Cardiovascular Surgery
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Cardiac surgery, or cardiovascular surgery, is
surgery Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...
on the
heart The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide t ...
or
great vessels Great vessels are the large vessels that bring blood to and from the heart. These are: *Superior vena cava *Inferior vena cava *Pulmonary arteries * Pulmonary veins *Aorta Transposition of the great vessels is a group of congenital heart defec ...
performed by cardiac
surgeon In modern medicine, a surgeon is a medical professional who performs surgery. Although there are different traditions in different times and places, a modern surgeon usually is also a licensed physician or received the same medical training as ...
s. It is often used to treat complications of
ischemic heart disease Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), myocardial ischemia, or simply heart disease, involves the reduction of blood flow to the heart muscle due to build-up of atherosclerotic pla ...
(for example, with
coronary artery bypass grafting Coronary artery bypass surgery, also known as coronary artery bypass graft (CABG, pronounced "cabbage") is a surgical procedure to treat coronary artery disease (CAD), the buildup of plaques in the arteries of the heart. It can relieve chest p ...
); to correct
congenital heart disease A congenital heart defect (CHD), also known as a congenital heart anomaly and congenital heart disease, is a defect in the structure of the heart or great vessels that is present at birth. A congenital heart defect is classed as a cardiovascular ...
; or to treat
valvular heart disease Valvular heart disease is any cardiovascular disease process involving one or more of the four valves of the heart (the aortic and mitral valves on the left side of heart and the pulmonic and tricuspid valves on the right side of heart). These ...
from various causes, including
endocarditis Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves. Other structures that may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, or the ...
,
rheumatic heart disease Rheumatic fever (RF) is an inflammatory disease that can involve the heart, joints, skin, and brain. The disease typically develops two to four weeks after a streptococcal throat infection. Signs and symptoms include fever, multiple painful jo ...
, and
atherosclerosis Atherosclerosis is a pattern of the disease arteriosclerosis in which the wall of the artery develops abnormalities, called lesions. These lesions may lead to narrowing due to the buildup of atheroma, atheromatous plaque. At onset there are usu ...
. It also includes
heart transplantation A heart transplant, or a cardiac transplant, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease when other medical or surgical treatments have failed. , the most common procedu ...
.


