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Median sternotomy is a type of surgical procedure in which a vertical inline incision is made along the sternum, after which the sternum itself is divided using a sternal saw. [1] This procedure provides access to the heart and lungs for surgical procedures such as heart transplant , lung transplant , corrective surgery for congenital heart ...
A thoracotomy is a surgical procedure to gain access into the pleural space of the chest. [1] It is performed by surgeons (emergency physicians or paramedics under certain circumstances) to gain access to the thoracic organs, most commonly the heart, the lungs, or the esophagus, or for access to the thoracic aorta or the anterior spine (the latter may be necessary to access tumors in the spine).
Median sternotomy – This is the primary incision used for cardiac procedures. It extends from the sternal notch to the xiphoid process. The sternum is divided, and a Finochietto retractor used to keep the incision open. [1] Thoracotomy – A division of the ribs from the side of the chest.
The heart is accessed via median sternotomy and its pericardium is removed so the coronary and great arteries can be seen. The ductus arteriosus and main right pulmonary artery, up to and including the first branches in the hilum of the right lung, are separated from the surrounding supportive tissue to allow mobility of the vessels.
The breastbone is sometimes cut open (a median sternotomy) to gain access to the thoracic contents when performing cardiothoracic surgery. Surgical fixation of sternotomy is achieved through the use of either wire cerclage or a plate and screw technique. The incidence of sternotomy complications falls within the narrow range of 0.5% to 5%.
Pericardiectomy takes place by removing the infected, fibrosed, or otherwise damaged pericardium. The procedure begins when the surgeon makes an incision in the skin over the breastbone and divides the breastbone to expose the pericardium, known as a median sternotomy. [3] [6] Alternatively, a larger incision known as a thoracotomy may be used. [6]
MIDCAB differs from OPCAB in the type of incision used for the surgery; with traditional CABG and OPCAB a median sternotomy (dividing the breastbone) provides access to the heart; with MIDCAB, the surgeon enters the chest cavity through a mini-thoracotomy (a 2-to-3 inch incision between the ribs).
After a median sternotomy, a surgical retractor is placed by the surgeon to optimize exposure of the heart. At this time, heparin is given to thin the blood to prevent thrombus from forming while on CPB. The surgeon places a cannula in the right atrium, vena cava, or femoral vein to withdraw blood from the venous circulation. The perfusionist ...