Open Heart Surgery Scars

As I personally remember, common questions that patients have about open heart surgery scars are, "What will my scar look like?", "How big will my scar be?" and "Will the scar fade over time?"  

Adam's Median Sternotomy Scar

Those are all great questions.  

So you know, the scar size will depend on the type of open heart surgery performed by your medical team. Not only are the different incision sizes but there are different incision locations that may or may not be used by your specific surgeron. 

Median Sternotomy Scars

As you can see above, I had a median sternotomy performed for my aortic valve and pulmonary valve replacement surgery.  During a median sternotomy, the patient's sternum is separated so the surgeon - and his assistants - can have direct access to the heart.  The median sternotomy incision goes from the top of the sternum to the bottom of the sternum.

Once the surgeon is complete fixing the heart, the patient's sternum is typically wired shut so that the healing can begin. Rigid sternal fixation is another techniqu used to fuse the patient's sternum back together.  

Stapled Incision Closure for Heart Surgery Patient

As for the skin... The patient's skin can be glued, stitched or stapled after the procedure.  My surgeon, Dr. Vaughn Starnes used glue.  As you can see above, this patient, Emmanuel Ibanez from the United Arab Emirates, had staples. 

Mini-Sternotomy Scars

During the past 20 years, there have been significant advances in minimally invasive techniques used to access the heart.  As a result, the inicisions used by cardiac sugeons have greatly decreased.  

While the traditional median sternotomy scar can be 8 to 11 inches, a mini-sternotomy scar can be just 3 to 4 inches, acording to Dr. Eric Roselli, the Chief of Adult Cardiac Surgery at the Cleveland Clinic.  

Mini-Sternotomy Open Heart Scar

Specific to mini-sternotomies and heart valve surgery... According to Brigham & Women’s Cardiovascular Center in Boston, Massachusetts:

• Mini-Sternotomy for aortic valve replacement incisions are performed through an upper mini-sternotomy, in which an incision is made from the sternal notch to the third intercostal space. 
• Mini-Sternotomy for mitral valve replacement/repair incisions are performed through a lower mini-sternotomy, in which a 6-8 cm incision is made at the lower end of the sternum upward to the second intercostal space and extending into the interspace on the right.

The use of mini-sternotomy incisions can be very common at leading cardiac centers.  Dr. Eric Roselli shared with me, "Almost all isolated first time aortic valve patients in my practice get a mini-sternotomy."

Mini-Thoracotomy Scars 

Another type of minimally invasive approach to treat heart disease is called mini-thoracotomy.  As shown below, Jim Englemann, a patient from our community, had his aortic valve replaced using a mini-thoracotomy. 

Jim's Mini-Thoracotomy Scar

As Jim wrote to me, "My medical team did not have to break the sternum. Instead they entered my chest from above the heart. The operation went well, and I was off the tube before being brought to post-op."

Diagram of Mini-Thoracotomy (Port Access)

Mini-thoracotomy procedures are also known as "Port Access" surgical approaches. Instead of having a single point of access to the heart, several different ports are used to enable the surgeon to see into the heart with small camera and fix the heart with very small instruments.

The sternum is not broken during a mini-thoracotomy procedure as the access points are through the patient's ribs. 

Robot-Assisted Scars

Another type of open heart surgery scar can result from the use of the Da Vinci robot.  If your surgeon elects to use a robot to repair your mitral valve, a series of access points will be used.  

As you can see above, there are similarities in the types of scars that resut from a robot and mini-thoracotomy approaches as several different ports are used during these procedures which can be very effective and reduce the scar size.

You May Also Like

To learn more about open heart surgery scars, you might enjoy these articles and patient updates:

• Julie's "Smiling Scar Selfie" Goes Viral
• Mederma: A Great Scar Cream for Open Heart Surgery Patients
• Non-Invasive Heart Valve Repair with a Robot
• Surgeon Q&A: Advantages of Port Access Therapy?
• Rigid Sternal Fixation: Top 6 Facts for Patients
• Find Patient-Recommended Heart Valve Surgeons
• Discover the Heart Valve Learning Center

Page last updated: September 18, 2020