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{{ClinPsy}}
 
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{{PsyPerspective}}
[[Image:Coronary artery bypass surgery Image 657B-PH.jpg|thumb|right|300px|Two cardiac surgeons performing a cardiac surgery known as coronary artery bypass surgery.]]
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[[Image:Coronary artery bypass surgery Image 657B-PH.jpg|thumb|right|300px|Two cardiac surgeons performing a cardiac surgery known as [[coronary artery bypass surgery]].]]
   
'''Heart surgery''' or '''Cardiac surgery''' is surgery on the heart and/or great vessels performed by a cardiac surgeon. Frequently, it is done to treat complications of ischemic heart disease (for example, coronary artery bypass grafting), correct congenital heart disease, or treat valvular heart disease created by various causes including endocarditis. It also includes [[heart transplantation]].
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'''Cardiac surgery''' is [[surgery]] on the [[heart]] and/or [[great vessel]]s performed by a [[cardiac surgeon]]. Frequently, it is done to treat complications of [[ischemic heart disease]] (for example, [[coronary artery bypass graft]]ing), correct [[congenital heart disease]], or treat [[valvular heart disease]] created by various causes including [[endocarditis]]. It also includes [[heart transplant]]ation.
   
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==History==
==Operations under hypnosis==
 
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The earliest operations on the [[pericardium]] (the sac that surrounds the heart) took place in the 19th century and were performed by, among others, [[Francisco Romero (surgeon)|Francisco Romero]],<ref>Aris A. Francisco Romero, the first heart surgeon. Ann Thorac Surg 1997 Sep;64(3):870-1. PMID 9307502</ref> [[Dominique Jean Larrey]], [[Henry Dalton]], and [[Daniel Hale Williams]]. The first successful surgery on the heart itself, performed without any complications, was by Dr. [[Ludwig Rehn]] of [[Frankfurt]], [[Germany]], who repaired a stab wound to the right [[Ventricle (heart)|ventricle]] on [[September 7]], [[1896]].
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Surgery on the [[great vessels]] ([[aortic coarctation]] repair, [[Blalock-Taussig]] shunt creation, closure of [[patent ductus arteriosus]]), became common after the turn of the century and falls in the domain of cardiac surgery, but technically cannot be considered heart surgery.
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===Closed heart surgery===
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Surgery on the great vessels was followed by the development of ''closed heart surgery'', where the surgeon blindly worked on the beating heart. It left a great deal to be desired, but had much to offer for great risk. [[Palliation]] of severe [[mitral valve stenosis]], which was common in the past due to [[rheumatic fever]], could be accomplished by poking a finger into the (mitral) valve through an incision in the [[left atrium]].<ref>Bigelow WG. Cold Hearts: The Story of Hypothermia and the Pacemaker in Heart Surgery. McClelland and Stewart Limited. 1984. ISBN 0-7710-1414-7.</ref> If a finger didn't do, a knife was passed through the incision to cut out tissue. Following successful treatment of mitral stenosis, a special cutter for [[aortic valve stenosis]] was developed, that maneuvered through an incision in the left atrium, accomplished much the same thing as the surgeon's finger in a stenosed mitral valve.
   
 
===Operations under hypothermia===
 
===Operations under hypothermia===
It was soon discovered that the repair of intracardiac pathologies required a bloodless and motionless environment, which means that the heart should be stopped and drained of blood. The first successful intracardiac correction of a [[congenital heart defect]] using [[hypothermia]] was performed by Dr. [[C. Walton Lillehei]] and Dr. [[F. John Lewis]] at the University of Minnesota on [[September 2]], [[1952]]. The following year, Soviet surgeon [[Aleksandr Aleksandrovich Vishnevskiy]] conducted the first cardiac surgery under [[local anesthesia]].
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It was soon discovered that the repair of intracardiac pathologies required a bloodless and motionless environment, which means that the heart should be stopped and drained of blood. The first successful intracardiac correction of a [[congenital heart defect]] using [[hypothermia]] was performed by Dr. [[C. Walton Lillehei]] and Dr. [[F. John Lewis]] at the University of Minnesota on [[September 2]], [[1952]]. The following year, Soviet surgeon [[Aleksandr Aleksandrovich Vishnevskiy]] conducted the first cardiac surgery under [[local anesthesia]].
   
