A sternotomy (median sternotomy) is the surgical approach used for most open-heart surgeries. The breastbone (sternum) is divided vertically to provide access to the heart and great vessels. The sternum is then wired back together with stainless steel wires and typically heals in 8-12 weeks. Sternal precautions (no lifting over 5-10 lbs, no pushing/pulling, no driving) are required during healing.
Sternotomy has been the standard approach for cardiac surgery since the 1950s and remains the most common access method due to excellent exposure of all cardiac structures. Alternatives include mini-sternotomy (partial sternotomy through a smaller incision), right mini-thoracotomy (between the ribs), and robotic-assisted approaches. These minimally invasive options offer faster recovery and smaller scars but are not appropriate for all procedures or all patients. Sternal wound complications occur in approximately 1-3% of cases and are more common in obese patients, diabetics, and those using bilateral internal mammary arteries.

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