Incisions, incisions

I’ve been thinking a lot about the different post-op paths for different types of heart surgery and I’ve come to realize it must depend upon the type of incision required. I’ve been hearing so many stories about friends, friends of friends, in-laws, grandparents, etc. who’ve had heart surgery and are running, playing tennis, or climbing mountains ‘x’ number of weeks later. I don’t doubt any of this is true, but even at two weeks out, I began to suspect that not all these people had their full sternum cracked. Based on how my sternum was radiating pain to the furthest reaches of my body, I had my doubts. So naturally I decided to look into it…

I have no idea if this is truly a complete list, but it seems there are at least six different ways to access the heart depending on which part of it needs to be operated on. The following chart lists them from most invasive to least invasion, left to right.

Spectrum of incision options for surgical access.

The least invasive options are starting to be used more and more as technology improves. The Texas Heart Institute advertises that its surgeons can now perform the following videoscopic and robotic procedures: coronary artery bypass surgery, valve repair and replacement, lead placement for pacemakers and defibrillators, heart tumor removal, atrial septal defect repair, and catheter ablation for atrial fibrillation. That’s starting to give sternotomies a run for their money.

Of course in general, the less invasive the surgery, the less post-op complications and the speedier the healing process for the patient. However, there are some things that surgeons still need direct and significant access to the heart for. While some valve repair and replacement may be able to be done robotically, much of it is still done via thoracatomy or mini-sternotomy. The type of access is also determined by the health of the patient, i.e., older patients are less likely to be strong enough to heal from any type of sternotomy and therefore often undergo the least invasive procedure possible. On the flip side, younger patients like myself are strong enough to withstand the full sternotomy so we get to have all the fun. Of course in my situation, there’s no other way to gain full access to the aorta so it was always going to be the full monty as I’ve taken to calling it.

Below is a schematic of the full sternotomy incision line. As I mentioned in a previous post, once the incision is made, the sternum is sawed in half from top to bottom. Post surgery, the sternum is then wired back shut (wires which will be now my lifelong companions). Then subcutaneous stitches are used to close the incision itself and finally a type of surgical skin glue is used to close the incision on the surface.

Full sternotonmy.

Here is a video of surgeons inserting and tightening the sternum wires on a patient (not me). WARNING: Not for the faint of heart(!).

And here’s an x-ray that shows the sternum wires post-op.

Sternum wires visible in post-op chest x-ray.

Put it all together and here’s what you get. This is my incision one week post-op. It goes for another three inches at least. When I’m not distracted by side-effects, complications, and pain, I sometimes look at it and smile.

My incision one week post-op.

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17 comments

  1. Jill Whisler

    It shows up front and center, a fraction of what you have been through. Brutal. It takes sheer guts to now walk the slow and painful path of recovery. I suspect what you have posted and time it took to do your research, is part of the healing process for you now. Post away girl…………I’ll read every word. God love ya.

  2. Kate

    Just watched the video of the aortic valve replacement as well. WOW. No wonder recovery is hard. What your body went through is amazing. Also, you are the bravest girl I know. Keep up the healing. xoxo

  3. Barbara Yount

    Summer, you are so brave! I am so proud of you to have done this now, when you could have put it off. This is a perfect time to become a champion napper…..zzzzzzzzzzzzz. Thank you for your sweet card—I can imagine that everything takes mountains of energy. Love, Aunt Barbie

  4. Ellen Hunt

    My dear Summer,
    How astonishing it is to be able to access and repair the heart… Summer’s heart… It is truly remarkable!
    Hugs… Always gentle hugs,
    Ellen

  5. Tricia McKinney

    Thinking about tattoos yet?

  6. afamiglietti

    I think you need to keep these blog posts, and your other notes on this experience, and write up a pop-sci-memoir. But hey, that’s just me…

  7. Again, I love your approach. Your writing and method of sharing really makes me wish that I had been blogging when I went through my major surgeries. You’re also giving me the gumption to show my own incision from the last surgery…

  8. Klaus

    i wish you a speedy recovery! Greetings from Indonesia,

  9. Kerstin

    I’m with Tricia and Andy, Tats and memoirs baby! 🙂 And you, you are just… wow. ❤ Brave awesome science cyborg chick!

  10. That is almost *exactly* like how I apply safety wire to my motorcycle. I was wondering, as the wire was being twisted and trimmed “what do they do about the sharp ends that are left behind” and wouldn’t you know it, they bend them up and back into the “surface”… just like I do. Fascinating similarity to something worlds apart.
    Thank you for sharing & best wishes for a speedy recovery.

  11. I have a hard time believing Hemingway would have had the sand to write anything coherent before, during, and after heart surgery, let alone with style, grace and wit. Words like courage, talent, precious gift really, really fall short. They look like they’re misspelled or something. I know all you want to do is crack a beer and go bowling and you get no argument from me on either one, but in the meantime, “Just keep on writin’, Butch, that’s what you’re good at.” See you at the lanes real soon.

  12. Thank you for all of this (especially the surgery photos). I went through this (and the valve replacement) at the end of January. Soon you will start to feel back to normal. Here is to a speedy recovery.

  13. Gale

    You are A*M*A*Z*I*N*G. Thank you for sharing your life and BLESSINGS on a speedy recovery.

  14. Laura

    The scar rocks.

  15. This is such a fantastic way to share. Having done three hip replacement surgeries unexpectedly in the last year, the scar really resonants. Mine are marginally more subtle, but only just, and they are strong reminders. Upside? Six months or a year form now you’re suddenly going to be doing something you weren’t allowed to do, or something you struggled with. You’re going to do it without thinking and then in the middle you’re going to go “YES. Life carries on.” and it will feel incredible.

  16. Hi Summer,

    My name is Kathleen Engel and I am an editor at Health Monitor Network in Montvale, NJ. My company publishes guides on various health conditions that are distributed free to patients through doctors’ offices. (You can see our site at heathmonitor.com.)

    Right now I am working on our Guide to Heart Valve Disease and would be delighted to include a few tips from you for our readers. You’ve mentioned on your blog things like short-term memory loss, rehab, the inability to do simple things and the fears that follow surgery (of getting bumped, or having an elevator door close on you, or getting into an accident). All these things would be great as a basis for a tip from you and I am sure would resonate with our readers.

    I’d be happy to send you a PDF of one of our guides so you can see what they look like before deciding whether you’d like to participate–just send me your email, and any questions you may have.

    Thanks for your consideration, Summer. I do hope to include a few quotes from you, along with your photo.

    Best,
    Kathleen Engel
    Editor, Health Monitor Network
    KathleenE@healthmonitor.com

  17. Bruno Pgott

    I have the same sternum incision because I had a defective mitral valve that was replaced with an artificial mitral valve. The valve ticks like a Timex watch! It is a scar I am proud of for sure! Video was great! Had a small cardiac death incident last week, but was shocked back into life and now have a nifty pacemaker/defribulator installed. The shocks from paddles really made my chest hurt again, just like the first time, but the pain is reduced a little every day.

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