The median sternotomy provides excellent exposure in all open-heart surgeries and procedures involving the ascending aorta. It's a fundamental technique that cardiac surgeons must learn early in their training and execute safely. During the initial cardiac surgery, thorough detachment of the upper and lower ends of the sternum and precise identification of the sternal midline enable a safe sternotomy. In reoperations, caution is essential due to adhesions on the back of the sternum, requiring careful attention to prevent injury to the heart and major blood vessels. In high-risk cases, readiness to promptly establish cardiopulmonary bypass is crucial. Various types of surgical instruments for sternum closure are commercially available, allowing for appropriate closure depending on the patient's specific complications and surgical requirements. The use of sternal wires is a standardized method that surgeons should master.