History


19th century

The earliest operations on the
pericardium The pericardium, also called pericardial sac, is a double-walled sac containing the heart and the roots of the great vessels. It has two layers, an outer layer made of strong connective tissue (fibrous pericardium), and an inner layer made of ...
(the sac that surrounds the heart) took place in the 19th century and were performed by Francisco Romero (1801) in the city of
Almería Almería (, , ) is a city and municipality of Spain, located in Andalusia. It is the capital of the province of the same name. It lies on southeastern Iberia on the Mediterranean Sea. Caliph Abd al-Rahman III founded the city in 955. The city gr ...
(Spain),
Dominique Jean Larrey Baron Dominique Jean Larrey (; 8 July 1766 – 25 July 1842) was a French surgeon and military doctor, who distinguished himself in the French Revolutionary Wars and the Napoleonic Wars. An important innovator in battlefield medicine and triage, ...
(1810),
Henry Dalton Henry Clay Dalton (May 7, 1847 – November 3, 1911) was superintendent of the St. Louis City Hospital, Missouri, United States, from 1886 to 1892, and later a professor of abdominal and clinical surgery at Marion Sims College of Medicine (now pa ...
(1891), and
Daniel Hale Williams Daniel Hale Williams (January 18, 1856 – August 4, 1931) was an African-American surgeon, who in 1893 performed what is referred to as "the first successful heart surgery". It was performed at Chicago's Provident Hospital, which he founded i ...
(1893). The first surgery on the heart itself was performed by
Axel Cappelen Axel Hermansen Cappelen (20 July 1858 – 13 November 1919) was a Norwegian surgeon. He was born in Selje as a son of district physician Johan Nicolay Cappelen (1818–1890) and Elisabeth Brunchorst Ravn (1825–1906). His brother Christian was ...
on 4 September 1895 at
Rikshospitalet Oslo University Hospital, Rikshospitalet is one of the four main campuses of Oslo University Hospital in Oslo, Norway. It was an independent hospital, ''Rigshospitalet'', later spelled ''Rikshospitalet'' ("The National Hospital"), from 1826 to 2009 ...
in Kristiania, now
Oslo Oslo ( , , or ; sma, Oslove) is the capital and most populous city of Norway. It constitutes both a county and a municipality. The municipality of Oslo had a population of in 2022, while the city's greater urban area had a population of ...
. Cappelen ligated a bleeding
coronary artery The coronary arteries are the arterial blood vessels of coronary circulation, which transport oxygenated blood to the heart muscle. The heart requires a continuous supply of oxygen to function and survive, much like any other tissue or organ of ...
in a 24-year-old man who had been stabbed in the left
axilla The axilla (also, armpit, underarm or oxter) is the area on the human body directly under the shoulder joint. It includes the axillary space, an anatomical space within the shoulder girdle between the arm and the thoracic cage, bounded superior ...
and was in deep
shock Shock may refer to: Common uses Collective noun *Shock, a historic commercial term for a group of 60, see English numerals#Special names * Stook, or shock of grain, stacked sheaves Healthcare * Shock (circulatory), circulatory medical emergen ...
upon arrival. Access was through a left
thoracotomy A thoracotomy is a surgical procedure to gain access into the pleural space of the chest. It is performed by surgeons (emergency physicians or paramedics under certain circumstances) to gain access to the thoracic organs, most commonly the hea ...
. The patient awoke and seemed fine for 24 hours but became ill with a
fever Fever, also referred to as pyrexia, is defined as having a body temperature, temperature above the human body temperature, normal range due to an increase in the body's temperature Human body temperature#Fever, set point. There is not a single ...
and died three days after the surgery from
mediastinitis Mediastinitis is inflammation of the tissues in the mid-chest, or mediastinum. It can be either Acute (medical), acute or Chronic (medical), chronic. It is thought to be due to four different etiologies: * direct contamination * hematogenous or Ly ...
.


