Introduction
A thoracotomy is a surgical incision made between the ribs on the side or front of the chest to reach the heart, the lungs or the large blood vessels. In cardiac surgery it is used as an alternative to opening the breastbone.
Depending on the operation, the surgeon may use a small thoracotomy (a few centimetres) or a larger one, sometimes with a camera, so that the heart or a particular valve or vessel can be reached with less cutting of bone.
Why the procedure is needed
A thoracotomy may be chosen instead of a breastbone incision when:
- A particular part of the heart, such as the mitral valve or the aorta, is best reached from the side of the chest
- The patient has had previous chest operations and a repeat sternotomy would be risky
- A smaller incision may reduce pain, blood loss and recovery time in a suitable patient
- The operation involves vessels in the chest, such as the descending aorta or a patent ductus arteriosus
- In an emergency, rapid access to the heart is needed
Who may benefit
- Patients in whom a side-of-the-chest approach gives the surgeon the best and safest view for the planned operation
- Patients who have had previous heart surgery through the breastbone
- Selected patients for minimally invasive valve or bypass operations
- Children needing certain procedures, such as closure of a patent ductus arteriosus or coarctation repair
- Not suitable for every operation or every patient — your surgeon will decide
Types of thoracotomy used in cardiac surgery
- Left anterolateral or posterolateral
- Used for operations on the descending aorta and some operations on the left side of the heart.
- Right mini-thoracotomy
- A small right-sided incision used by some centres for mitral or aortic valve surgery, with or without a camera.
- Left mini-thoracotomy (MIDCAB)
- A small left-sided incision for bypass of the front artery of the heart, in selected patients.
- Video-assisted
- A camera and fine instruments through small cuts may be used together with the thoracotomy.
- Emergency thoracotomy
- In rare emergencies such as trauma, it allows rapid access to the heart.
Procedure overview
Step 1: Planning
Scans and echocardiography show the best way to reach the heart. You and your surgeon discuss the approach.
Step 2: Anaesthesia
General anaesthesia is used. A special breathing tube may allow one lung to rest during the operation.
Step 3: Positioning and incision
You lie on your side or back, and an incision is made between the ribs, spreading them gently apart.
Step 4: The operation
The planned repair or bypass is carried out, with or without the heart-lung machine, depending on the case.
Step 5: Closure and pain control
The ribs are brought together, drains are placed and the incision is closed. Pain control, such as nerve blocks, is important because this area can be painful.
Step 6: Recovery
Breathing exercises and early walking help recovery. Recovery time depends on the operation performed.
Clinical advantages
- Avoids dividing the breastbone, which may help in some patients
- Gives good access to certain parts of the heart and aorta
- A good option after previous breastbone surgery
- May reduce blood loss and speed recovery for some patients
Risks and considerations
Every operation carries risk. The points below are general; your own risk depends on your health and on the operation you need.
- Pain at the incision, which may last for weeks or sometimes longer
- Bleeding, infection, and the general risks of the planned heart operation
- Lung problems such as fluid or collapse of part of the lung
- Nerve injury or numbness around the incision
- In some cases the surgeon may have to change to a breastbone incision for safety
Frequently asked questions
Is a thoracotomy less painful than a breastbone incision?
Not always. Pain after a thoracotomy can be significant, but pain control methods are used. Experiences differ from patient to patient.
Why might the surgeon choose this approach?
Because it gives the best access to the part of the heart that needs treatment, or because you have had previous chest surgery.
Will I have a visible scar?
Yes, but the incision is usually placed along the line of a rib or skin fold, and often is smaller than the breastbone incision.
Can the surgeon change the approach during the operation?
Yes. If this is needed for your safety, the surgeon may change to a breastbone incision.
How long is the recovery?
It depends on the operation done through the thoracotomy. Your surgeon will give you a guide.
Patient-friendly summary
A thoracotomy reaches the heart through the side of the chest instead of the breastbone. It can be the best route for some operations or after previous surgery, but it is not right for everyone, and pain control and breathing exercises are important in recovery. Your surgeon will explain the approach that is safest for you.