Heart surgery

What is open heart surgery?


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Open heart surgery is an incision made through the breastbone, also known as the breastbone, which is then pulled apart. This form of opening is called a full or midline sternotomy. After the operation, the sternum is closed with stainless steel threads and the skin is sutured.

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Due to the stretching of muscles, bones, and ligaments that occurs during surgery, pain is usually felt after the operation; however, the breastbone heals over time. The term open heart surgery is also called traditional heart surgery. However, due to the advent of new, more efficient and safer procedures, open heart surgery can be performed with only small incisions that do not require large openings.

What types of open heart surgery are there?

According to the National Heart, Lung, and Blood Institute (NHLBI), coronary artery bypass grafting (CABG) is the most common type of open heart surgery in adults. This procedure involves a healthy Bing artery or vein grafted, or attached, to a blocked coronary artery. This transplanted artery can bypass the blocked artery and supply blood to the heart. PAC is used to treat people with severe coronary artery disease (CHD). Other forms of open heart surgery include:

  • Laser transmyocardial revascularization (TMR), which is used to treat angina pectoris. If TMR is performed alone, the procedure can be performed through a small opening. The surgeon uses lasers to form small channels through the heart muscle and into the left ventricle.
  • Repair or replacement of heart valves, which is used to fix a set of leaflets that control the opening of the valves. If they get stuck or coalesce, it can impede blood flow through the valve. In the absence of a properly functioning leaflet, blood can flow back to the heart chambers, rather than flowing in the intended direction to the arteries. The valves are replaced by synthesized or biological alternatives. Biological alternatives are formed from pig, cow or human heart tissue and may also incorporate synthetic material.
  • Treatment of arrhythmia; If the therapeutic relief offered by medicine has failed, open heart surgery of this form can be used to implant a pacemaker or an implantable cardioverting defibrillator (ICD). The device generates low-energy electrical impulses that control the heart rate. An ICD is a small device that is connected to the heart and monitors the heartbeat for dangerous arrhythmias. If an arrhythmia is detected, a small electrical pulse is generated to restore a normal heart rhythm.
  • Aneurysm repair: Aneurysms are generated in the walls of the arteries, causing them to swell. This bulge can occur if the wall of the artery weakens; the pressure generated by the blood flowing through the artery or the heart causes swelling of the weekend area. Over time, an aneurysm can rupture causing fatal bleeding inside the body – they can also divide into one or more layers of the arterial wall, which can cause bleeding along them. Repairing an aneurysm involves placing a patch or graft to replace the weakened section of the artery or heart wall.
  • Heart transplantation, which is performed in patients with end-stage heart failure. Heart failure occurs when the heart is damaged or weakened. The term end-stage refers to the severity of the disease, indicating that all other treatments have failed to restore heart function.
  • Ventricular Assist Devices and Total Artificial Hearts: A ventricular assist device is a mechanical pump that supports heart function in patients with weakened hearts. This is usually implanted in cases where heart failure that does not respond to treatment is present, or the patient is on a waiting list for a heart transplant. A total artificial heart replaces the two ventricles of the heart

Open heart surgery with and without a pump

There are generally two different methods of performing open heart surgery; on pump and off pump. Open heart pump surgery is a time-limited procedure that is performed with the heart completely stopped. The blood supply must be supplied to the body when the heart is at a standstill and therefore surgeons will use a cardiopulmonary bypass machine, also known as a heart-lung machine or pump. It works as an artificial circulation system that performs a function of the heart and lungs.

Cannulas are placed in the heart to drain the blood to the pump where it is purified and returned to the patient; this allows temporary immobilization of the heart. At the end of the procedure, the heart is restarted and once it reaches a satisfactory operating threshold, the cardiopulmonary bypass machine is disconnected after the cannulas are withdrawn.

Open heart surgery at the pump has a low risk of death and other complications. These complications can include kidney or liver failure, cognitive dysfunction, stroke, and bleeding. Despite the fight against risks, the development of new technologies continues to increase the efficiency and safety of extracorporeal circulation devices.

Open heart surgery without a pump is a relatively new method of performing open heart surgery. As the name suggests, the open heart surgery procedure is performed while the heart is still beating and in the absence of the cardiopulmonary bypass machine.

Despite the absence of cannulas and tubing for the machine, the use of artificial circulatory fluid, and the manipulation of the aorta without exception, this technique involves complex attachment of grafts to the heart as it moves and moves. filled with blood. This lack of stabilization can increase the risk of error; however, specialized devices can mechanically stabilize the targeted area of ​​the heart, allowing suturing to occur on a much more still surface.

Despite the constant movement which introduces the probability of error in the procedure, the risk of complications from open heart surgery without a pump is also low in a low risk patient. However, this technique requires a great deal of experience. The benefits of open heart surgery without a pump mitigate the same complications seen in open heart surgery with a pump, with overall lower complication rates. These include a decreased risk of stroke and cognitive dysfunction, as well as a decreased risk of atrial fibrillation and organ dysfunction.

What are the risks associated with open heart surgery?

All forms of heart surgery, including open heart surgery, carry risks. These include:

  • Bleeding
  • Reaction to anesthetic
  • Infection, fever, swelling, and other signs of inflammation associated with it
  • Damage to the heart, lungs, kidneys and liver
  • Arrhythmia
  • Stroke, which can cause long-term and short-term damage
  • Death

Other side effects can include memory loss or other forms of neurocognitive dysfunction, such as difficulty concentrating or thinking clearly. These neurological problems are more likely to affect older patients and women and often improve within 6 to 12 months of surgery.

In general, the risk of complications is increased if heart surgery is performed in an emergency setting. This includes for example, during a heart attack. The risk of complications is also increased in cases where other co-morbidities are present, such as kidney and lung disease or peripheral artery disease.

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Further reading

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