20th century

Surgery on the
great vessels Great vessels are the large vessels that bring blood to and from the heart. These are: *Superior vena cava *Inferior vena cava *Pulmonary arteries * Pulmonary veins *Aorta Transposition of the great vessels is a group of congenital heart defec ...
(e.g.,
aortic coarctation Coarctation of the aorta (CoA or CoAo), also called aortic narrowing, is a congenital condition whereby the aorta is narrow, usually in the area where the ductus arteriosus (ligamentum arteriosum after regression) inserts. The word ''coarctation' ...
repair, Blalock–Thomas–Taussig shunt creation, closure of
patent ductus arteriosus ''Patent ductus arteriosus'' (PDA) is a medical condition in which the ''ductus arteriosus'' fails to close after birth: this allows a portion of oxygenated blood from the left heart to flow back to the lungs by flowing from the aorta, which has ...
) became common after the turn of the century. However, operations on the
heart valve A heart valve is a one-way valve that allows blood to flow in one direction through the chambers of the heart. Four valves are usually present in a mammalian heart and together they determine the pathway of blood flow through the heart. A heart v ...
s were unknown until, in 1925,
Henry Souttar Sir Henry Sessions Souttar (14 December 1875 – 12 November 1964) was a British surgeon with a wide breadth of interests. He trained first as a mathematician and engineer. His engineer’s training enabled him to design and make new types of s ...
operated successfully on a young woman with
mitral valve stenosis Mitral stenosis is a valvular heart disease characterized by the narrowing of the opening of the mitral valve of the heart. It is almost always caused by rheumatic valvular heart disease. Normally, the mitral valve is about 5 cm2 during d ...
. He made an opening in the appendage of the left
atrium Atrium may refer to: Anatomy * Atrium (heart), an anatomical structure of the heart * Atrium, the genital structure next to the genital aperture in the reproductive system of gastropods * Atrium of the ventricular system of the brain * Pulmona ...
and inserted a finger in order to palpate and explore the damaged
mitral valve The mitral valve (), also known as the bicuspid valve or left atrioventricular valve, is one of the four heart valves. It has two cusps or flaps and lies between the left atrium and the left ventricle of the heart. The heart valves are all one-w ...
. The patient survived for several years, but Souttar's colleagues considered the procedure unjustified, and he could not continue.Lawrence H Cohn (2007), '&Cardiac Surgery in the Adult'', pp. 6+
Alfred Blalock Alfred Blalock (April 5, 1899 – September 15, 1964) was an American surgeon most noted for his work on the medical condition of shock as well as Tetralogy of Fallot— commonly known as Blue baby syndrome. He created, with assistance from h ...
,
Helen Taussig Helen Brooke Taussig (May 24, 1898 – May 20, 1986) was an American cardiologist, working in Baltimore and Boston, who founded the field of pediatric cardiology. She is credited with developing the concept for a procedure that would extend the l ...
, and
Vivien Thomas Vivien Theodore Thomas (August 29, 1910 – November 26, 1985) was an American laboratory supervisor who developed a procedure used to treat blue baby syndrome (now known as cyanotic heart disease) in the 1940s. He was the assistant to surgeon ...
performed the first successful palliative
pediatric Pediatrics ( also spelled ''paediatrics'' or ''pædiatrics'') is the branch of medicine that involves the medical care of infants, children, adolescents, and young adults. In the United Kingdom, paediatrics covers many of their youth until the ...
cardiac operation at
Johns Hopkins Hospital The Johns Hopkins Hospital (JHH) is the teaching hospital and biomedical research facility of the Johns Hopkins School of Medicine, located in Baltimore, Maryland, U.S. It was founded in 1889 using money from a bequest of over $7 million (1873 mo ...
on 29 November 1944, in a one-year-old girl with Tetralogy of Fallot. Cardiac surgery changed significantly after
World War II World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the vast majority of the world's countries—including all of the great powers—forming two opposin ...
. In 1947, Thomas Sellors of
Middlesex Hospital Middlesex Hospital was a teaching hospital located in the Fitzrovia area of London, England. First opened as the Middlesex Infirmary in 1745 on Windmill Street, it was moved in 1757 to Mortimer Street where it remained until it was finally clos ...
in London operated on a
Tetralogy of Fallot Tetralogy of Fallot (TOF), formerly known as Steno-Fallot tetralogy, is a congenital heart defect characterized by four specific cardiac defects. Classically, the four defects are: *pulmonary stenosis, which is narrowing of the exit from the ri ...
patient with
pulmonary stenosis Pulmonic stenosis, is a dynamic or fixed obstruction of flow from the right ventricle of the heart to the pulmonary artery. It is usually first diagnosed in childhood. Signs and symptoms Cause Pulmonic stenosis is usually due to isolated valvula ...
