sternotomie

Sternotomy, or sternotomie, is a surgical procedure that involves making a vertical incision along the sternum to expose the mediastinal structures, most commonly the heart and great vessels. The sternum is divided (a sternotomy) to provide direct access for open cardiac or thoracic procedures. After the operation, the sternum is closed with wires or other fixation devices and allowed to heal.

The most common approach is the median sternotomy, which splits the sternum along the midline. Alternative approaches include partial or parasternal incisions, and clamshell thoracosternotomy for extensive exposure, such as complex trauma or certain transplant procedures.

Indications include coronary artery bypass grafting, valvular repair or replacement, congenital heart defect repairs, cardiac transplantation, and operations on the ascending aorta or other mediastinal structures. Sternotomy also provides access in some tumor resections or trauma surgeries.

Procedure overview: under general anesthesia, a skin incision is made over the sternum. The sternum is divided with an oscillating saw, and a sternotomy retractor keeps the chest opened. After the cardiac or thoracic procedure, the sternum is closed with wires, and mediastinal drains are placed as needed. The recovery period focuses on pain control, respiratory therapy, and wound care.

Risks include infection (including mediastinitis), sternal dehiscence, bleeding, myocardial injury, arrhythmias, pneumothorax, pneumonia, and chronic chest pain. Healing of the sternum takes several weeks.

History: Median sternotomy became the standard access route for open-heart surgery in the mid-20th century with advances in cardiopulmonary bypass.