Opening the Chest for Heart Surgery (Sternotomy): What You Need to Know

When your doctor tells you that you need heart surgery, and that it involves opening your chest, you may feel a little scared and nervous. That's normal. No one likes surgery. But it's something that heart surgeons do very commonly and successfully. So there's no reason to be afraid. In this article, we'll simply talk about what a sternotomy is, why it's done, how it's done, and what you need to know after the surgery.

What is a sternotomy, simply put?

Simply put, a sternotomy is the surgical procedure where the flat bone in the middle of your chest, the sternum, is cut in two for the purpose of surgery. Some people also call this a "median sternotomy."

Think about it, this sternum and ribs are there to protect the very important organs inside our chest, like the heart and lungs. It's like a safety cage. So, when there's a problem with your heart and you need to fix it surgically, the best and easiest way for the surgeon to get to the heart is to cut this sternum down the middle and make a path on both sides.

There is also a method called "mini sternotomy" in which the entire sternum is not cut, but a small incision is made. In this, a small incision of about 2-3 inches is made.

Is this what open heart surgery is for? Is this a major surgery?

This is something that confuses many people. A sternotomy is a procedure that opens the way for open heart surgery . It's like when you want to fix something inside your house, you first have to open the door. That's how it is. A sternotomy is a procedure that "opens the door" to get to the heart. Open heart surgery is a procedure that repairs the heart from the inside.

Yes, this is considered major surgery . Because it takes about two months for the bone to fully heal and reattach after the cut. And because it is done as part of another major surgery, like open-heart surgery, it is a major surgery when the two are combined.

Why do you need to have this kind of surgery?

A doctor uses this method to reach organs protected by the sternum and ribs. Mainly:

• Heart: For things like repairing heart valves and performing coronary artery bypass surgery.
• Aorta: For problems with the aorta, the main blood vessel that exits the heart.
• Pulmonary arteries: The arteries that carry blood from the heart to the lungs.

A sternotomy is not a cure for any disease. It is a procedure that is done to make room for the organs so that the surgeon can do his job more easily. In a country like America, more than 700,000 of these surgeries are performed every year. It is that common.

What happens before the surgery?

Before your surgery, the medical team will give you some instructions, such as:

• They tell you to take a good shower and come clean before coming to the hospital.
• If you have hair on your chest, they will be carefully removed.
• Antibiotics will be given to prevent infection after surgery.
• The chest area where the surgery will be performed is thoroughly cleaned with antiseptic solutions.

How the surgery is performed step by step

This may sound a little scary to you, but remember , all of this is done after you've been given anesthesia and are sound asleep. So you won't feel anything.

1. First, the surgeon makes an incision in the skin, starting between your shoulder blades and extending down along the sternum.

2. Then, a special medical instrument called a "sternal saw" is used to cut the sternum in a neat line from top to bottom.

3. The two cut bone fragments are placed side by side, and a device called a "retractor" is inserted to create access to the heart.

4. Next, the protective membrane surrounding the heart, the pericardium, is opened.

5. Now the surgeon can see the heart clearly. Then they perform the major surgery they want to perform (e.g. bypass surgery).

6. After the main surgery is complete, the two parts of the sternum that were cut are put back together and secured using about 8 or 12 steel wires (sternotomy wires) . It's like tying something that's broken.

7. Finally, the chest tissue and skin are sewn back together, and an antibiotic ointment is applied to the wound.

What can you expect after surgery?

After the surgery, you will stay in the intensive care unit (ICU) for a day or two, and then be transferred to a regular ward.

• Pain: You may experience some pain after the surgery, but your doctor will give you painkillers to help control it. Most people can manage the pain with over-the-counter painkillers like Paracetamol.
• Chest tubes: One or more tubes may be placed in the chest to drain excess fluid and blood from the wound. These will be removed in a few days.
• Special advice for women: If your breasts are quite large, doctors advise you to wear a well-supported bra 24 hours a day for one to two weeks after leaving the hospital to reduce the weight and pressure on the wound.

What are the benefits and risks of this surgery?

Like any surgery, this one has benefits and minor risks.

How long does it take to recover? How can I take care of myself at home?

It takes about 8 weeks for the sternum to fully heal. During this time, you should limit your upper body movement. It is very important to follow your doctor's instructions exactly.

• Avoid lifting weights: Don't lift anything heavier than 10 pounds (about 4.5 kilograms). In simple terms, that's about the weight of 4 liters of milk.
• Use both hands: When lifting something, use both hands to lift it evenly. Do not lift the weight with just one hand.
• Keep your arms close to your body: When lifting something, keep your arms close to your body.

About driving

You will be able to drive again about a month after the surgery. But before that, you should definitely ask your doctor for permission. Until your sternum heals, it is best to sit in the front passenger seat when traveling in a car. Even if you feel uncomfortable when the seat belt presses against your chest, be sure to wear a seat belt because it will protect you in the event of an accident.

What are the best times to see a doctor?

You will have follow-up appointments with your doctor on a regular basis. However, if you experience any of the following symptoms, you should notify your doctor immediately.

Choosing the best approach for your heart surgery is a decision your doctor will make based on your specific situation. In most cases, a sternotomy is the best way to access the heart. If you have any questions about this, don't hesitate to ask your doctor.