The Advantages of Having Heart Surgery Without the Chest Being Opened

In classical heart surgery, cutting the breastbone (sternum) right down the middle (sternotomy) is a standard method that has been applied safely for decades. However, this bone incision has its own healing process and certain risks. In this article I will explain the advantages offered by operations performed without touching the breastbone.

The Benefits of Surgery Without Sternotomy (Bone Incision)

When the breastbone is not cut, the 6-8 week period of restriction needed for the bone to knit (no heavy lifting, no raising the arms) disappears. Our patients can use their arms normally right after surgery and do not experience the fear of the bone moving when they cough or sneeze.

Less Pain, Less Bleeding and Early Discharge

A small incision means less tissue trauma and less bleeding; this in turn keeps the level of pain after surgery markedly lower. Meta-analyses show that in valve operations performed through a mini-incision, the need for blood transfusion and the length of hospital stay are significantly reduced compared with the classical method.

Reduction of Infection Risk

One of the most serious, rare but severe complications of a breastbone incision is deep sternal wound infection (mediastinitis); this risk increases especially in diabetic and overweight patients. Because the bone is not cut at all in small-incision techniques, the risk of this type of deep infection is almost completely eliminated; large meta-analyses show that wound infection rates in operations performed through a mini-incision are significantly lower than with the classical method.

Frequently Asked Questions

Is small-incision surgery safer than classical surgery? When chosen in the right patient, it offers similar results in terms of the risk of death and stroke, and generally more favourable results in terms of infection and bleeding.

Does the risk of surgery decrease because the bone is not cut? Bone-related complications (non-union, deep infection) are eliminated; however, the overall risk of the operation depends on the patient’s cardiac function and comorbidities.

Can this method be applied in every centre? No; working through a small incision requires special training and experience, and for this reason it is preferred in centres experienced in this field.

Conclusion

Heart operations performed without touching the breastbone offer less pain, less bleeding, a lower risk of infection and faster recovery in the right patient. The decision is personalised according to the valve pathology and the patient’s general condition.

You can book an appointment for a detailed examination to assess your option of having surgery without the breastbone being opened.

References

1. Loop FD, Lytle BW, Cosgrove DM, et al. Sternal Wound Complications After Isolated Coronary Artery Bypass Grafting: Early and Late Mortality, Morbidity, and Cost of Care. Ann Thorac Surg. 1990;49(2):179-186.
2. Cao C, Gupta S, Chandrakumar D, et al. A Meta-Analysis of Minimally Invasive Versus Conventional Mitral Valve Repair for Patients with Degenerative Mitral Disease. Ann Cardiothorac Surg. 2013;2(6):693-703.