While still considered a high-risk procedure, open heart surgery has become increasingly common over the past decades. Having first been successfully performed on a patient with a heart defect by Dr. C. Walton Lillehei and Dr. F. John Lewis at the University of Minnesota in 1952, the surgery is now used to correct and address a wide range of cardiovascular issues, ranging from ischemic and congenital and valvular heart disease to heart transplantation. According to the Texas Heart Institute, there are literally thousands of open heart procedures performed in the U.S. daily, and in a recent year, there were as many as 500,000 coronary bypass procedures.
Though open heart surgery is used to correct several different cardiovascular issues, all surgeries present a very similar challenge to patients: severe recovery pain in the sternum. The use of thoracotomy — an incision into the pleural space of the chest — followed by a sternotomy, wherein the sternum is cut open, or “cracked” to gain access to the heart, are incredibly invasive procedures that require substantial recovery and rehabilitation efforts on the part of the patient. The pain associated with the healing process can be so intense as to discourage the rehabilitation of patients back to a baseline fitness level. Pain medication is prescribed at the outset of recovery, but as the patient progresses, pain management meds need to be reduced.
Sternum Support Devices For Reducing Open Heart Surgery Pain
The majority of pain associated with the sternotomy is local to the area of incision. Because bone and tissue both need to heal, virtually every physical movement aggravates the wound, leading to patients feeling discouraged in regaining mobility. Even involuntary acts such as coughing as well as respiration techniques performed in and out of the hospital can be excruciating. In order to mitigate this pain, a series of medical devices called sternum support devices have become increasingly effective in giving open heart surgery patients a non-medicinal means of adding support to the sternum, avoiding the intense pain caused by movement during the recovery process.
Sternum support devices are relatively simple designs that typically do not involve electronic components. They are composed of a manual leverage system that wraps around the chest and includes some kind of dual grip that allows the patient to compress the chest together while undertaking an activity. This compression protects the wound from being pulled apart and aggravated, reducing pain and increasing patient confidence in being more ambulatory.
Several studies have tested via questionnaire the viability of sternum support devices to mitigate pain and increase recovery time and quality. In a study conducted at Hospital Maria Middelaresse in Gent, Belgium, Dr. R. Hamerlijnck, a cardio thoracic surgeon at the hospital, led a study to determine the effectiveness of a popular sternum support device in 69 patients who had undergone cardio-thoracic surgery. Using a simple 1 to 10 scale for measuring the effectiveness of the device, with 1 equaling “completely disagree” and 10 equaling “completely agree,” the participants answered questions on its use and effectiveness both in the hospital and at home.
The period of use of the device included patients’ hospital stay, plus voluntary use from the first day at home during a wide range of voluntary and involuntary activities such as coughing, sneezing, moving, laughing, practicing, standing up, and climbing stairs. The study reported that participants wore the device for an average of 25 days once home from the hospital.
The survey grouped questions into two categories: “In the Hospital” and “At Home.” For the hospital related questions, participants scored the use of a sternum support device as a 9 in giving pain relief and support while coughing, and an 8 in supporting the chest well when changing positions in bed.
Once at home, participants scored the device a 9 for pain relief during coughing; 8.5 for pain relief when getting in and out of bed; 8 for pain relief when standing up from a chair and getting in and out of a car; 8 for both respiration and revalidation practice; and 7.5 for pain relief when climbing stairs.
Next-Generation Sternum Support Device Design
While the method itself for compressing the chest and reducing pain from movement after open heart surgery is well-established, the medical device community is making strides towards improving on the designs of early sternum support devices. The commonly used fulcrum in the device is a grip or handle directly in the center of the sternum that allows patients to squeeze together with one hand while being active. However, new designs are making it easier for patients to use — particularly those who are too weak from the surgery to provide a strong grip on the device. With these new designs, drawstrings utilizing a lacing type pulley system allow for greater ease of use with less reliance on grip strength on the part of the patient to provide ample compression on the sternum.
Regardless of the design, sternum support devices have become increasingly prevalent in recovering from open heart surgery, with patients and physicians alike agreeing that its simple, effective and non-medicinal approach is simply good medicine for getting patients back on their feet.