and successfully divided the stenosed
pulmonary valve The pulmonary valve (sometimes referred to as the pulmonic valve) is a valve of the heart that lies between the right ventricle and the pulmonary artery and has three cusps. It is one of the four valves of the heart and one of the two semilunar va ...
. In 1948, Russell Brock, probably unaware of Sellors's work, used a specially designed dilator in three cases of pulmonary stenosis. Later that year, he designed a punch to resect a stenosed
infundibulum An infundibulum (Latin for ''funnel''; plural, ''infundibula'') is a funnel-shaped cavity or organ. Anatomy * Brain: the pituitary stalk, also known as the ''infundibulum'' and ''infundibular stalk'', is the connection between the hypothalamus an ...
, which is often associated with Tetralogy of Fallot. Many thousands of these "blind" operations were performed until the introduction of
cardiopulmonary bypass Cardiopulmonary bypass (CPB) is a technique in which a machine temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and oxygen to the body. The CPB pump itself is often referred to as a he ...
made direct surgery on valves possible.Harold Ellis (2000) ''A History of Surgery'', p. 223+ Also in 1948, four surgeons carried out successful operations for mitral valve stenosis resulting from
rheumatic fever Rheumatic fever (RF) is an inflammatory disease that can involve the heart, joints, skin, and brain. The disease typically develops two to four weeks after a streptococcal throat infection. Signs and symptoms include fever, multiple painful jo ...
. Horace Smithy of Charlotte used a
valvulotome A valvulotome is a catheter-based controllable surgical instrument used for cutting or disabling the venous valves. This is needed to enable an in situ bypass in patients with an occluded artery (especially femoral artery), where the saphenous ve ...
to remove a portion of a patient's mitral valve, while three other doctors— Charles Bailey of
Hahnemann University Hospital Hahnemann University Hospital was a tertiary care center in Center City Philadelphia. It was the teaching hospital of Drexel University College of Medicine. Established in 1885, it was for most of its history the main teaching hospital associate ...
in Philadelphia;
Dwight Harken Dwight Emary Harken (1910–1993) was an American surgeon. He was an innovator in heart surgery and introduced the concept of the intensive care unit. Life Dwight Harken was born in Osceola, Iowa. He received his Bachelor's and Medical degrees f ...
in Boston; and Russell Brock of
Guy's Hospital Guy's Hospital is an NHS hospital in the borough of Southwark in central London. It is part of Guy's and St Thomas' NHS Foundation Trust and one of the institutions that comprise the King's Health Partners, an academic health science centre. ...
in London—adopted Souttar's method. All four men began their work independently of one another within a period of a few months. This time, Souttar's technique was widely adopted, with some modifications. The first successful intracardiac correction of a
congenital heart defect A congenital heart defect (CHD), also known as a congenital heart anomaly and congenital heart disease, is a defect in the structure of the heart or great vessels that is present at birth. A congenital heart defect is classed as a cardiovascular ...
using
hypothermia Hypothermia is defined as a body core temperature below in humans. Symptoms depend on the temperature. In mild hypothermia, there is shivering and mental confusion. In moderate hypothermia, shivering stops and confusion increases. In severe h ...
was performed by lead surgeon Dr.
F. John Lewis Floyd John Lewis (1916 – September 20, 1993) was an American surgeon who performed the first successful open heart operation, closing an atrial septal defect in a 5-year-old girl, on 2 September 1952. For the next 3 years, Lewis and colleagues ...
(Dr.
C. Walton Lillehei Clarence Walton Lillehei (October 23, 1918 – July 5, 1999), was an American surgeon who pioneered open-heart surgery, as well as numerous techniques, equipment and prostheses for cardiothoracic surgery. Background Clarence (often called "W ...
assisted) at the
University of Minnesota The University of Minnesota, formally the University of Minnesota, Twin Cities, (UMN Twin Cities, the U of M, or Minnesota) is a public university, public Land-grant university, land-grant research university in the Minneapolis–Saint Paul, Tw ...
on 2 September 1952. In 1953,
Alexander Alexandrovich Vishnevsky Alexander Alexandrovich Vishnevsky (russian: Алекса́ндр Алекса́ндрович Вишне́вский, , Kazan – 19 December 1975, Moscow) was a Soviet surgeon, member of the Academy of Medical Sciences of the USSR (1953), honou ...
conducted the first cardiac surgery under
local anesthesia Local anesthesia is any technique to induce the absence of sensation in a specific part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It ...
. In 1956, Dr. John Carter Callaghan performed the first documented open-heart surgery in Canada.


