What Is the Sternotomy Approach for Aortic Aneurysm Repair?
A sternotomy is an incision to expose your heart for many types of heart surgery. Your doctor may repair a balloon-like bulge in your aorta called an aortic aneurysm through a sternotomy incision.
An aortic aneurysm causes your aorta to weaken and increases the risk for rupture. Because your aorta is the main artery that carries blood from your heart to other parts of your body, a ruptured aortic aneurysm can be life-threatening.
Types of sternotomy approaches for aortic aneurysm repair
There are two sternotomy approaches for aortic aneurysm repair, including:
Mini sternotomy
A mini sternotomy is a minimally invasive incision, measuring about 3 to 4 inches, that gives surgeons access to your heart. This often results in a shorter recovery time and a reduced risk of infection.
Full sternotomy
A full sternotomy is an 8-10-inch vertical incision along your sternum to expose your heart for different types of surgery.
Conditions we treat with sternotomy approach for aortic aneurysm repair
Why Would I Need a Sternotomy for Aortic Aneurysm Repair?
Depending on the size of your aneurysm, doctors may only need to watch it periodically. But if it grows quickly or to a large size, surgeons may need to treat it with open surgery or a stent.
Aneurysm repair may be the right choice for you if you're healthy enough for surgery and:
- The aneurysm is 50 percent larger than the rest of your artery.
- The aneurysm is more than five centimeters (about two inches).
- You have a connective tissue disorder, such as Marfan syndrome, Loey-Dietz syndrome, or Ehlers-Danlos syndrome.
- Your aneurysm is growing quickly.
Who’s a candidate for a sternotomy for aortic aneurysm repair?
You may be a candidate for a sternotomy for aortic aneurysm repair if your aneurysm is at high risk of rupturing and minimally invasive treatment would not be effective due to the size or location of your aneurysm.
Is a sternotomy major surgery?
A sternotomy is considered to be a major surgical procedure because it will take several months for you to heal fully.
Alternatives to sternotomy for aortic aneurysm repair
What Are the Risks and Complications of Sternotomy for Aortic Aneurysm Repair?
Repair of an aortic aneurysm through sternotomy can save your life. But, as with any invasive procedure, there is some risk involved.
Risks of sternotomy for aortic aneurysm repair include:
- Bleeding.
- Blood clots.
- Hemorrhage.
- Infection.
- Injury to nerves.
- Kidney damage.
- Pneumonia.
- Side effects from anesthesia, such as headache, nausea, and confusion.
- Spinal cord injury.
What Should I Expect from a Sternotomy for Aortic Aneurysm Repair?
Before: How to prepare for a sternotomy for aortic aneurysm repair
You'll have an appointment a few weeks before for pre-surgery testing. Tests may include:
- Blood work and urine studies — Your doctor may order blood work and urine studies to ensure you are healthy enough for surgery and check for signs of illness or infection.
- Chest x-ray — A chest x-ray is a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs on film. An x-ray can show enlargement in any area of the heart.
- CT scan — CT scans create images of your heart.
- Echocardiogram (ECHO) — This noninvasive ultrasound test uses sound waves to evaluate your heart's chambers and valves. The ECHO sound waves create an image on a monitor as an ultrasound transducer is passed over your heart.
- Electrocardiogram (ECG or EKG) — This test records the electrical activity of your heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and can sometimes detect heart muscle damage.
- Lung function studies —Lung function studies show your doctor how well your lungs work to ensure you are healthy enough for surgery.
- Doppler ultrasound — This test uses sound waves to create pictures of your arteries and find blockages.
- Cardiac (heart) catheterization — This test is a diagnostic procedure that allows your doctor to see blockages, blood flow, and other problems within your arteries.
Your doctor will explain the sternotomy procedure to you and answer your questions. To prepare for the procedure, you should:
- Tell your doctor if you are sensitive or allergic to any medications, iodine, latex, tape, or anesthetic agents (local and general).
- Tell your doctor about all medications (prescription and over-the-counter) and herbal or other supplements you are taking.
- Tell your doctor if you have heart valve disease, as you may need to receive an antibiotic before the procedure.
- Tell your doctor if you have a history of bleeding disorders or if you are taking any blood-thinning medications, aspirin, or other medications that affect blood clotting. You may need to stop some of the medications prior to the procedure.
- Fast for a certain period of time prior to the procedure. Your doctor will tell you how long to fast (usually overnight).
- Have any tests that your doctor recommends. For example, your doctor may request a blood test before the procedure to determine how long it takes your blood to clot.
