Mini-Sternotomies: A Less Invasive Approach to Open-Heart Surgery
Pediatric cardiac surgery presents unique challenges to the surgeon. Researchers are continually searching for ways to minimize pain and other side effects for pediatric patients while optimizing outcomes. At the Nicklaus Children’s Hospital Heart Institute, our renowned pediatric cardiovascular surgeons are dedicated to offering the most advanced, least invasive procedures available, including the minimally invasive mini-sternotomy.
“Mini-sternotomy is a clinical technique that is attractive for a lot of families who have a child needing cardiovascular surgery,” says Joseph Forbess, MD, Chief of Cardiovascular Surgery at Nicklaus Children’s Hospital. “It allows us to give young, developing patients a smaller incision than previous techniques, and it yields optimal results.”
Benefits of Mini-Sternotomy
Median sternotomy is the primary method of accessing the heart for cardiac surgical interventions in adults as well as children. While these open procedures lead to excellent outcomes in most cases, they can also cause scarring, longer hospital stays and longer recovery times. Mini-sternotomies allow the surgeon to repair cardiac defects through a much smaller incision without opening the entire breastbone to access the heart.
The right atrium sits below the bottom part of the sternum, and as such, surgeons don’t have to open the entire breastbone, according to Dr. Forbess. Instead, the surgeon makes a small incision over this end of the sternum.
“The nice thing about the mini-sternotomy is that once we are inside the chest, the rest of the technique is identical to what we do in a traditional median sternotomy,” Dr. Forbess says. In particular, we are able to operate on infants and toddlers using very small incisions.”
Because the procedure is performed in the same way as conventional sternotomies, no special equipment is necessary, and the skills required are the same as those of conventional sternotomies.
“The flexibility of a child’s chest, compared with the rigidity of an adult’s chest, makes this procedure easy to perform on children,” Dr. Forbess says.
Mini sternotomies have much better cosmetic results, which can be important to many families. Most importantly, this minimally invasive procedure has proven to be safe and effective, with outcomes similar to those of traditional open surgeries.
Advantages of mini-sternotomies include:
- Less pain
- Less post-operative bleeding
- Less scarring
- Shorter ICU/hospital stays
For pediatric patients who qualify for this option, mini-sternotomies can be used for surgical intervention of several cardiac conditions, including:
- Atrial septal defects
- Partial anomalous pulmonary venous return
- Sinus venosus defects
- Tetralogy of Fallot birth defects
- Ventricular septal defects
Paving the Way Forward in Pediatric Cardiology and Cardiovascular Surgery
At the Heart Institute, we have treated infants and children with heart defects using the most innovative treatments available since the 1960s, when we became the first facility in Florida to perform pediatric open-heart surgeries. This dedication continues today. Dr. Forbess, who joined Nicklaus Children’s in June 2023, works closely with the team to continue to expand services and offer families the highest quality of cardiovascular care for their children.
“My vision for this program is to place us at the forefront of positive innovation,” Dr. Forbess says. “We continue to research better ways to optimize care and make sure we are staying ahead of what’s good for our patients for their lifelong health.”
To do this, our team participates in data registries, including the Society of Thoracic Surgeons registry, and stays abreast of research into care advancements.
The Heart Institute has one of the largest and most experienced cardiac teams in South Florida and has been consistently recognized by U.S. News & World Report as among the nation’s best in pediatric cardiology and cardiovascular surgery.
Additionally, the Heart Institute consistently produces surgical outcomes among the top in the nation, with a 98 percent overall survival rate and 100 percent survival rate for many conditions.
“We’re also looking at other quality indicators, such as length of hospital stay, how the children are doing post-op, how the brain is functioning and whether they need other procedures,” Dr. Forbess says. “Do they need another surgery or to get a pacemaker following the procedure? Did they need to go to the cardiac catheterization laboratory to have a blood vessel dilated? There are many downstream quality indicators that we look at nowadays.”
If you have a patient who may benefit from care at the Heart Institute, email a physician liaison today to discuss a referral.