When facing heart valve disease or complex coronary issues, choosing the surgical approach is a critical decision you’ll make with your cardiac surgeon. Modern medicine offers two primary paths: the traditional, proven sternotomy and the advanced minimally invasive approach.
Both aim to restore heart function and improve your quality of life, but they differ significantly in technique, recovery, and patient experience. Understanding these differences is essential for making an informed choice.
Sternotomy heart surgery, commonly known as open-heart surgery, involves making a vertical incision along the chest and dividing the sternum (breastbone) to expose the heart and surrounding structures. This traditional technique provides surgeons with direct visibility and unrestricted access to all parts of the heart.
It has been the gold standard in cardiac surgery for decades, allowing the treatment of complex conditions such as:
The surgical process usually follows these key steps:
Sternotomy remains the safest and most comprehensive approach for:
Sternotomy is a highly safe and time-tested procedure when performed by experienced cardiac surgeons.
| Parameter | Recovery Details |
| Hospital Stay | 5 to 7 days (including 1 to 2 days in ICU). |
| Activity Restrictions | Avoid heavy lifting (over 5 to 10 lbs) for 6 to 8 weeks to allow the sternum to heal. |
| Return to Work | 2 to 3 months (depending on the nature of the work). |
| Full Recovery | 3 to 4 months (12 to 16 weeks), primarily due to the time required for complete sternal fusion. |
Minimally invasive heart surgery is a modern approach where surgeons operate through small incisions (2 to 4 inches) between the ribs, avoiding the need to cut the sternum.
Using specialised tools, high-definition cameras, and sometimes robotic assistance, surgeons can perform the same heart procedures with less trauma, less pain, and faster recovery.
MICS uses specialised, long, thin instruments and advanced video technology to access the heart through small openings between the ribs or via a partial sternum cut.
| Technique | Access Method | Common Procedures |
| Mini-Thoracotomy | A single 2 to 4-inch incision is made between the ribs on the side of the chest. The sternum is intact. | Mitral valve, Tricuspid valve, Atrial Septal Defect (ASD) repair, selected Aortic valve, MICS-CABG. |
| Mini-Sternotomy | A partial vertical cut through only the upper or lower part of the sternum. | Aortic valve replacement, upper coronary bypass (CABG). |
| Robotic-Assisted | Multiple 1 to 2 inch ‘port’ incisions where the surgeon controls miniature instruments from a console, viewing the heart on a 3D high-definition monitor. | Mitral valve repair, CABG. |
| Parameter | Sternotomy (Open Heart) | Minimally Invasive Surgery (MICS) |
| Incision | 8 to 10-inch cut down the centre of the chest. | 2 to 4 inch cut(s) between the ribs or via partial sternum. |
| Breastbone | Fully divided and wired back together. | Usually intact (Mini-Thoracotomy) or partially divided (Mini-Sternotomy). |
| Visualisation | Full, direct, and unrestricted access. | Limited but enhanced via specialised instruments and 3D video cameras. |
| Hospital Stay | 5 to 7 days. | 2 to 5 days (shorter). |
| Return to Work | 8 to 12 weeks (3 months). | 3 to 6 weeks (faster). |
| Full Recovery | 3 to 4 months (12 to 16 weeks). | 6 to 8 weeks (2 to 3 months). |
| Blood Loss/Transfusions | Higher. | Lower. |
| Best For | Complex, multi-vessel, and emergency procedures. | Single/limited procedures in suitable patients (valve repair/replacement, selected CABG). |
| Surgical Time | Often shorter. | May require longer cardiopulmonary bypass and cross-clamp times (though overall patient outcomes remain comparable). |
| Long-Term Outcomes | Excellent, time-tested durability. | Comparable excellent long-term durability for suitable cases. |
One of the most common procedures performed through both sternotomy and minimally invasive techniques is Coronary Artery Bypass Grafting (CABG).
Coronary Artery Bypass Grafting (CABG) is performed to restore normal blood flow to the heart when the coronary arteries are blocked or narrowed.
How it’s done:
Healthy blood vessels from the leg, chest, or arm are used to create new routes for blood to flow around blockages. Once the grafts are attached, the heart is restarted and checked for proper circulation.
Depending on how many arteries are blocked, patients may need a single, double, triple, or quadruple bypass.
| Aspect | Traditional CABG | MICS-CABG (Minimally Invasive) |
| Approach | Full chest opening (sternotomy). | Small incision between ribs on the left chest. |
| Pump Status | Uses a heart-lung machine (On-Pump). | Can be done on a beating heart (Off-Pump), without cutting the breastbone. |
| Best suited for | Complex multi-vessel disease. | Selected single or limited-vessel blockages. |
The surgical approach is chosen after evaluating several factors:
A detailed assessment through coronary angiography, echocardiography, and pre-surgical evaluations helps the cardiac team decide the safest and most effective technique for each patient.
CABG is a proven and generally safe procedure, though certain risks exist:
Long-term outcomes:
The landscape of cardiac surgery is evolving faster than ever, driven by technology and innovation. New techniques and advanced imaging are transforming how heart diseases are treated, making surgeries less invasive, more precise, and quicker to recover from.
Emerging trends include:
These innovations aim to make cardiac surgery safer, more personalised, and focused on improving long-term quality of life for every patient.
Both sternotomy and minimally invasive heart surgery have vital roles in modern cardiac care.
A detailed consultation helps determine whether a minimally invasive or traditional approach offers the safest and most durable outcome for your specific case.
At Heart Valve Experts, our surgeons are skilled in both traditional and minimally invasive techniques, ensuring every patient receives individualised, safest, and most effective treatment possible.
Choosing between sternotomy heart surgery and minimally invasive heart surgery depends on balancing complexity, safety, recovery, and comfort. While sternotomy remains unmatched for complex cases, minimally invasive surgery represents the future of cardiac care, offering faster recovery, fewer scars, and comparable long-term outcomes.
Reach out to HeartValveExperts now and book your consultation with our team, which specialises in both advanced surgical techniques, helping you make confident, informed decisions for your heart health.
Sternotomy involves cutting the breastbone for full heart exposure. Minimally invasive surgery uses small incisions between ribs, avoiding bone division and reducing trauma.
Yes. It’s a time-tested, safe, and highly effective method for complex heart problems when done by experienced surgeons.
Traditionally, yes, but modern approaches allow bypass to be done through minimally invasive or off-pump techniques.
Sternotomy recovery takes about 8 to 12 weeks, while minimally invasive patients usually recover in 3 to 6 weeks.
Minimally invasive surgery leaves small, often barely visible scars better cosmetically than the central sternotomy scar.
Your cardiac surgeon evaluates your anatomy, disease complexity, and health to recommend the most suitable approach.
