The bone in the center of your chest is called the "sternum" or "breast bone".  Every rib joins

the breast bone to provide a protective covering over your heart, lungs, and vital organs.   At

the lower end of the breast bone is a small fragment of cartilage called the xiphoid (pronounced

"zi-foid").  This tag of cartilage does not play any

role in the strength or structural integrity of your

chest and can be removed without any

consequences.  Most people think the xiphoid is

part of the breast bone, but the true sternum is

calcified bone while the xiphoid is cartilage (a

softer, non-calcified tissue).

For the past 40 years, almost all heart surgery

(bypasses, valve replacements, etc). have been

performed using a single, versatile incision called

"sternotomy" where the breast bone is divided

down the middle using a surgical saw and the two

bone fragments are then spread apart with a

mechanical retractor.   This approach gives the

surgeon full exposure to the heart and great

vessels.  Once the heart is repaired, the bone

fragments are wrapped with stainless steel wires to hold them together.  Healing and new bone

formation takes place at the same rate as any other broken bone (over the next 2 to 3 months).

In patients who perform manual labor as part of

their employment, time off work can be as long

as 3 months while the bone is allowed to heal

completely.  In addition, potential complications

from splitting the sternum include:

Failure of bone healing, or

Infection

The term subxiphoid literally means "below the

xiphoid".   The technique developed by Dr.

Levinson involves removal of the xiphoid

cartilage and lifting of the lower end of the

sternum.  Since none of the bone, muscles, nerves, or other structural elements of the chest

wall are injured, pain is much less.  Here you can see

Dr. Levinson raising the lower sternum while the Left

Internal Mammary Artery is mobilized from inside of

the rib cage.

The incision is typically a 4 inch vertical ("up and

down") incision which only separates (but does not

injure or divide) the muscles in the upper

abdomen.  Using special retraction devices, a working

space is created which gives the surgeon access to the

heart as well as the donor vessels (the Internal

Mammary Arteries and Gastroepiploic Artery).

At the conclusion of the procedure, Dr. Levinson

injects local anesthetic to numb the whole incision.

Patients typically wake up with minimal or no pain.  In some cases, the anesthesiologist can then

remove the breathing tube before the patient is fully awake, avoiding the disturbing memory of

waking up with a  breathing tube.