Extended indications for the median sternotomy incision.

Median sternotomy, the preferred incision for most procedures on the heart and ascending aorta, has now gained acceptance in selected cases for the surgical treatment of pulmonary metastases and emphysematous blebs whether single or multiple, unilateral or bilateral. Contrasted to lateral thoracotomy, the median sternotomy combines adequate exposure for most pulmonary procedures with reduction in postoperative pain, pulmonary complications, and hospital stay. Patients with reduced pulmonary function, inoperable by standard incisions, become acceptable surgical risks when operated through the median sternotomy. Synchronous pulmonary, mediastinal, and cardiovascular procedures are readily performed, reducing the need for separate operations with their separate risks. This report is based on the eight cases approached by median sternotomy. Postoperative pain was acceptable. Postoperative narcotic requirement and hospitalization were reduced; there was no significant morbidity and no mortality.