Cardiac Surgery
Cardiac surgery, or cardiovascular surgery, is surgery on the heart or great vessels performed by cardiac surgeons. It is often used to treat complications of ischemic heart disease (for example, with coronary artery bypass grafting); to correct congenital heart disease; or to treat valvular heart disease from various causes, including endocarditis, rheumatic heart disease, and atherosclerosis. It also includes heart transplantation.
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.
HEART TRANSPLANT
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 patient’s own heart is either removed and replaced with the donor heart or, much less commonly, the recipient’s diseased heart is left in place to support the donor hear.
Heart transplantation is not considered to be a cure for heart disease but a life-saving treatment intended to improve the quality of life for recipients.
CARDIAC BYPASS SURGERY
Coronary bypass surgery is a surgical procedure that diverts the flow of blood around a section of a blocked or partially blocked artery by creating a new pathway to the heart. Coronary or heart bypass surgery can relieve chest pain. In the operation, your surgeon uses a blood vessel from your leg, arm or chest to bypass a narrowed section of a coronary artery.
Heart Bypass Surgery helps lower risk for a heart attack. Once you recover, you’ll feel better and be able to get back to your regular activities.
Bypass surgery is also known as coronary artery bypass grafting (CABG). It’s the most common type of open-heart surgery. Most people have great results and live symptom-free for the rest of their lives if they modify their lifestyle in a healthy manner.
CARDIAC VALVE REPLACEMENT SURGERY
The aortic valve and the mitral valve are the most commonly replaced valves. The most common valve surgical procedure is aortic valve replacement for aortic stenosis, or narrowing of the aortic valve. Mitral stenosis is another condition that sometimes requires a valve replacement procedure.
Aortic regurgitation, (sometimes referred to as aortic insufficiency) is a common valve problem that may require valve replacement. Regurgitation means that the valve allows blood to return back through the valve and into the heart instead of moving it forward and out to the body. Aortic regurgitation can eventually lead to heart failure. The surgeon repairs or replaces the affected heart valves using open or minimally invasive heart surgery.
Heart valve surgery is performed at a hospital that has expert surgeons with long experience in successfully performing high volumes of heart valve surgeries.
CORONARY ANGIOPLASTY AND STENTING
Angioplasty is advanced Cardiac treatment that avoids a major open heart surgery. Interventional radiologists can now open blocked or narrowed blood vessels. Angioplasty involves temporarily inserting and inflating a tiny balloon where your artery is clogged to help widen the artery. In many cases, doctors insert a coronary artery stent after an angioplasty. The stent helps keep the blood flowing and the artery from narrowing again.
Some stents are coated with medication to help keep your artery open (drug-eluting stents), while others are not (bare-metal stents). Angioplasty can improve symptoms of blocked arteries, such as chest pain and shortness of breath. It’s an efficient way to get blood flowing to the heart again quickly. The sooner your doctor restores your blood supply, the less damage there will be to your heart muscle.
However, if the main artery that brings blood to the left side of your heart is narrow, if your heart muscle is weak or if you have multiple diseased blood vessels, then coronary artery bypass surgery may be a better option than angioplasty. The decision of angioplasty versus bypass surgery will depend on the extent of your heart disease and overall medical condition.
PAEDIATRIC CARDIAC SURGERY
Heart surgery in children is done to repair heart defects a child is born with (congenital heart defects) and heart diseases a child gets after birth that need surgery. The surgery is needed for the child’s wellbeing.
Congenital heart defects are problems with the heart’s structure that change the normal flow of blood through the heart and can have severe, life-threatening symptoms. Many of these defects are simple conditions that are easily fixed but a small number of babies are born with complex congenital heart defects that require special medical care soon after birth.
Open-heart surgery is done to close holes in the heart with stitches or with a patch, Repair or replace heart valves and widen arteries or openings to heart valves.
The diagnosis and treatment of these complex defects has greatly improved. As a result, almost all children who have complex heart defects survive to adulthood and can live active, productive lives. A successful cardiac surgery in children requires an expert medical team – doctors, nurses, and other support staff – who are experienced in such surgeries, can promptly recognize problems and emerging side effects, and know how to react swiftly and properly if problems do arise.
Open-heart surgery is when the surgeon uses a heart-lung bypass machine
An incision is made through the breastbone (sternum) while the child is under general anesthesia (the child is asleep and pain free).
Tubes are used to re-route the blood through a special pump called a heart-lung bypass machine. This machine adds oxygen to the blood and keeps the blood warm and moving through the rest of the body while the surgeon is repairing the heart.
