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Since the first successful open heart operation in 1953, most cardiac surgeons initially used the bilateral anterior thoracotomy, which was a very complication-prone and painful approach. [6] In 1957, after the demonstration of the superiority of median sternotomy, it became the standard incision and has remained so until today. [5]
Left anterolateral thoracotomy is the incision of choice for open chest massage, a critical maneuver in the management of traumatic cardiac arrest. Bilateral anterior thoracotomy with transverse sternotomy, or clamshell incision, is the incision of choice for bilateral lung transplantation. [5] It is also a valuable tool in trauma settings. [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).
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.
Minimally invasive cardiac surgery, encompasses various aspects of cardiac surgical procedures (aortic valve replacement, mitral valve repair, coronary artery bypass surgery, ascending aorta or aortic root surgery) that can be performed with minimally invasive approach either via mini-thoracotomy or mini-sternotomy.
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]
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%.
No median sternotomy incision; instead, an endoscope and/or "mini-thoracotomy" incisions between the ribs are used. No cardiopulmonary bypass; instead, these procedures are performed on the normally beating heart. Few or no actual incisions into the heart itself.