Two cardiac surgeons performing a cardiac surgery known as coronary artery bypass surgery. Coronary artery bypass surgery, also coronary artery bypass graft surgery, and colloquially heart bypass or bypass surgery is a surgical procedure

Cardiac surgery is surgery on the heart and/or great vessels performed by a cardiac surgeon. Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental The heart is a muscular organ in all Vertebrates responsible for pumping Blood through the Blood vessels by repeated rhythmic Great vessels is a term used to refer collectively to the primary Blood vessels, which include Vena cavae Superior vena cava A cardiac surgeon is a Surgeon who performs Cardiac surgery - operative procedures on the Heart and Great vessels. 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. Ischaemic or ischemic heart disease (IHD or myocardial ischaemia, is a Disease characterized by reduced blood supply to the heart muscle Coronary artery bypass surgery, also coronary artery bypass graft surgery, and colloquially heart bypass or bypass surgery is a surgical procedure A congenital heart defect (CHD is a defect in the structure of the Heart and Great vessels of a Newborn. Valvular heart disease is any disease process involving one or more of the valves of the heart (the aortic and mitral valves on the left and the pulmonary Endocarditis is an Inflammation of the inner layer of the Heart, the Endocardium. It also includes heart transplantation. Heart transplantation or cardiac transplantation, is a surgical transplant procedure performed on patients with end-stage Heart failure or severe Coronary

History

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,^[1] Dominique Jean Larrey, Henry Dalton, and Daniel Hale Williams. The pericardium is a double-walled sac that contains the Heart and the roots of the Great vessels. Dominique Jean Larrey ( 8 July, 1766 &ndash 25 July, 1842) was a French surgeon in Napoleon 's army and an important Henry C Dalton (born May 7, 1847) was superintendent of the St Daniel Hale Williams ( January 18, 1856 - August 4, 1931) was the first African-American heart surgeon. 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 on September 7, 1896. Ludwig Wilhelm Carl Rehn ( April 13, 1849 – May 29, 1930) was a German surgeon Germany, officially the Federal Republic of Germany ( ˈbʊndəsʁepuˌbliːk ˈdɔʏtʃlant is a Country in Central Europe. In the Heart, a ventricle is a heart chamber which collects Blood from an atrium (another heart chamber that is smaller than a ventricle and Events 1251 BC - A Solar eclipse on this date might mark the birth of legendary Heracles at Thebes Greece. Year 1896 ( MDCCCXCVI) was a Leap year starting on Wednesday (link will display the full calendar of the Gregorian Calendar (or a Leap year

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. Great vessels is a term used to refer collectively to the primary Blood vessels, which include Vena cavae Superior vena cava The Blalock-Taussig shunt is a surgical procedure to give palliation to Cyanotic heart defects which are common causes of Blue baby syndrome. Patent ductus arteriosus ( PDA) is a Congenital Heart defect wherein a child's Ductus arteriosus fails to close after birth.

Closed heart surgery

Surgery on the great vessels was followed by the development of closed heart surgery, where a small incision is made (the chest cavity is not opened) and 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. Palliative care (from Latin palliare to cloak is any form of medical care or treatment that concentrates on reducing the severity of Disease Symptoms Mitral Stenosis is a Valvular heart disease characterized by the narrowing of the orifice of the Mitral valve of the Heart. Rheumatic fever is an Autoimmune inflammatory Disease which may develop two to three weeks after a Group A streptococcal infection (such as The left atrium is one of the four chambers in the Human Heart. ^[2] 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

