We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Again, Via the Median Sternotomy

Arch Surg. 1974;109(5):604. doi:10.1001/archsurg.1974.01360050002002.
Text Size: A A A
Published online


As the essentially palliative nature of many kinds of heart surgery becomes more fully recognized, secondary open heart procedures are being performed with increasing frequency. Reoperations most commonly involve replacement of malfunctioning prosthetic valves or insertion of new prosthetic devices where previous valvuloplastic precedures have failed. Additionally, reoperation is occasionally indicated in the face of progressive coronary atherosclerosis wherein previously placed grafts have occluded or new coronary lesions have developed. Numerous further special situations can occur in which a second operation becomes necessary.

A certain amount of controversy surrounds the advisability of performing the second cardiac surgical procedure via the median sternotomy used for the earlier operation. Certainly, all agree the supine position on the operating table is far superior to the lateral for hemodynamic stability. Generally, objections to reoperating by vertical sternotomy have concerned safety, problems with intraoperative and postoperative hemostasia, and impatience with the sometimes tedious dissection. It


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.