===Open heart surgery===
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===Operations on the open heart===
This is a surgery in which the patient chest is opened and surgery is performed on the heart. The term "open" refers to the chest, not to the heart itself. The heart may or may not be opened depending on the particular type of surgery. Surgeons realized the limitations of hypothermia - complex intracardiac repairs take more time and the patient needs blood flow to the body (and particularly the brain); the patient needs the function of the heart and lungs provided by an artificial method, hence the term [[cardiopulmonary bypass]]. Dr. [[John Heysham Gibbon]] at Jefferson Medical School in Philadelphia reported in 1953 the first successful use of extracorporeal circulation by means of an [[oxygenator]], but he abandoned the method, disappointed by subsequent failures. In 1954 Dr. Lillehei realized a successful series of 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]] at the [[Mayo Clinic]] in Rochester, Minnesota started using a Gibbon type pump-oxygenator in a series of successful operations, and was soon followed by surgeons in various parts of the world.
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Surgeons realized the limitations of hypothermia - complex intracardiac repairs take more time and the patient needs blood flow to the body (and particularly the brain); the patient needs the function of the heart and lungs provided by an artificial method, hence the term [[cardiopulmonary bypass]]. Dr. [[John Heysham Gibbon]] at Jefferson Medical School in Philadelphia reported in 1953 the first successful use of extracorporeal circulation by means of an [[oxygenator]], but he abandoned the method, disappointed by subsequent failures. In 1954 Dr. Lillehei realized a successful series of 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]] at the [[Mayo Clinic]] in Rochester, Minnesota started using a Gibbon type pump-oxygenator in a series of successful operations, and was soon followed by surgeons in various parts of the world.
   
 
===Modern beating-heart surgery===
 
===Modern beating-heart surgery===
Since the 1990s, surgeons have begun to perform "[[OPCAB|off-pump bypass surgery]]" - coronary artery bypass surgery without the aforementioned [[cardiopulmonary bypass]]. In these operations, the heart is beating during surgery, but is stabilized to provide an almost still work area. Some researchers believe this approach results in fewer post-operative complications (such as [[postperfusion syndrome]]) and better overall results (study results are controversial as of 2007, the surgeon's preference and hospital results still play a major role).
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Since the 1990s, surgeons have begun to perform "[[OPCAB|off-pump bypass surgery]]" - coronary artery bypass surgery without the aforementioned [[cardiopulmonary bypass]]. In these operations, the heart is beating during surgery, but is stabilized to provide an (almost) still work area. Some researchers believe this approach results in fewer post-operative complications (such as [[postperfusion syndrome]]) and better overall results (studies results are controversial as of 2007, surgeon's preference and hospital results still play a major role).
   
 
===Minimally invasive surgery===
 
===Minimally invasive surgery===
A new form of heart surgery that has grown in popularity is [[robot-assisted heart surgery]]. This is where a machine is used to perform surgery while being controlled by the heart surgeon. The main advantage to this is the size of the incision made in the patient. Instead of an incision being at least big enough for the doctor to put his hands inside, it does not have to be bigger than 3 small holes for the robot's much smaller hands to get through. Also, a major advantage to the robot is the recovery time of the patient, instead of months of recovery time, some patients have recovered and resumed playing athletics in a matter of weeks.{{Fact|date=September 2007}}
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A new form of heart surgery that has grown in popularity is robotic heart surgery. This is where a machine is used to perform surgery while being controlled by the heart surgeon. The main advantage to this is the size of the incision made in the patient. Instead of an incision being at least big enough for the doctor to put his hands inside, it does not have to be bigger than 3 small holes for the robot's much smaller hands to get through. Also, a major advantage to the robot is the recovery time of a patient, instead of 6 months of recovery time, some patients have recovered and resumed playing athletics in a matter of weeks.{{Fact|date=September 2007}}
   