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. A congenital heart defect (CHD is a defect in the structure of the Heart and Great vessels of a Newborn. Hypothermia is a condition in which an organism's temperature drops below that required for normal Metabolism and bodily functions C. Walton Lillehei and Dr. Clarence Walton Lillehei ( October 23, 1918 &ndash July 5, 1999) was an American surgeon who pioneered open-heart surgery as well as numerous F. John Lewis at the University of Minnesota on September 2, 1952. Events 44 BC - Pharaoh Cleopatra VII of Egypt declares her son co-ruler as Ptolemy XV Caesarion. Year 1952 ( MCMLII) was a Leap year starting on Tuesday (link will display full calendar of the Gregorian calendar. The following year, Soviet surgeon Aleksandr Aleksandrovich Vishnevskiy conducted the first cardiac surgery under local anesthesia. Aleksandr Aleksandrovich Vishnevskiy (Александр Александрович Вишневский, Kazan — December 19, 1975, Moscow Local anesthesia is any technique to render part of the body insensitive to pain without affecting consciousness

Open heart surgery

This is a surgery in which the patient's 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. Cardiopulmonary bypass (CPB is a technique that temporarily takes over the function of the Heart and Lungs during surgery maintaining the circulation of blood 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. John Heysham Gibbon Jr, AB, MD, ( September 29, 1903 &ndash February 5, 1973) a Surgeon who is famous An oxygenator is a medical device that is capable of exchanging Oxygen and Carbon dioxide in the blood of human patient in surgical procedures that may necessitate the interruption 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'. Cardiopulmonary bypass (CPB is a technique that temporarily takes over the function of the Heart and Lungs during surgery maintaining the circulation of blood 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. John W Kirklin ( 1917 - April 21, 2004) was born in Muncie Indiana, United States Mayo Clinic is a Non-profit medical practice Its headquarters the Mayo Medical School and its research facilities are in Rochester Minnesota in

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. Coronary artery bypass surgery, also coronary artery bypass graft surgery, and colloquially heart bypass or bypass surgery is a surgical procedure Cardiopulmonary bypass (CPB is a technique that temporarily takes over the function of the Heart and Lungs during surgery maintaining the circulation of blood In these operations, the heart is beating during surgery, but is stabilized to provide a(n) (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). Postperfusion syndrome, also known as pumphead, is a constellation of neurocognitive impairments attributed to Cardiopulmonary bypass (CPB during Cardiac surgery

Minimally invasive surgery

A new form of heart surgery that has grown in popularity is robot-assisted heart surgery. Minimally invasive robot-assisted Heart surgery ( Cardiac surgery) is a procedure that allows heart surgery to be performed through tiny incisions in the patient’s 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 months of recovery time, some patients have recovered and resumed playing athletics in a matter of weeks.

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. ^[3][4]

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. A stroke is the rapidly developing loss of brain functions due to a disturbance in the blood vessels supplying blood to the brain A more subtle constellation of neurocognitive deficits attributed to cardiopulmonary bypass is known as postperfusion syndrome (sometimes called 'pumphead'). Cardiopulmonary bypass (CPB is a technique that temporarily takes over the function of the Heart and Lungs during surgery maintaining the circulation of blood Postperfusion syndrome, also known as pumphead, is a constellation of neurocognitive impairments attributed to Cardiopulmonary bypass (CPB during Cardiac surgery The symptoms of postperfusion syndrome were initially felt to be permanent,^[5] but were shown to be transient with no permanent neurological impairment. ^[6]

See also

• Cardiac surgeon
• Cardiothoracic surgery
• Vascular surgery

References

Further reading

• [edited by] Lawrence H. Cohn, L. Henry Edmunds, Jr (2003). Cardiac surgery in the adult. New York: McGraw-Hill, Medical Pub. Division. ISBN 0-07-139129-0.   Full text online

External links

• The American Heart Association
• The Cleveland Clinic Heart Center
• "Congenital Heart Disease Surgical Corrective Procedures", a list of surgical procedures
• The Heart Disease Information Center
• What to expect before, during and after heart surgery from Children's Hospital Heart Center, Seattle.
• Minimally invasive heart surgery. Medical Encyclopedia, MedlinePlus.
• Heart surgery slideshow from Children's Hospital Heart Center, Seattle.
• Mitral Valve Repair at The Mount Sinai Hospital
• Open Heart Surgery Videos
• Heart Surgery USA - A summary of bypass surgery procedures.
• Open Heart Surgery Video, Bakulev center in Moscow