Types of cardiac surgery


Open-heart surgery

Open-heart surgery is any kind of surgery in which a surgeon makes a large incision (cut) in the chest to open the rib cage and operate on the heart. "Open" refers to the chest, not the heart. Depending on the type of surgery, the surgeon also may open the heart. Dr.
Wilfred G. Bigelow Wilfred Gordon "Bill" Bigelow (June 18, 1913 – March 27, 2005) was a Canadians, Canadian cardiac surgery, heart Physicians in Canada, surgeon known for his role in developing the artificial pacemaker and the use of hypothermia in open heart ...
of the
University of Toronto The University of Toronto (UToronto or U of T) is a public research university in Toronto, Ontario, Canada, located on the grounds that surround Queen's Park. It was founded by royal charter in 1827 as King's College, the first institution ...
found that procedures involving opening the patient's heart could be performed better in a bloodless and motionless environment. Therefore, during such surgery, the heart is temporarily stopped, and the patient is placed on
cardiopulmonary bypass Cardiopulmonary bypass (CPB) is a technique in which a machine temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and oxygen to the body. The CPB pump itself is often referred to as a he ...
, meaning a machine pumps their blood and oxygen. Because the machine cannot function the same way as the heart, surgeons try to minimize the time a patient spends on it. Cardiopulmonary bypass was developed after surgeons realized the limitations of
hypothermia Hypothermia is defined as a body core temperature below in humans. Symptoms depend on the temperature. In mild hypothermia, there is shivering and mental confusion. In moderate hypothermia, shivering stops and confusion increases. In severe h ...
in cardiac surgery: Complex intracardiac repairs take time, and the patient needs blood flow to the body (particularly to the brain), as well as heart and lung function. In July 1952, Forest Dodrill was the first to use a mechanical pump in a human to bypass the left side of the heart whilst allowing the patient's lungs to oxygenate the blood, in order to operate on the mitral valve. In 1953, Dr.
John Heysham Gibbon John Heysham Gibbon (September 29, 1903 – February 5, 1973) was an American surgeon best known for inventing the heart–lung machine and performing subsequent open-heart surgery, open-heart surgeries which revolutionized heart surger ...
of Jefferson Medical School in Philadelphia reported the first successful use of
extracorporeal circulation An extracorporeal is a medical procedure which is performed outside the body. Extracorporeal devices are the artificial organs that remain outside the body while treating a patient. Extracorporeal devices are useful in hemodialysis and cardiac surg ...
by means of an
oxygenator An oxygenator is a medical device that is capable of exchanging oxygen and carbon dioxide in the blood of human patient during surgical procedures that may necessitate the interruption or cessation of blood flow in the body, a critical organ or ...
, but he abandoned the method after subsequent failures. In 1954, Dr. Lillehei performed a series of successful operations with the controlled cross-circulation technique, in which the patient's mother or father was used as a "heart-lung machine". Dr.
John W. Kirklin John Webster Kirklin (April 5, 1917 – April 21, 2004) was an American cardiothoracic surgeon, general surgeon, prolific author and medical educator who is best remembered for refining John Heysham Gibbon, John Gibbon's cardiopulmonary bypass, h ...
at the
Mayo Clinic The Mayo Clinic () is a nonprofit American academic medical center focused on integrated health care, education, and research. It employs over 4,500 physicians and scientists, along with another 58,400 administrative and allied health staff, ...
was the first to use a Gibbon-type pump-oxygenator. Nazih Zuhdi performed the first total intentional hemodilution open-heart surgery on Terry Gene Nix, age 7, on 25 February 1960 at Mercy Hospital in Oklahoma City. The operation was a success; however, Nix died three years later. In March 1961, Zuhdi, Carey, and Greer performed open-heart surgery on a child, aged , using the total intentional hemodilution machine.


Modern beating-heart surgery

In the early 1990s, surgeons began to perform
off-pump coronary artery bypass Off-pump coronary artery bypass or "beating heart" surgery is a form of coronary artery bypass graft (CABG) surgery performed without cardiopulmonary bypass (heart-lung machine) as a treatment for coronary heart disease. It was primarily develope ...
, done without cardiopulmonary bypass. In these operations, the heart continues beating during surgery, but is stabilized to provide an almost still work area in which to connect a conduit vessel that bypasses a blockage. The conduit vessel that is often used is the Saphenous vein. This vein is harvested using a technique known as
endoscopic vessel harvesting Endoscopic vessel harvesting (EVH) is a surgical technique that may be used in conjunction with coronary artery bypass surgery (commonly called a "bypass"). For patients with coronary artery disease, a physician may recommend a bypass to reroute blo ...
(EVH).


