sternotomy

A sternotomy is a surgical procedure that involves making an incision through the sternum to access the thoracic cavity. The most common form, the median sternotomy, splits the sternum with a specialized saw and uses retractors to expose the heart and great vessels. In many cardiac operations, cardiopulmonary bypass is used to maintain circulation while the heart is operated on.

Variants include partial sternotomies (ministernotomies) and clamshell sternotomy for extensive exposure, as well as manubriotomy or other incisions for specific conditions. The choice depends on the planned operation and patient anatomy.

The procedure typically begins under anesthesia, with an incision along the midline, division of the sternum, and placement of a sternal retractor. If cardiopulmonary bypass is used, cannulation of the great vessels and other steps are performed before the heart is stopped for repair or grafting. After the operation, the heart is restarted, the sternum is closed with wires or other fixation devices, and mediastinal drains may be placed to remove blood or fluid.

Indications include coronary artery bypass grafting, valve repair or replacement, and correction of congenital heart disease, as well as access for certain esophageal or mediastinal procedures. Risks include infection (including mediastinitis), sternal dehiscence, bleeding, pneumothorax, arrhythmias, myocardial infarction, stroke, and respiratory complications.

Recovery involves pain management, breathing exercises, and gradual mobilization. Hospital stays vary, and patients are typically advised to avoid heavy lifting and contact sports for about 6 to 12 weeks to allow sternum healing. Long-term outcomes depend on the underlying condition and procedural success.