Removal Of Sternum After Bypass Surgery

Question

Asked by DaddysGirl

Removal Of Sternum After Bypass Surgery

This is a question for my father. He is 69 and up until chest pains when he pushed a mower, rode his bike or heaved a bale of hay, he was the picture of health. He had 4 blockages at 95%, so bypass was our only option. Here is a short of it:

July 11: Quadruple bypass. Difficult surgery due to his extraordinarily thick sternum, but good graphs.

July 27: Rush to the hospital with fever, vomiting. Discover infection in his chest.

July 30: Chest cavity and sternum infected. Doc cleans but leaves the cavity open so he can go back in to clean out again later.

July 31: In the wee hours, Dad as being moved, or coughed, or sat up (we are unclear as to the exact circumstance). His heart had already healed from the bypass and connected to the chest wall. Due to the mobility of the ribs (no sternum), his right ventricle tore 4 1/2 inches. The nurse reached in (it was open) grabbed his heart and off they went to the heart/lung machine. Nine hours of surgery and 2 patches later, he came out of surgery. The doc said this trauma had never been survived.

Since he was in induced coma for 3 weeks, he is having to have physical rehab now but will be home in the next week or two.

He has nothing in the place of the sternum. The doc was able to pull up the omentum and flap muscles, but that is it. I am curious as to how others have gotten along. Do you need a protective vest? Will his heart be in danger of tearing again since there is mobility? Will he have restrictions that will prevent him from lifting, riding or pushing?

Thank you to anyone who can help me.

Answer

DaddysGirl,

Thanks for your question.

I have had 3 or 4 patients through the years who developed a sternal wound infection, and required the removal of the sternum. They all had a follow-up procedure in which a flap was placed over the sternum, containing abdominal wall muscle, and sometimes underlying omentum. This serves to protect the chest cavity from minor contact with people and objects, that most people would encounter in daily living.

You may notice that when your father breathes in, his chest/ribs will balloon out a bit, while the flap retracts in a bit. The opposite occurs when he breathes out. When lifting heavy objects, people usually take a breath, then hold it and exert heavy pressure by contracting their abdominal muscles. This should be avoided by your father as this would put extra pressure on the flap.

The walls of the cavity (ribs) will smooth out with time and should not be an issue for another tear. In addition, the muscles of the flap will help prevent this also.

You will need to discuss all of your questions with the surgeon, especially his future restrictions and precautions. Wearing a vest for daily activities should not be necessary.

You should also know that all of my patients lived for several years, with no further problems related to the removal of their sternums.

Best wishes.

Martin Cane, M.D.