Sternotomy Approach for Aortic Aneurysm Repair

What Is Sternotomy?

Sternotomy is an incision to expose the heart for many types of heart surgery.

What is an aortic aneurysm?

The aorta is the main artery that carries blood from your heart to other parts of your body.

An aortic aneurysm is a balloon-like dilation or bulge in the aorta, causing it to weaken and increases the risk for rupture. A ruptured aortic aneurysm can be life-threatening.

Contact Us

To contact the UPMC Center for Aortic Disease for more information or to make an appointment, please call 412-647-7070 or email AorticCenter@upmc.edu.

Our multidisciplinary team aims to provide timely, comprehensive, and individualized disease management strategies for patients suffering from complex thoracic aortic diseases. Learn more about our experts.

Conditions We Treat with Sternotomy Approach

• Aortic root aneurysm.
• Ascending and aortic arch aneurysm.

Is Sternotomy Right for Me?

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% larger than the rest of the artery.
• The aneurysm is more than five centimeters (about two inches).
• You have a connective tissue disorder (Marfan syndrome, Loey-Dietz syndrome, Ehlers-Danlos).
• Your aneurysm is growing quickly.

Mini Sternotomy

_{A mini sternotomy is a minimally invasive incision, measuring about 3 to 4 inches, that gives surgeons access to the heart. This often results in a shorter recovery time and a reduced risk of infection.} 

Full Sternotomy

_{A full sternotomy is an 8-to-10-inch vertical incision along the sternum to expose the heart for different types of surgery.} 

Risks of 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:

• Infection.
• Bleeding.
• Blood clots.
• Pneumonia.
• Injury to nerves.
• Hemorrhage.
• Kidney damage.
• Spinal cord injury.
• Side effects from anesthesia, such as headache, nausea, and confusion.

How to Prep for Your Sternotomy

Follow these guidelines to help you get ready for your surgery.

• If you smoke, do your best to quit. Smoking raises your blood pressure and heart rate and will slow your recovery.
• Avoid heavy meals or hard exercise the day before your surgery.
• Take a shower with the anti-microbial soap the doctor gives you.
• Remove nail polish and makeup before coming to the hospital.
• Don't use any hair products.
• Take out earrings or piercings.
• After midnight before your surgery, don't eat or drink anything.
• On the day prior to surgery you will be instructed which medications to take on the day of surgery.
• Have someone who can drive you to and from the hospital.
• Arrange for family or friends to be with you, 24/7, for at least the first week of your recovery. You won't be able to drive for 4 to 6 weeks.

How Long Does it Take to Recover from a Sternotomy?

It takes at least 4 to 6 weeks to heal from a sternotomy.

During that time, you can't drive or lift anything heavy. You should have someone at home with you the first week after surgery.

What to Expect Before, During, and After a Sternotomy?

Before surgery

You'll have an appointment a few weeks before for pre-surgery testing.

Tests may include:

• Blood work
• Urine studies
• Chest x-ray
• CT scan
• Echocardiogram
• EKG
• Lung function studies
• Doppler ultrasound
• Heart catheterization

On the morning of your surgery, you'll check in at the Surgical Family Waiting Room.

Your designated support person can stay in the waiting room until the surgery is over, as per our Covid-19 guidelines.

After check-in, you'll go 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 surgery.

Your support person will be able to come to your room to see you before the surgery. They'll get a pager so doctors can update them and let them know when they can see you after surgery.

During surgery

The operation will take about 4 to 6 hours.

Here's what will happen:

• 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 the aorta. They'll replace it with a tube-shaped fabric graft. Then they'll close the 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.

After surgery

After surgery, you'll need to stay in the hospital for about a week.

Here are the basic steps in the initial recovery.

• The team will transfer you to the cardiothoracic ICU. Within 4 to 6 hours, you'll be breathing on your own. In a few more hours, you can get up out of bed and into a chair.
• You will have pain, so doctors will give you pain meds.
• Breathing specialists will help you use a device to start deep-breathing exercises. After surgery, it hurts to cough or take a deep breath, so mucus can build up in your lungs. The exercises will help get rid of the mucus and prevent infections that lead to pneumonia.
• You'll spend 1 or 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.

Once 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 after your discharge.

Expect full recovery to take 2 to 3 months.

Keep in mind:

• You can't drive a car for 4 to 6 weeks.
• Do not lift more than 10 pounds.
• Do not lift your arms over your head.
• 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.
• Elevate your legs above your heart when you're sitting.
• Take a few short walks throughout the day. Stairs are fine.