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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.
Operations under hypnosis
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.
Open heart surgery
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.
Modern beating-heart surgery
Since the 1990s, surgeons have begun to perform "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).
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.[How to reference and link to summary or text]
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.
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. [How to reference and link to summary or text] 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, but were shown to be transient with no permanent neurological impairment.
- 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
- 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. Abstract
- Newman M, Kirchner J, Phillips-Bute B, Gaver V, Grocott H, Jones R, Mark D, Reves J, Blumenthal J (2001). Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med 344 (6): 395–402.
- 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 (2002). Cognitive outcome after off-pump and on-pump coronary artery bypass graft surgery: a randomized trial. JAMA 287 (11): 1405–12.
- [edited by] Lawrence H. Cohn, L. Henry Edmunds, Jr (2003). Cardiac surgery in the adult, New York: McGraw-Hill, Medical Pub. Division. Full text online
- Overview at American Heart Association
- The Heart Center at Cleveland Clinic
- "Congenital Heart Disease Surgical Corrective Procedures", a list of surgical procedures at learningradiology.com
- The Heart Disease Information Center at afar.org
- What to expect before, during and after heart surgery from Children's Hospital and Regional Medical Center (Seattle)
- Minimally invasive heart surgery. Medical Encyclopedia, MedlinePlus
- Heart surgery slideshow from Children's Hospital and Regional Medical Center (Seattle)
- Mitral Valve Repair at Mount Sinai Hospital
- Open Heart Surgery Videos at Google Answers
- News: Cardiac Surgery and Health Insurance at KHOU-TV
- Open Heart Surgery Video, Bakulev center in Moscow at YouTube
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