On the day of your procedure, be sure to bring your photo ID and health insurance card(s). Leave valuables such as cash and jewelry at home. If you have a CPAP machine, please bring it with you.
You will need to stay in the hospital for about a week after your procedure. You should bring toiletries, a robe, slippers, a cell phone and charger, medications, and a change of clothes. You should also arrange for someone to drive you home from the hospital after you are discharged.
How long does a sternotomy for aortic aneurysm repair take?
Aortic aneurysm repair using the sternotomy approach usually takes 4 to 6 hours, depending on the complexity of your condition.
During your sternotomy for aortic aneurysm repair
On the morning of your surgery, you'll check in and be taken to a room where a nurse will place an IV, draw blood, and place a bladder catheter. The IV line will supply fluids and medicine during and after your surgery.
Your support person can come to your room to see you before the surgery. They'll get a pager so doctors can update them and tell them when they can see you after surgery.
During your surgery:
- An anesthesiologist will put you to sleep under general anesthesia — A breathing tube and a ventilator will get air to your lungs.
- Doctors will make a cut in the middle of your chest — They will divide your breastbone in half to get to your aorta.
- Doctors will connect you to the heart and lung bypass machine to control your circulation — They can then work in a bloodless, motionless area.
- The surgeon will remove the diseased part of your aorta — They'll replace it with a tube-shaped fabric graft. Then they'll close your sternum with stainless steel wires and sew the skin back in place.
- Doctors will place drains around your heart to remove excess fluid — They'll remove the drains before you go home from the hospital.
Recovery after sternotomy for aortic aneurysm repair
After surgery, you'll need to stay in the hospital for about a week. During your hospital stay:
- The team will transfer you to the cardiothoracic ICU — Within 4 to 6 hours, you'll be breathing on your own. You can get out of bed and into a chair in a few more hours.
- Breathing specialists will help you use a device to start deep-breathing exercises — After surgery, coughing or taking a deep breath hurts, so mucus can build up in your lungs. The exercises will help remove the mucus and prevent infections that lead to pneumonia.
- You'll spend 1 to 2 days in the ICU, then move to the regular floor — There, you'll focus on getting your strength back with physical therapy. It's crucial to move around as much as possible after surgery.
- The surgical team will discharge you when you're stable — That means doctors have removed your chest tubes and you can walk the hallways and breathe on your own.
- You must have someone stay with you 24/7 for the first week — If that's not possible, a patient care coordinator can help find a skilled nursing or rehab center.
After you go home, we'll call within 72 hours to set up your follow-up appointment. You'll have home care visits for 2 to 4 weeks (about a month) after discharge.
How painful is a sternotomy?
You will have pain immediately following surgery that will get worse with coughing or deep breathing. Your pain should improve as you begin to heal. Your care team will give you medication to help manage your pain.
How long does it take a sternotomy to heal?
Expect full recovery to take 2 to 3 months. During your recovery:
- Do not lift more than 10 pounds.
- Do not lift your arms over your head.
- Elevate your legs above your heart when you’re sitting.
- Take a few short walks throughout the day. Walking up and down stairs is fine.
- While you heal, you should sleep on your back or side to keep pressure off your incision. You may feel more comfortable in a recliner or with your head propped up with pillows.
- You can’t drive a car for 4 to 6 weeks.
How long do sternotomy wires stay in?
Unless you experience complications or discomfort related to your sternotomy wires, they will remain in your body after surgery and will not be removed.
When to call your doctor about sternotomy complications
You should call your doctor if you are experiencing any unusual symptoms, including:
- A fever of more than 100.0°F.
- Chest pain.
- Difficulty breathing.
- Fainting.
- Pain, redness, bleeding, drainage, or increased swelling at the incision site.
If any of these symptoms are severe or if you experience loss of consciousness, you should dial 911 immediately.
What’s the prognosis after sternotomy for aortic aneurysm repair?
The sternotomy approach for aortic aneurysm repair reduces your risk of a life-threatening aortic rupture. However, your specific prognosis will depend on a number of factors that your doctor will discuss with you.
What’s the success rate of an aortic aneurysm repair using the sternotomy approach?
The sternotomy approach for aortic aneurysm repair is a highly successful procedure for reducing the risk of aortic rupture. However, you may need to have routine follow-up care.
Why Choose UPMC for Sternotomy for Aortic Aneurysm Repair?
The surgeons at UPMC are at the forefront of advanced and life-saving surgical techniques for aortic aneurysm repair. We provide personalized care tailored to your condition, using minimally invasive techniques whenever possible.
Last reviewed by a UPMC medical professional on 2024-10-01.
