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.
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.
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.
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.