for the surgical procedure.

  • After sternotomy: The surgeon completes the necessary cardiac procedure, such as coronary artery bypass grafting or valve repair/replacement. The sternum is then closed using wires or plates to stabilize the bone. The patient is transferred to the recovery room for monitoring and pain management.

  • Postoperative recovery: The patient will typically stay in the hospital for several days for monitoring and rehabilitation. They will receive pain medication, physical therapy, and instructions for postoperative care. Follow-up appointments will be scheduled to monitor recovery and assess the success of the surgical procedure.

What to Ask Your Doctor

  1. What are the risks and benefits of undergoing a sternotomy compared to minimally invasive approaches for my specific procedure?

  2. How experienced are you in performing sternotomies and are there any potential complications I should be aware of?

  3. Will I experience more pain or have a longer recovery time with a sternotomy compared to a minimally invasive approach?

  4. How long will I need to stay in the hospital after a sternotomy and what is the typical recovery process like?

  5. Are there any specific post-operative care instructions or limitations I should follow after undergoing a sternotomy?

  6. How does the cost of a sternotomy compare to minimally invasive approaches and will my insurance cover the procedure?

  7. Are there any alternative treatment options to a sternotomy that I should consider?

  8. What is the success rate of sternotomy for my specific condition and what are the long-term outcomes I can expect?

  9. How soon after a sternotomy can I return to my normal daily activities and exercise routine?

  10. Are there any specific lifestyle changes I should make or precautions I should take after undergoing a sternotomy?

Reference

Authors: Yan T, Flynn C. Journal: Multimed Man Cardiothorac Surg. 2017 Aug 4;2017. doi: 10.1510/mmcts.2017.009. PMID: 28960051