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Pros and Cons of open sternum vs through rib
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Pros and Cons of open sternum vs through rib


  Hi,
  I have a 79 year old neighbor who had valve replacement surgery in 1981.  That was done by opening the sternum.  Her heart doctor in the past told her she could not have this same surgery again.
  Recently, she has had shortness of breath.  She recently had an echocardiogram and then a week ago she had a catharidization (sp) and was told her valve needed to be replaced again.
  Her doctor now thinks she would be a candidate for the more minimally invasive rib surgery.  She has severe osteoporosis.  After visiting the surgeon, he told her that the open sternum surgery would be used.
  She is now confused and doesn't know what she should do.  
  It would seem that the least bone disturbance would be preferable with severe osteoporsis, is this true or not?
  What are the pros and cons of each?
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Dear Helen, thank you for your question.  I'm not sure why your neighbor's  surgeon told her in 1981 that she would never be a candidate again for the traditional median sternotomy again.  Minimally invasive open heart surgery involves a 4 - 5 inch incision in the sternum or the ribcage that involves less post operative pain and a shorter post operative recuperation period.  However, due to the dense adhesions that develop after a first open heart surgery, this limited access approach is very limited for a second open heart surgery.  Since the surgeon will need the maximum viewing field available to take down the old adhesions during the redo surgery, a median sternotomy approach sounds best.  Osteoporosis usually doesn't affect the sternum and ribs much compared to the back and the hips so this should not be a contraindication to performing a median sternotomy  - which should still heal well.  I think you should have her check with her cardiologist who could talk to the cardiac surgeon about the plans for surgery.

I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.   The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.





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