Median sternotomy

Median sternotomy
Skin incision of a median sternotomy

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 defects, or coronary artery bypass surgery.[2][3][4]

Example of a median sternotomy on a young adult male, around 72 hours following the procedure

The median sternotomy was first proposed by Herbert M. N. Milton in 1897.[5] 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] Through this approach, the surgeon can see the entire heart and control the whole operative field visually and tactically. Cardiac surgery through sternotomy is safe and efficient, and is considered to be the gold standard for surgical treatment of all congenital and acquired heart diseases resulting in low failure rates and excellent proven long-term outcomes.[7]

Cardiac surgery via median sternotomy is performed in over 1 million patients per year worldwide.[8]

  1. ^ Reser, Diana; Caliskan, Etem; Tolboom, Herman; Guidotti, Andrea; Maisano, Francesco (2015). "Median sternotomy". Multimedia Manual of Cardiothoracic Surgery. 2015: mmv017. doi:10.1093/mmcts/mmv017. ISSN 1813-9175. PMID 26188337.
  2. ^ Blum, Matthew G.; Fry, William A. (2011). "25. Thoracic incision". In Shields, Thomas W.; LoCicero, Joseph; Reed, Carolyn E.; Feins, Richard H. (eds.). General Thoracic Surgery (Seventh ed.). Philadelphia: Lippincott Williams & Wilkins. p. 397. ISBN 978-0-7817-7982-1.
  3. ^ Jaffe, Richard A.; Schmiesing, Clifford A.; Golianu, Brenda (2014). Anesthesiologist's Manual of Surgical Procedures. Lippincott Williams & Wilkins. p. 470. ISBN 978-1-4511-7660-5.
  4. ^ Herring, John A. (2020). "9. Scoliosis". Tachdjian's Pediatric Orthopaedics: From the Texas Scottish Rite Hospital for Children (Sixth ed.). Philadelphia: Elsevier. p. 226. ISBN 978-0-323-56769-5.
  5. ^ a b Julian OC; Lopez-Belio M; Dye WS; Javid H; Grove WJ (1957). "The median sternal incision in intracardiac surgery with extracorporeal circulation: a general evaluation of its use in heart surgery". Surgery. 42: 753–61.
  6. ^ Dalton ML; Connally SR; Sealy WC (1992). "Julian's reintroduction of Milton's operation". Ann Thorac Surg. 53: 532–3.
  7. ^ Bonow RO; Carabello BA; Chatterjee K; de Leon AC Jr.; Faxon DP (2006). "ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons". J Am Coll Cardiol. 48 (1–148).
  8. ^ El-Ansary, Doa; Kinney LaPier, Tanya; Adams, Jenny; Gach, Richard; Triano, Susan; Ali Katijjahbe, Md; Hirshhorn, Andrew D; Mungovan, Sean F; Lotshaw, Ana; Cahalin, Lawrence P (2019). "An Evidence-Based Perspective on Movement and Activity Following Median Sternotomy". Physical Therapy & Rehabilitation Journal. 99 (12): 1587–1601.