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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]
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.
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.
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).
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%.
This required an extensive series of full-thickness incisions through the walls of both atria, a median sternotomy (vertical incision through the sternum), and cardiopulmonary bypass (heart-lung machine; extracorporeal circulation). After the introduction of the initial procedure, a series of improvements were made, culminating in 1992 in the ...
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 ...