Using the machine allows the heart to be stopped. Stopping the heart makes it possible to repair the heart muscle itself, the heart valves, or the blood vessels outside the heart. After the repair is done, the heart is started again, and the machine is removed. The breastbone and the skin incision are then closed.
For some heart defect repairs, the incision is made on the side of the chest, between the ribs. This is called a thoracotomy. It is sometimes called closed-heart surgery. This surgery may be done using special instruments and a camera.
Another way to fix defects in the heart is to insert small tubes into an artery in the leg and pass them up to the heart. Only some heart defects can be repaired this way.
Why Paediatric heart surgery performed?
Some heart defects need repair soon after birth. For others, it is better to wait months or years. Certain heart defects may not need to be repaired.
In general, symptoms that indicate that surgery is needed are:
Blue or gray skin, lips, and nail beds (cyanosis). These symptoms mean there is not enough oxygen in the blood (hypoxia).
Difficulty breathing because the lungs are “wet,” congested, or filled with fluid (heart failure).
Problems with heart rate or heart rhythm (arrhythmias).
Poor feeding or sleeping, and lack of growth and development of the child.
Risks
Hospitals and medical centers that perform heart surgery on children have surgeons, nurses, and technicians who are specially trained to perform these surgeries. They also have staff that will take care of your child after surgery.
Risks for any surgery are:
Bleeding during surgery or in the days after surgery
Bad reactions to medicines
Problems breathing
Infection
Additional risks of heart surgery are:
- Blood clots (thrombi)
- Air bubbles (air emboli)
- Pneumonia
- Heartbeat problems (arrhythmias)
- Heart attack
- Stroke
Before the Procedure
If your child is talking, tell them about the surgery. If you have a preschool-aged child, tell them the day before what will happen. Say, for example, “We are going to the hospital to stay for a few days. The doctor is going to do an operation on your heart to make it work better.”
If your child is older, start talking about the procedure 1 week before the surgery. You should involve the child’s life specialist (someone who helps children and their families during times like major surgery) and show the child the hospital and surgical areas.
Your child may need many different tests:
- Blood tests (complete blood count, electrolytes, clotting factors, and “cross match”)
- X-rays of the chest
- Electrocardiogram (EKG, or ECG)
- Echocardiogram (ECHO, or ultrasound of the heart)
- Cardiac catheterization
- History and physical examinition
Always tell your child’s health care provider what medicines your child is taking. Include drugs, herbs, and vitamins you bought without a prescription.
On the day of the surgery:
- Your child will most often be asked not to drink or eat anything after midnight the night before the surgery.
- Give your child any drugs you have been told to give with a small sip of water.
- You will be told when to arrive at the hospital.
After the Procedure
Most children who have open-heart surgery need to stay in the intensive care unit (ICU) for 2 to 4 days right after surgery. They most often stay in the hospital for 5 to 7 more days after they leave the ICU. Stays in the intensive care unit and the hospital are often shorter for people who have closed-heart surgery.
During their time in the ICU, your child will have:
- A tube in the airway (endotracheal tube) and a respirator to help with breathing. Your child will be kept sleeping (sedated) while on the respirator.
- One or more small tubes in a vein (IV line) to give fluids and medicines.
- A small tube in an artery (arterial line).
- One or 2 chest tubes to drain air, blood, and fluid from the chest cavity.
- A tube through the nose into the stomach (nasogastric tube) to empty the stomach and deliver medicines and feedings for several days.
- A tube in the bladder to drain and measure the urine for several days.
- Many electrical lines and tubes used to monitor the child.
By the time your child leaves the ICU, most of the tubes and wires will be removed. Your child will be encouraged to start many of their regular daily activities. Some children may begin eating or drinking on their own within 1 or 2 days, but others may take longer.
When your child is discharged from the hospital, parents and caregivers are taught what activities are okay for their child to do, how to care for the incision(s), and how to give medicines their child may need.
Your child needs at least several more weeks at home to recover. Talk with your provider about when your child can return to school or day care.
Your child will need follow-up visits with a cardiologist (heart doctor) every 6 to 12 months. Your child may need to take antibiotics before going to the dentist for teeth cleaning or other dental procedures, to prevent serious heart infections. Ask the cardiologist if this is necessary.
Outlook (Prognosis)
The outcome of heart surgery depends on the child’s condition, the type of defect, and the type of surgery that was done. Many children recover completely and lead normal, active lives.
