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Open –Heart Surgery

It is well known that open heart surgery is any surgery where the chest is opened and surgery is performed on the heart muscle, valves, arteries, or other heart structures (such as the aorta). The term "open" means that the chest is "cut" open. A heart-lung machine (also called cardiopulmonary bypass) is usually used during open heart surgery. While the surgeon works on the heart, the machine helps provide oxygen-rich blood to the brain and other vital organs. The definition of open heart surgery has become confusing with new procedures being performed on the heart through smaller incisions. There are some new surgical procedures being done with the heart still beating.

gelatin appliance of an open heart surgery.

Content

History Significance Function Types Warning

History
Open-heart surgery was not widely available until the mid-1970s. The first recorded successful heart surgery performed on a living human being was in 1896, when a Frankfurt physician sutured a wound in the heart of a young German soldier. Great strides have been made in this field of surgery since the removal of shell fragments from the hearts of American soldiers in World War II and the first repairs of inborn (congenital) abnormalities in 1945. Surgical technique in the early 1900s was far more advanced than the ability to keep patients alive. Ability to operate, however, was limited by the inability to operate on a heart that was still beating. The difficulty of operating on a beating heart was not resolved until the mid-1950s and early 1960s. In early experiments, scientists found they could stop and restart the heart, but this left less than three minutes in which to operate before irreparable brain damage occurred. Philadelphia’s John Gibbon was one of the doctors working on a solution: a machine that would take over the circulation of the blood. His first model was tested in animal experiments in 1931, but it was not until 1953 that Gibbon was able to perform a successful operation on a human patient using total cardiopulmonary bypass.

It was not until the mid-1970s that the machines became sufficiently sophisticated to achieve safe, widespread use. Today’s bypass machines can maintain the patient’s circulation for many hours without serious side effects to the body. The other technical innovation that allowed doctors to operate on the heart for an extended period of time was the introduction of safe preservation techniques, using extremely cold temperatures (hypothermia), for a heart that has been stopped. In the late 1950s, Dr. Norman Shumway showed that the heart’s demand for oxygen could be considerably reduced and the heart muscle cells preserved if the heart was immersed in a cold salt (saline) solution.

Clockwise from upper left: Dr. Nazih Zuhdi holds the heart of a 14-year-old Georgia girl who died in a car accident; Dr. Zuhdi performs transplant surgery on Nancy rogers; Dr. Zuhdi and a nurse debribrillate the heart of Nancy Rogers; Dr. Zuhdi with first heart transplant recipient Nancy Rogers, 45, Oklahoma City, at left, and second heart transplant recipient Robert Fortson.

Significance
Open-heart surgery is one of the most commonly performed operations each year in the United States, and boasts a high survival rate considering the complexity of the procedure. The surgery has come a long way over the years, and is now used to treat many conditions that were once strictly fatal. Performed by a cardiac surgeon, openheart surgery repairs complications of ischemic heart disease, corrects congenital defects, treats valvular heart disease, and makes heart transplantation a possibility. Without this advancement in medicine, many people with heart conditions would not have a second chance at life.

Function
Open-heart surgery is a fairly broad term used to describe any cardiac surgery involving opening of the chest cavity. The term typically refers to any operation in which a heart-lung machine is used during surgery to support circulation while changes are made to the heart. A heartlung machine, also known as cardiopulmonary bypass, provides oxygen-rich blood to vital organs, including the brain. The bypass machine also administers anesthesia to the patient and removes carbon dioxide from the blood. The term open-heart surgery is also used to describe off pump bypass surgeries, during which a surgeon opens the chest and works on outer areas of the heart and the cardiac arteries. This type of surgery is less invasive and does not involving opening of the heart itself. Open-heart surgery is used to perform surgery on the heart muscle, the cardiac valves, surrounding arteries and other cardiac structures.

Two cardiac surgeons performing a cardiac surgery known as coronary artery bypass surgery. Note the use of a steel retractor used to forcefully maintain the exposure of the patient's heart.

Types
There are several types of open-heart surgeries and which kind a patient receives depends on the heart condition being treated and the patient's overall health. Most types of openheart surgery are performed while the patient's blood is diverted through a heart-lung machine, but some forms of minimally invasive heart surgery are also available. Roboticassisted heart surgery is one type of minimally invasive heart surgery that is used as an alternative to open-heart surgery requiring the use of a heart-lung machine. All open-heart surgeries involve an incision in the middle of the chest and exposure of the heart. According to the American Heart Association, the most commonly performed open-heart surgeries in the United States are valve replacements, bypass procedures, and heart transplants. Coronary artery bypass graft, or CABG, involves taking a portion of a healthy blood vessel from another site in the body and using it to create a new route around a blocked blood vessel in the heart. Common reasons for open-heart surgery include treatment of heart failure, treatment of atrial fibrillation, tumor removal, repairs of congenital defects, and treatment of cardiac traumas.

Warning

Although open-heart surgery is a relatively common procedure with a high survival rate, the surgery does carry a risk of complications and mortality. Older people and those with other serious medical conditions are more prone to developing complications, and about 5 to 10 percent of all open-heart surgery patients experience strokes or transient ischemic attacks during or following open-heart surgery. The most significant risk of open-heart surgery is neurological damage, and cardiopulmonary bypass is associated with a group of neurocognitive deficits known as postperfusion syndrome. While the symptoms of postperfusion syndrome were once believed to be permanent, in most cases the symptoms are transient and no permanent neurological impairment is usually experienced. Other complications of open-heart surgery include infection and bleeding.

http://www.med.yale.edu/library/heartbk/2 5.pdf http://en.wikipedia.org/wiki/Open_heart_su rgery http://www.ehow.com/about_4602132_openh eart-surgery.html http://ndepth.newsok.com/zuhdi

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