Heart transplant

In 1945, the Soviet pathologist Nikolai Sinitsyn successfully transplanted a heart from one frog to another frog and from one dog to another dog.
Norman Shumway Norman Edward Shumway (February 9, 1923 – February 10, 2006) was a pioneer of heart surgery at Stanford University. He was the 67th president of the American Association for Thoracic Surgery and the first to perform an adult human to human ...
is widely regarded as the father of human
heart transplantation A heart transplant, or a cardiac transplant, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease when other medical or surgical treatments have failed. , the most common procedu ...
, although the world's first adult heart transplant was performed by a
South Africa South Africa, officially the Republic of South Africa (RSA), is the southernmost country in Africa. It is bounded to the south by of coastline that stretch along the South Atlantic and Indian Oceans; to the north by the neighbouring countri ...
n cardiac surgeon,
Christiaan Barnard Christiaan Neethling Barnard (8 November 1922 – 2 September 2001) was a South African cardiac surgeon who performed the world's first human-to-human heart transplant operation. On 3 December 1967, Barnard transplanted the heart of accident-v ...
, using techniques developed by Shumway and Richard Lower. McRae, D. (2007). Every Second Counts. Berkley. Barnard performed the first transplant on
Louis Washkansky Louis Joshua Washkansky (12 April 1912 – 21 December 1967) was a South African man who was the recipient of the world's first human-to-human heart transplant, and the first patient to regain consciousness following the operation. Washkansky l ...
on 3 December 1967 at
Groote Schuur Hospital Groote Schuur Hospital is a large, government-funded, teaching hospital situated on the slopes of Devil's Peak in the city of Cape Town, South Africa. It was founded in 1938 and is famous for being the institution where the first human-to-huma ...
in
Cape Town Cape Town ( af, Kaapstad; , xh, iKapa) is one of South Africa's three capital cities, serving as the seat of the Parliament of South Africa. It is the legislative capital of the country, the oldest city in the country, and the second largest ...
.
Adrian Kantrowitz Adrian Kantrowitz (October 4, 1918 – November 14, 2008) was an American cardiac surgeon whose team performed the world's second heart transplant attempt (after Christiaan Barnard) at Maimonides Medical Center in Brooklyn, New York on December ...
performed the first pediatric heart transplant on 6 December 1967 at Maimonides Hospital (now
Maimonides Medical Center Maimonides Medical Center is a non-profit, non-sectarian hospital located in Borough Park, Brooklyn, Borough Park, in the New York City Borough (New York City), borough of Brooklyn, in the U.S. state of New York (state), New York. Maimonides is b ...
) in Brooklyn, New York, barely three days later. Shumway performed the first adult heart transplant in the United States on 6 January 1968 at Stanford University Hospital.


Coronary Artery Bypass Grafting (CABG)

Coronary artery bypass grafting Coronary artery bypass surgery, also known as coronary artery bypass graft (CABG, pronounced "cabbage") is a surgical procedure to treat coronary artery disease (CAD), the buildup of plaques in the arteries of the heart. It can relieve chest p ...
, also called revascularization, is a common surgical procedure to create an alternative path to deliver blood supply to the heart and body, with the goal of preventing
clot formation Coagulation, also known as clotting, is the process by which blood changes from a liquid to a gel, forming a blood clot. It potentially results in hemostasis, the cessation of blood loss from a damaged vessel, followed by repair. The mechanism ...
. This can be done in many ways, and the
arteries An artery (plural arteries) () is a blood vessel in humans and most animals that takes blood away from the heart to one or more parts of the body (tissues, lungs, brain etc.). Most arteries carry oxygenated blood; the two exceptions are the pu ...
used can be taken from several areas of the body. Arteries are typically harvested from the chest, arm, or wrist and then attached to a portion of the coronary artery, relieving pressure and limiting
clotting factors Coagulation, also known as clotting, is the process by which blood changes from a liquid to a gel, forming a blood clot. It potentially results in hemostasis, the cessation of blood loss from a damaged vessel, followed by repair. The mechanism ...
in that area of the heart. The procedure is typically performed because of
coronary artery disease Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), myocardial ischemia, or simply heart disease, involves the reduction of blood flow to the heart muscle due to build-up of atherosclerotic pla ...
(CAD), in which a plaque-like substance builds up in the coronary artery, the main pathway carrying oxygen-rich blood to the heart. This can cause a blockage and/or a rupture, which can lead to a
heart attack A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to the coronary artery of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may tr ...
.