 
==Risks==
 
==Risks==
 
The development of cardiac surgery and cardiopulmonary bypass techniques has reduced the mortality rates of these surgeries to relatively low levels. For instance, repairs of congenital heart defects are currently estimated to have 4-6% mortality rates.<ref>Stark J, Gallivan S, Lovegrove J, Hamilton JR, Monro JL, Pollock JC, Watterson KG. Mortality rates after surgery for congenital heart defects in children and surgeons' performance. Lancet 2000 March 18;355(9208):1004-7. PMID 10768449</ref><ref>Klitzner TS, Lee M, Rodriguez S, Chang RR. Sex-related Disparity in Surgical Mortality among Pediatric Patients. Congenital Heart Disease 2006 May;1(3):77. [http://www.blackwell-synergy.com/doi/abs/10.1111/j.1747-0803.2006.00013.x Abstract]</ref>
 
The development of cardiac surgery and cardiopulmonary bypass techniques has reduced the mortality rates of these surgeries to relatively low levels. For instance, repairs of congenital heart defects are currently estimated to have 4-6% mortality rates.<ref>Stark J, Gallivan S, Lovegrove J, Hamilton JR, Monro JL, Pollock JC, Watterson KG. Mortality rates after surgery for congenital heart defects in children and surgeons' performance. Lancet 2000 March 18;355(9208):1004-7. PMID 10768449</ref><ref>Klitzner TS, Lee M, Rodriguez S, Chang RR. Sex-related Disparity in Surgical Mortality among Pediatric Patients. Congenital Heart Disease 2006 May;1(3):77. [http://www.blackwell-synergy.com/doi/abs/10.1111/j.1747-0803.2006.00013.x Abstract]</ref>
   
A major concern with cardiac surgery is the incidence of [[neurological]] damage. [[Stroke]] occurs in 2-3% of all people undergoing cardiac surgery, and is higher in patients at risk for stroke. {{Fact|date=February 2007}} A more subtle constellation of neurocognitive deficits attributed to [[cardiopulmonary bypass]] is known as [[postperfusion syndrome]] (sometimes called 'pumphead'). The symptoms of postperfusion syndrome were initially felt to be permanent,<ref name="Newman">{{cite journal | author = Newman M, Kirchner J, Phillips-Bute B, Gaver V, Grocott H, Jones R, Mark D, Reves J, Blumenthal J | title = Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery | journal = N Engl J Med | volume = 344 | issue = 6 | pages = 395–402 | year = 2001 | pmid = 11172175 | doi = 10.1056/NEJM200102083440601}}</ref> but were shown to be transient with no permanent neurological impairment.<ref name="VanDijk">{{cite journal | author = Van Dijk D, Jansen E, Hijman R, Nierich A, Diephuis J, Moons K, Lahpor J, Borst C, Keizer A, Nathoe H, Grobbee D, De Jaegere P, Kalkman C | title = Cognitive outcome after off-pump and on-pump coronary artery bypass graft surgery: a randomized trial | journal = JAMA | volume = 287 | issue = 11 | pages = 1405–12 | year = 2002 | pmid = 11903027 | doi = 10.1001/jama.287.11.1405}}</ref>
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A major concern with cardiac surgery is the incidence of [[neurological]] damage. [[Stroke]] occurs in 2-3% of all people undergoing cardiac surgery, and is higher in patients at risk for stroke. {{Fact|date=February 2007}} A more subtle constellation of neurocognitive deficits attributed to [[cardiopulmonary bypass]] is known as [[postperfusion syndrome]] (sometimes called 'pumphead'). The symptoms of postperfusion syndrome were initially felt to be permanent,<ref name="Newman">{{cite journal | author = Newman M, Kirchner J, Phillips-Bute B, Gaver V, Grocott H, Jones R, Mark D, Reves J, Blumenthal J | title = Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. | journal = N Engl J Med | volume = 344 | issue = 6 | pages = 395-402 | year = 2001 | id = PMID 11172175}}</ref> but were shown to be transient with no permanent neurological impairment.<ref name="VanDijk">{{cite journal | author = Van Dijk D, Jansen E, Hijman R, Nierich A, Diephuis J, Moons K, Lahpor J, Borst C, Keizer A, Nathoe H, Grobbee D, De Jaegere P, Kalkman C | title = Cognitive outcome after off-pump and on-pump coronary artery bypass graft surgery: a randomized trial. | journal = JAMA | volume = 287 | issue = 11 | pages = 1405-12 | year = 2002 | id = PMID 11903027}}</ref>
   
 
==See also==
 
==See also==
* [[Organ transplantation]]
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* [[Cardiac surgeon]]
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* [[Cardiothoracic surgery]]
 
