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14-September-2008 12:50:25 - surgery Two cardiac surgeons performing a cardiac surgery known as coronary artery bypass surgery. Two cardiac surgeons performing a cardiac surgery known as coronary artery bypass surgery. 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. Contents 1 History 1.1 Closed heart surgery 1.2 Operations under hypothermia 1.3 Open heart surgery 1.4 Modern beating-heart surgery 1.5 Minimally invasive surgery 2 Risks 3 See also 4 References 5 Further reading 6 External links 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 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. 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. 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.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. 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'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. 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 studies results are controversial as of 2007, 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 a patient, instead of months of recovery time, some patients have recovered and resumed playing athletics in a matter of weeks.citation needed 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.34 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.citation needed 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,5 but were shown to be transient with no permanent neurological impairment.6 See also Cardiac surgeon Cardiothoracic surgery Vascular surgery References ^ Aris A. Francisco Romero, the first heart surgeon. Ann Thorac Surg 1997 Sep;643:870-1. PMID 9307502 ^ Bigelow WG. Cold Hearts: The Story of Hypothermia and the Pacemaker in Heart Surgery. McClelland and Stewart Limited. 1984. ISBN 0-7710-1414-7. ^ 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;3559208:1004-7. PMID 10768449 ^ Klitzner TS, Lee M, Rodriguez S, Chang RR. Sex-related Disparity in Surgical Mortality among Pediatric Patients. Congenital Heart Disease 2006 May;13:77. 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. doi:10.1056/NEJM200102083440601. PMID 11172175. ^ 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. doi:10.1001/jama.287.11.1405. PMID 11903027. Further reading ed 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 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 Heart Surgery USA - A summary of bypass surgery procedures at heartsurgery-usa.com Open Heart Surgery Video, Bakulev center in Moscow at YouTube v d e Health Science - Medicine - Surgery - Cardiac surgery procedures ICD-9-CM V3 35-37 Coronary heart disease Angioplasty - Coronary artery bypass - MIDCAB - Off-pump coronary artery bypass - TECAB Heart valves Aortic valve repair - Aortic valve replacement - Mitral valve repair - Mitral valve replacement - Ross procedure Great vessels Bentall procedure - Pulmonary thromboendarterectomy - Valve-sparing aortic root replacement Myocardium Cardiomyoplasty - Dor procedure - Heart transplantation - Septal myectomy - Ventricular reduction Pericardium Pericardiocentesis - Pericardiectomy Congenital heart disease Atrial septostomy - Blalock-Taussig shunt - Fontan procedure - Norwood procedure - Rastelli procedure Conduction system Maze procedure Cox maze and minimaze - Pacemaker insertion Retrieved from http://en..org/wiki/Cardiac_surgery Categories: Cardiac surgeryHidden categories: All articles with statements | Articles with statements since September 2007 | Articles with statements since February 2007 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages ÄŒesky Euskara Français Italiano МакедонÑ?ки Polski РуÑ?Ñ?кий Suomi УкраїнÑ?ька ä¸æ–‡ This page was last modified on 13 September 2008, at 00:05
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