Minimally invasive surgery

As an alternative to open-heart surgery, which involves a five- to eight-inch incision in the
chest wall The thoracic wall or chest wall is the boundary of the thoracic cavity. Structure The bone, bony human skeleton, skeletal part of the thoracic wall is the rib cage, and the rest is made up of muscle, skin, and fasciae. The chest wall has 10 lay ...
, a surgeon may perform an
endoscopic An endoscopy is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are insert ...
procedure by making very small incisions through which a camera and specialized tools are inserted. In
robot-assisted heart surgery Robotic surgery are types of surgical procedures that are done using robotic systems. Robotically assisted surgery was developed to try to overcome the limitations of pre-existing minimally-invasive surgical procedures and to enhance the capabi ...
, a machine controlled by a cardiac surgeon is used to perform a procedure. The main advantage to this is the size of the incision required: three small port holes instead of an incision big enough for the surgeon's hands. The use of robotics in heart surgery continues to be evaluated, but early research has shown it to be a safe alternative to traditional techniques.


Post-surgical procedures

As with any surgical procedure, cardiac surgery requires postoperative precautions to avoid complications. Incision care is needed to avoid infection and minimize
scar A scar (or scar tissue) is an area of fibrous tissue that replaces normal skin after an injury. Scars result from the biological process of wound repair in the skin, as well as in other organs, and tissues of the body. Thus, scarring is a na ...
ring. Swelling and
loss of appetite Anorexia is a medical term for a loss of appetite. While the term in non-scientific publications is often used interchangeably with anorexia nervosa, many possible causes exist for a loss of appetite, some of which may be harmless, while others i ...
are common. Recovery from open-heart surgery begins with about 48 hours in an
intensive care unit 220px, Intensive care unit An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility that provides intensiv ...
, where
heart rate Heart rate (or pulse rate) is the frequency of the heartbeat measured by the number of contractions (beats) of the heart per minute (bpm). The heart rate can vary according to the body's physical needs, including the need to absorb oxygen and excr ...
,
blood pressure Blood pressure (BP) is the pressure of circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term "blood pressure" r ...
, and oxygen levels are closely monitored. Chest tubes are inserted to drain blood around the heart and lungs. After discharge from the hospital, compression socks may be recommended in order to regulate blood flow.