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* [[Vascular surgery]]
   
 
==References==
 
==References==
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==Further reading==
 
==Further reading==
* {{cite book | author = [edited by] Lawrence H. Cohn, L. Henry Edmunds, Jr | title = Cardiac surgery in the adult | publisher = McGraw-Hill, Medical Pub. Division | location = New York | year = 2003 | isbn = 0-07-139129-0}} [http://cardiacsurgery.ctsnetbooks.org/ Full text online]
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* {{cite book | author = [edited by] Lawrence H. Cohn, L. Henry Edmunds, Jr | title = Cardiac surgery in the adult | publisher = McGraw-Hill, Medical Pub. Division | location = New York | year = 2003 | id = ISBN 0-07-139129-0}} [http://cardiacsurgery.ctsnetbooks.org/ Full text online]
   
 
==External links==
 
==External links==
* [http://www.americanheart.org Overview] at [[American Heart Association]]
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* [http://www.americanheart.org The American Heart Association]
* [http://www.clevelandclinic.org/heartcenter/ The Heart Center] at [[Cleveland Clinic]]
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* [http://www.clevelandclinic.org/heartcenter/ The Cleveland Clinic Heart Center]
* [http://www.learningradiology.com/notes/cardiacnotes/surgicalcorrectivepage.htm "Congenital Heart Disease Surgical Corrective Procedures"], a list of surgical procedures at learningradiology.com
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* [http://www.learningradiology.com/notes/cardiacnotes/surgicalcorrectivepage.htm "Congenital Heart Disease Surgical Corrective Procedures"], a list of surgical procedures
* [http://websites.afar.org/site/PageServer?pagename=IA_d_heart_home The Heart Disease Information Center] at afar.org
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* [http://websites.afar.org/site/PageServer?pagename=IA_d_heart_home The Heart Disease Information Center]
* [http://heartcenter.seattlechildrens.org/what_to_expect/surgery.asp What to expect before, during and after heart surgery] from [[Children's Hospital and Regional Medical Center (Seattle)]]
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* [http://heartcenter.seattlechildrens.org/what_to_expect/surgery.asp What to expect before, during and after heart surgery] from Children's Hospital Heart Center, Seattle.
* [http://www.nlm.nih.gov/medlineplus/ency/article/007012.htm Minimally invasive heart surgery]. Medical Encyclopedia, [[MedlinePlus]]
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* [http://www.nlm.nih.gov/medlineplus/ency/article/007012.htm Minimally invasive heart surgery]. Medical Encyclopedia, MedlinePlus.
* [http://heartcenter.seattlechildrens.org/about/stories/williams_heart_operation.asp Heart surgery slideshow] from [[Children's Hospital and Regional Medical Center (Seattle)]]
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* [http://heartcenter.seattlechildrens.org/about/stories/williams_heart_operation.asp Heart surgery slideshow] from Children's Hospital Heart Center, Seattle.
* [http://www.mitralvalverepair.org Mitral Valve Repair] at [[Mount Sinai Hospital]]
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* [http://www.mitralvalverepair.org Mitral Valve Repair at The Mount Sinai Hospital]
* [http://answers.google.com/answers/threadview?id=393245 Open Heart Surgery Videos] at [[Google Answers]]
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* [http://answers.google.com/answers/threadview?id=393245 Open Heart Surgery Videos]
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* [http://www.heartsurgery-usa.com/heart_surgery_procedures.htm Heart Surgery USA] - A summary of bypass surgery procedures.
* [http://www.khou.com/news/local/stories/khou071218_tj_healthinsurance.2d0c2aea.html News: Cardiac Surgery and Health Insurance] at [[KHOU-TV]]
 
*[http://www.youtube.com/watch?v=SAaJWZhlUxo Open Heart Surgery Video, Bakulev center in Moscow] at [[YouTube]]
 
   
 
<BR>
 
<BR>
{{Cardiac surgery}}
 
   
 
[[Category:Heart surgery]]
 
[[Category:Heart surgery]]
[[Category:Surgery]]
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[[Category:Physical health psychology]]
[[
 
   
 
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[[fr:Chirurgie cardiaque]]
 
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[[pl:Kardiochirurgia]]
 
[[ru:Кардиохирургия]]
 
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