Surgical Openings

Open heart surgery requires the opening of the chest area. Depending on the surgery type, incisions (cuts) on the chest wall may be done in different areas of the chest.

 

Median sternotomy 

Sternotomy is a procedure done by surgeons operating on the heart / nearby organs. A cut is made in the skin over the breast bone and then the breast bone itself. This is the preliminary step to most of the surgeries involving the heart. It is important to know that open heart surgery is different from sternotomy. For open heart surgery, after sternotomy, the covering of the heart called pericardium is opened and the heart itself is opened. Open heart surgery is done under the back up of cardiopulmonary bypass. Through the median sternotomy opening, the surgeon can see the entire heart and reach all parts of the heart and control the whole operative field. Heart surgery done through median sternotomy is safe and efficient. This is the standard approach for correcting all types of congenital and valvular/ structural heart defects. 

 

Performing sternotomy and later putting it back together - sternal closure - are important steps in any heart surgery. If they are not done correctly, it can trouble the patient immediately after the surgery as well as later. The sternum or breastbone plays a major role in the stability of the chest wall. This stability is required for proper breathing. At the end of the surgery, the divided breast bone has to be put back together and stabilized. This has to be done in such a way that healing occurs despite the continuous stress of breathing movements, and movements of other bones/muscles around. 

 

Thoracotomy

A thoracotomy is a surgical procedure in which a cut is made between the ribs to reach the organs inside - which include the lungs and the blood carrying tubes - aorta, pulmonary artery and the heart itself. This is from the side of the chest as opposed to sternotomy which is from the front. 

 

A thoracotomy approach is utilized in specific situations in congenital heart surgery. Coarctation of aorta, which is a narrowing in the large blood carrying tube is classically operated upon by a left lateral thoracotomy approach. BT shunt, which is a procedure done to increase blood flow to the lungs can also be done through a thoracotomy approach. Both these surgeries are done as closed heart procedures, without the need for cardiopulmonary bypass. 

 

Of late, simpler open heart surgical procedures requiring cardiopulmonary bypass, like ASD Closure are also done through thoracotomy. Avoidance of a large scar in the front of the chest is one of the advantages of the procedure. In addition, shorter hospital stay and quicker healing has also been pointed out as advantages.