Risks

The advancement of cardiac surgery and cardiopulmonary bypass techniques has greatly reduced the mortality rates of these procedures. For instance, repairs of congenital heart defects are currently estimated to have 4–6% mortality rates. A major concern with cardiac surgery is neurological damage.
Stroke A stroke is a medical condition in which poor blood flow to the brain causes cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. Both cause parts of the brain to stop functionin ...
occurs in 2–3% of all people undergoing cardiac surgery, and the rate is higher in patients with other risk factors for stroke. A more subtle complication attributed to cardiopulmonary bypass is
postperfusion syndrome Postperfusion syndrome, also known as "pumphead", is a constellation of neurocognitive impairments attributed to cardiopulmonary bypass (CPB) during cardiac surgery. Symptoms of postperfusion syndrome are subtle and include defects associated wit ...
, sometimes called "pumphead". The
neurocognitive Neurocognitive functions are cognitive functions closely linked to the function of particular areas, neural pathways, or cortical networks in the brain, ultimately served by the substrate of the brain's neurological matrix (i.e. at the cellular ...
symptoms of postperfusion syndrome were initially thought to be permanent, but turned out to be transient, with no permanent neurological impairment. In order to assess the performance of surgical units and individual surgeons, a popular risk model has been created called the
EuroSCORE EuroSCORE (European System for Cardiac Operative Risk Evaluation) is a risk model which allows the calculation of the risk of death after a heart operation. The model asks for 17 items of information about the patient, the state of the heart and t ...
. It takes a number of health factors from a patient and, using precalculated
logistic regression In statistics, the logistic model (or logit model) is a statistical model that models the probability of an event taking place by having the log-odds for the event be a linear function (calculus), linear combination of one or more independent var ...
coefficients, attempts to quantify the probability that they will survive to discharge. Within the
United Kingdom The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Europe, off the north-western coast of the continental mainland. It comprises England, Scotland, Wales and North ...
, the EuroSCORE was used to give a breakdown of all
cardiothoracic surgery Cardiothoracic surgery is the field of medicine involved in surgical treatment of organs inside the thoracic cavity — generally treatment of conditions of the heart ( heart disease), lungs (lung disease), and other pleural or mediastinal st ...
centres and to indicate whether the units and their individuals surgeons performed within an acceptable range. The results are available on the
Care Quality Commission The Care Quality Commission (CQC) is an executive non-departmental public body of the Department of Health and Social Care of the United Kingdom. It was established in 2009 to regulate and inspect health and social care services in England. I ...
website. Another important source of complications are the neuropsychological and psychopathologic changes following open-heart surgery. One example is Skumin syndrome, described by
Victor Skumin Victor Andreevich Skumin ( rus, Ви́ктор Андре́евич Ску́мин, p=ˈvʲiktər ɐnˈdrʲejɪvʲɪtɕ ˈskumʲɪn, born 30 August 1948) is a Russian and Soviet scientist, psychiatrist, philosopher and writer. After graduating ...
in 1978, which is a "cardioprosthetic psychopathological syndrome" associated with mechanical heart valve implants and characterized by irrational fear,
anxiety Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...
, depression,
sleep disorder A sleep disorder, or somnipathy, is a medical disorder of an individual's sleep patterns. Some sleep disorders are severe enough to interfere with normal physical, mental, social and emotional functioning. Polysomnography and actigraphy are test ...
, and
weakness Weakness is a symptom of a number of different conditions. The causes are many and can be divided into conditions that have true or perceived muscle weakness. True muscle weakness is a primary symptom of a variety of skeletal muscle diseases, i ...
.


Risk reduction

Pharmacological and non-pharmacological prevention approaches may reduce the risk of atrial fibrillation after an operation and reduce the length of hospital stays, however there is no evidence that this improves mortality.


Non-pharmacologic approaches

Preoperative
physical therapy Physical therapy (PT), also known as physiotherapy, is one of the allied health professions. It is provided by physical therapists who promote, maintain, or restore health through physical examination, diagnosis, management, prognosis, patient ...
may reduce postoperative pulmonary complications, such as
pneumonia Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severity ...
and
atelectasis Atelectasis is the collapse or closure of a lung resulting in reduced or absent gas exchange. It is usually unilateral, affecting part or all of one lung. It is a condition where the alveoli are deflated down to little or no volume, as distinct ...
, in patients undergoing elective cardiac surgery and may decrease the length of hospital stay by more than three days on average. There is evidence that quitting
smoking Smoking is a practice in which a substance is burned and the resulting smoke is typically breathed in to be tasted and absorbed into the bloodstream. Most commonly, the substance used is the dried leaves of the tobacco plant, which have bee ...
at least four weeks before surgery may reduce the risk of postoperative complications.


Pharmacological approaches

Beta-blocking medication is sometimes prescribed during cardiac surgery. There is some low certainty evidence that this perioperative blockade of beta-adrenergic receptors may reduce the incidence of atrial fibrillation and ventricular arrhythmias in patients undergoing cardiac surgery.


See also

*
Frank Gerbode (surgeon) Frank Leven Albert Gerbode, popularly known as Frank Gerbode, (February 3, 1907 – December 6, 1984) was an American cardiovascular surgeon and founder of the Medical Research Institute and the Heart Research Institute at Pacific Medical Center. ...


References


Further reading

*


External links

* {{DEFAULTSORT:Cardiac Surgery Surgery Surgical specialties