Before, During, and After a Sternotomy

Posted by Heart Hugger on May 7, 2024 12:09:00 PM

If you or a loved one is having a sternotomy, you likely have a lot of questions about the procedure, the healing process, what to expect, and more. While it's always best to ask your doctor for guidance, it never hurts to do a bit of foundational research so you know what to ask.

Here's a quick look at sternotomy surgery: before, during, and after.

Before a Sternotomy: Preparation and Questions

The most important thing to know about a sternotomy is that it's usually only one part of a larger healthcare approach. During this procedure, your doctor separates your sternum--or breastbone--to reach your heart, lungs, or other body parts. Other surgeries, such as open heart surgery, may occur after that, depending on your needs and doctors' recommendations.

Before the sternotomy and related procedures, you'll have plenty of time to ask questions. This is your chance to learn what will happen, what to expect, and what you'll need to do. You'll also have various tests done, including X-rays and blood work.

In addition to the usual pre-surgery preparation, your doctor may recommend specific exercises or lifestyle changes to improve your overall health and reduce the risk of complications. These may include quitting smoking, losing weight, or managing underlying health conditions like diabetes or high blood pressure.

Pre-surgery preparation often includes:

Showering or bathing the day before surgery and using special anti-microbial soap provided by the doctor.
Avoiding exercise for at least 24 hours before surgery.
Removing nail polish, makeup, earrings, and piercings.
Taking appropriate medications before coming to the hospital.
Not eating or drinking after midnight on the morning of your surgery.

Your doctor will provide more specific instructions, so be sure to follow all the necessary steps.

During a Sternotomy: Surgical Approach

Depending on your healthcare needs and doctor's recommendations, you may have a mini or full sternotomy. Either way, the procedure will likely follow these general steps:

Your doctor starts between your collarbones. They use a scalpel to cut through the skin to the sternum.
They'll make an incision of a certain length depending on the type of sternotomy. The full procedure involves an incision of about 6 inches.
Your doctor uses a sternal saw to cut through the middle of your sternum.
They use a tool like a retractor to separate the two halves of your split sternum.
They'll open the pericardium, the sac around your heart.
Your doctor then performs whatever surgery or procedure is necessary.
When the other surgery is complete, the doctor closes your sternum with up to 12 sternotomy wires.
They'll close your chest and skin.

Recent advancements in surgical techniques have led to the development of minimally invasive sternotomy procedures. These involve smaller incisions and specialized instruments, which can result in less pain, faster recovery, and reduced risk of complications compared to traditional sternotomy.

After the procedure, you'll go to the ICU, where you'll be breathing on your own and moving around in less than a day. You'll receive pain medication and breathing devices to help keep you comfortable. When you're stable, you'll move to a different part of the hospital, where your official healing and recovery process begins.

After a Sternotomy: Healing and Recovery

Healing from a sternotomy--and, in fact, any kind of heart surgery--is a journey. Here's what to expect:

In The Hospital

While healing at the hospital, your goal is to regain your strength. That means physical therapy and deep breathing exercises will be part of your daily routine. Once you're comfortable moving, walking, and breathing on your own, you'll likely be able to go home.

Many hospitals now offer enhanced recovery after surgery (ERAS) protocols, which aim to optimize patient care and improve outcomes. These protocols may include early mobilization, pain management strategies, nutritional support, and patient education to help you recover more quickly and comfortably.

At Home

You'll need someone to stay with you 24/7 for at least the first week after leaving the hospital. During this time, it's important to focus on a few key areas of recovery:

Physical

Physical recovery is perhaps the most obvious part of heart surgery healing. To take care of yourself:

Don't lift anything over 10 pounds.
Sleep on your back or side.
Take short walks throughout the day, but avoid strenuous activity.
Maintain a healthy diet based on your doctor's recommendations.
Don't drive until your doctor says you're well enough to do so.
Use a sternal support vest to breathe and cough more comfortably.

Engage in cardiac rehabilitation as prescribed by your doctor. This medically supervised program can help you regain strength, improve cardiovascular fitness, and reduce the risk of future heart problems.

Mental

It's important to set yourself up for success when it comes to mental recovery. For example, you may feel anxious or stressed when you first come home from the hospital. Be prepared for this and get the support you need to develop a healthy mindset. For many people, that means setting achievable goals, being patient with themselves, and staying in contact with family and friends.

Consider joining a support group for people who have undergone similar surgeries. Sharing your experiences and learning from others can help you cope with the challenges of recovery and maintain a positive outlook.

Emotional

Emotional recovery is a little different from mental recovery, but they go hand-in-hand. Your emotions may change based on medications, your ability to sleep, your pain level, and more. Be aware of any significant mood or personality shifts, and keep track of signs that may indicate ongoing issues such as depression.

If you experience persistent feelings of sadness, hopelessness, or anxiety, don't hesitate to reach out to a mental health professional. They can help you develop coping strategies and provide additional support during your recovery.

In conclusion, a sternotomy is a major surgery, which means it comes with a significant healing journey. Knowing what to expect before, during, and after can help you decide what questions to ask your doctor and how to prepare for every step of this undertaking.