Our Summary

In recent years, more and more people have had to have heart surgery again after their initial operation. This means that re-sternotomy, a procedure where the chest is reopened, is becoming more common, especially in busy hospitals. This operation can be risky, particularly for patients who need to have parts of their aorta (the main blood vessel in the body) operated on again. There’s a high chance of damaging important blood vessels or parts of the heart.

To reduce these risks, it’s crucial to carefully plan the operation in advance and adjust the approach for each individual patient. This can help to limit complications and improve the patient’s recovery after the surgery. Some of the decisions that need to be made before the operation include where to insert the cannula (a tube used during surgery), whether to cool the patient down, how to relieve pressure in the left side of the heart, and whether to use a special kind of balloon catheter (a thin tube) to stop blood flow in the aorta. Making these decisions on a case-by-case basis helps ensure that the brain and organs get enough blood during the operation and can reduce the risk of serious bleeding or interruption of blood flow if there is an injury during the operation.

FAQs

  1. What is the risk associated with re-sternotomy in complex aortic reinterventions?
  2. What are some of the preoperative decisions that must be made on a case-by-case basis before re-sternotomy?
  3. How does preoperative planning and case individualization minimize complications in re-sternotomy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about sternotomy is to follow post-operative care instructions closely to ensure proper healing of the sternum and surrounding tissues. This may include avoiding heavy lifting or strenuous activities for a certain period of time, taking prescribed medications as directed, and attending follow-up appointments with your healthcare provider. It is also important to report any unusual symptoms or complications to your doctor promptly. By following these recommendations, you can help minimize the risk of complications and promote a successful recovery after sternotomy surgery.

Suitable For

Patients who may be recommended for sternotomy include those requiring re-sternotomy for complex aortic reinterventions, such as those with aneurysms or other cardiac conditions that necessitate surgical intervention. These patients may have previously undergone cardiac surgery and now require a second procedure, making re-sternotomy necessary. The decision to perform a sternotomy is made based on the individual patient’s condition and the risks and benefits of the procedure. Preoperative planning and case individualization are critical in determining the appropriate surgical strategy to minimize complications and ensure optimal outcomes.

Timeline

Before sternotomy:

  1. Patient undergoes preoperative evaluation including medical history, physical examination, and diagnostic tests such as echocardiogram and cardiac catheterization.

  2. Surgical team reviews patient’s medical history, imaging studies, and previous surgical reports to plan the reoperation.

  3. Decision is made on the approach for arterial cannulation, need for hypothermia, left ventricle decompression, and use of aortic occlusion balloon catheter based on individual patient factors.

  4. Patient is informed about the risks and benefits of the reoperation and consent is obtained.

After sternotomy:

  1. Patient is taken to the operating room and positioned for surgery.

  2. Sternotomy is performed to access the heart and major vessels.

  3. Cardiopulmonary bypass is initiated and the heart is stopped to allow for surgical intervention.

  4. Aortic cross-clamping and cardioplegic arrest may be used to provide a bloodless surgical field.

  5. Aortic cannulation and antegrade cerebral perfusion may be used to maintain brain and visceral perfusion during the procedure.

  6. Surgical interventions are performed to address the specific cardiac pathology, such as aortic resection and repair, valve replacement, or coronary artery bypass grafting.

  7. Once the surgical procedure is completed, the heart is restarted and the patient is weaned off cardiopulmonary bypass.

  8. The sternum is closed with wires and the patient is transferred to the intensive care unit for postoperative monitoring and recovery.

What to Ask Your Doctor

  1. What is the reason for recommending sternotomy for my surgery?
  2. What are the potential risks and complications associated with sternotomy?
  3. How will sternotomy affect my recovery time and postoperative pain?
  4. Are there any alternative surgical approaches that could be considered instead of sternotomy?
  5. How experienced is the surgical team with performing sternotomies and what is their success rate?
  6. Will I require any special postoperative care or follow-up after undergoing sternotomy?
  7. How will sternotomy impact any future surgeries or procedures I may need?
  8. How can I best prepare myself physically and mentally for undergoing sternotomy?
  9. What can I expect in terms of scarring and long-term effects of sternotomy?
  10. Are there any specific lifestyle changes or precautions I should take after undergoing sternotomy?

Reference

Authors: Morales-Rey I, Quintana E, Alcocer J, Pereda D, Ascaso M. Journal: Multimed Man Cardiothorac Surg. 2024 Aug 1;2024. doi: 10.1510/mmcts.2023.106. PMID: 39087707