open heart surgery

Surgery
• (from the Greek: χειρουργική cheirourgikē, via Latin:
chirurgiae, meaning "hand work") is a medical
specialty that uses operative manual and
instrumental techniques on a patient to investigate
and/or treat a pathological condition such as
disease or injury, to help improve bodily function or
appearance, or sometimes for some other reason.
Types of surgery

• Elective surgery
• Emergency surgery
• Exploratory surgery
• Amputation
• Replantation
• Reconstructive surgery
• Cosmetic surgery
• Excision
• Transplant
Cardiac surgery 
• is a 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 caused by
various causes including endocarditis. It
also includes heart transplantation.
History

• The earliest operations on

the pericardium (the sac that surrounds the
heart) took place in the 19th century and
were performed by, Francisco
Romero Dominique Jean Larrey, Henry
Dalton, and Daniel Hale Williams.
• The first surgery on the heart itself was
performed by Norwegian surgeon Axel
Cappelen on the 4th of September 1895
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.
 Procedure
• Your heart surgeon will make a 2-inch to 5-inch-
long surgical cut in the chest wall. Muscles in the
area will be divided so your surgeon can reach the
heart. The surgeon can repair or replace a valve or
perform bypass surgery.
• During endoscopic surgery, your surgeon makes
one to four small holes in your chest. Then your
surgeon uses special instruments and a camera to
perform the surgery.
 Procedure
• During robot-assisted valve surgery, the surgeon
makes two to four tiny cuts (about 1/2 inch to 3/4
inch) in your chest. The surgeon uses a special
computer to control robotic arms during the
surgery. The surgeon sees a three-dimensional
view of the surgery on the computer. This method
is very precise.
• You will not need to be on a heart-lung machine for
these types of surgery, but your heart rate will be
slowed with medicine or a mechanical device.
 The heart-lung
machine

• is medical equipment that provides

cardiopulmonary bypass, or mechanical
circulatory support of the heart and
lungs.

•The machine may consist of venous

and arterial cannula (tubes), polyvinyl
chloride (PVC) or silicone tubing,
reservoir (to hold blood), bubbler or
membrane oxygenator, cardiotomy
(filtered reservoir), heat exchanger(s),
arterial line filter, pump(s), flow meter,
inline blood gas and electrolyte analyzer,
and pressure-monitoring devices.

•Treatment provides removal of carbon

dioxide from the blood, oxygen delivery
to the blood, blood flow to the body,
and/or temperature maintenance.
Pediatric and adult patients both benefit
from this technology.
List of open heart surgery
• Aortic valve surgery - minimally invasive
• Aortic valve surgery - open
• Atrial septal defect repair
• Cardiac transplant
• Coarctation of the aorta repair
• Congenital heart defect corrective surgery
• Heart bypass surgery (coronary artery bypass
graft - CABG)
• Heart transplant
• Heart valve surgery
 List of open heart surgery
• Hypo plastic left heart repair
• Minimally invasive heart surgery (MIDCAB,
OPCAB, RACAB)
• Mitral valve surgery - minimally invasive
• Mitral valve surgery - open
• Pediatric heart surgery
• Tetralogy of Fallot repair
• Total anomalous pulmonary venous
return correction
List of open heart surgery
• Transplant of the heart
• Transposition of great vessels repair
• Tricuspid atresia repair
• Truncus arteriosus repair
• Ventricular septal defect (VSD) repair
 Nursing Diagnosis
• Activity intolerance related to pulmonary
congestion and decreased blood supply to
meet the demands of the body.
• Deficient knowledge (Learning Need)
regarding condition, treatment plan, self-care,
and discharge needs
• Risk for decreased cardiac output
• Acute pain
• Ineffective role performance
• Risk for ineffective breathing pattern
Heart valve surgery

•There are four valves in

the heart: aortic valve,
mitral valve, tricuspid
valve, and pulmonary
valve.
•The valves are
designed to control the
direction of blood flow
through the heart. The
opening and closing of
the heart valves produce
the heart-beat sounds.
Heart valve surgery (Indications)

•Heart valve replacement may be

recommended for:

•narrowing of the heart valve

(stenosis)

•leaking of the heart valve

•Valve problems may be caused by

infections (rheumatic fever) or birth
defects and may cause heart
failure (congestive heart failure)
and infections (infective
endocarditis).

•The surgery is done while the

patient is deep-asleep and pain-
free (general anesthesia). An
incision is made through the breast
bone (sternum).
Heart valve surgery (Procedure Part 1)

•Heart valve surgery is

open-heart surgery.

•Tubes are used to re-route

the blood away from the
heart to a heart-lung
bypass machine to keep
the blood oxygenated and
circulating while the heart is
being operated on.
Heart valve surgery (Procedure Part 2)

•Valves may be repaired or replaced.

Replacement heart valves are either
natural (biologic) or artificial (mechanical).

•Natural valves are from human donors

(cadavers), modified natural valves are
from animal donors (porcine: pigs) which
are placed in synthetic rings, and artificial
valves are made of metal or plastic.
•Natural valves rarely require life-long
medication to prevent blood clot formation
(anticoagulation), whereas artificial valves
will require anticoagulation.

•The advantage of mechanical valves is

that they last longer-thus, the tradeoff of
lifelong anticoagulation in some cases is
worth it to avoid a second valve
replacement surgery.
Heart valve surgery (Procedure Part 3)

•The ineffective mitral valve

is removed and the heart
valve replacement is sutured
into place.
Heart valve surgery (Procedure Part 3)

•The rate of success of heart valve surgery is

high and increasing. The operation provides
symptom relief and prolongs life. The death
rate varies depending on the heart valve and
averages 2% to 5%.

• Approximately 2 out of 3 patients who

received an artificial mitral valve are still alive
9 years after the surgery. Life-long
anticoagulant therapy is necessary for
patients with artificial heart valves.

•The clicking of the mechanical heart valve

may be heard in the chest and is normal.

•The first 2 or 3 days following the operation

are spent in an intensive care unit where
heart functions can be monitored constantly.
The average hospital stay is 1 - 2 weeks. A
few weeks to several months should be
allowed for complete recovery, depending on
health before surgery.
History

•Surgery is the branch of

medicine that deals with the
physical manipulation of a
bodily structure to diagnose,
prevent, or cure an ailment.
Ambroise Paré a 16th century
French surgeon, stated that
there were five reasons to
perform surgery:

•"To eliminate that which is

superfluous, restore that which
has been dislocated, separate
that which has been united,
join that which has been
divided and repair the defects
of nature."