Cardiac surgery facts for kids

Quick facts for kids Cardiac surgery
Two heart surgeons doing coronary artery bypass surgery. They use a special tool called a retractor to keep the chest open and show the heart.
Specialty	{{#statements:P1995}}
ICD-9-CM	35-37
MeSH	D006348
OPS-301 code	5-35...5-37

Cardiac surgery, also known as heart surgery, is an operation on the heart or the large blood vessels connected to it. Special doctors called cardiac surgeons perform these surgeries. They are often done to fix problems caused by ischemic heart disease, like using coronary artery bypass grafting to improve blood flow. Heart surgery also helps correct congenital heart disease (heart problems you're born with) or treat issues with heart valves. Sometimes, it even includes heart transplantation, which is replacing a diseased heart with a healthy one.

History of Heart Surgery

Early Steps in the 1800s

The first operations on the pericardium (the protective sac around the heart) happened in the 1800s. Surgeons like Francisco Romero (1801) and Dominique Jean Larrey (1810) were among the first. Later, Henry Dalton (1891) and Daniel Hale Williams (1893) also performed important early procedures.

The very first surgery on the heart itself was done by Axel Cappelen in Norway on September 4, 1895. He tied off a bleeding coronary artery in a young man who had been stabbed. The patient seemed to recover at first but sadly died a few days later from an infection.

Big Changes in the 1900s

Surgeries on the great vessels (large blood vessels near the heart) became more common after 1900. However, operating directly on heart valves was still very new. In 1925, Henry Souttar successfully operated on a young woman with a narrowed mitral valve. He made a small opening and used his finger to feel and explore the damaged valve. The patient lived for several years, but other doctors at the time thought the procedure was too risky, so Souttar couldn't continue his work.

A major breakthrough happened on November 29, 1944. Alfred Blalock, Helen Taussig, and Vivien Thomas performed the first successful heart operation on a one-year-old girl with a complex heart defect called Tetralogy of Fallot. This was a huge step for children's heart surgery.

After World War II, heart surgery changed a lot. In 1947, Thomas Sellors successfully fixed a narrowed pulmonary valve in a patient. Around the same time, Russell Brock also developed tools to fix similar problems. For many years, these "blind" operations were common until new technology allowed doctors to see inside the heart during surgery.

In 1948, four different surgeons—Horace Smithy, Charles Bailey, Dwight Harken, and Russell Brock—all found ways to successfully operate on the mitral valve for problems caused by rheumatic fever. They worked independently but came up with similar solutions, making Souttar's earlier technique more widely accepted.

The first successful surgery to fix a congenital heart defect (a problem present from birth) using hypothermia (cooling the body to slow down its needs) was performed by Dr. F. John Lewis in 1952. In 1953, Alexander Alexandrovich Vishnevsky performed the first heart surgery using only local anesthesia, meaning the patient was awake but couldn't feel the pain.

Different Kinds of Heart Surgery

Open-Heart Surgery

When people talk about "open-heart surgery," it means a surgeon makes a large cut in the chest to open the rib cage and reach the heart. The term "open" refers to the chest, not always the heart itself. Depending on the surgery, the heart might also be opened.

Dr. Wilfred G. Bigelow discovered that heart operations were easier if the heart was still and there wasn't much blood around. So, during these surgeries, the heart is often temporarily stopped. A special machine called a cardiopulmonary bypass machine then takes over the job of pumping blood and oxygen around the body. Surgeons try to keep the time a patient spends on this machine as short as possible.

Cardiac surgery at Gemelli Hospital in Rome

The cardiopulmonary bypass machine was developed because cooling the body (hypothermia) wasn't enough for complex heart repairs. In 1952, Forest Dodrill was the first to use a mechanical pump to help a human heart during surgery. In 1953, Dr. John Heysham Gibbon successfully used a machine that acted as both heart and lungs. Later, Dr. C. Walton Lillehei even used a parent as a "heart-lung machine" for a child's surgery.

Modern Beating-Heart Surgery

In the early 1990s, doctors started doing a type of surgery called off-pump coronary artery bypass. This means the heart keeps beating during the operation, and the patient doesn't need the cardiopulmonary bypass machine. The surgeon uses special tools to keep a small part of the heart still enough to work on.

Heart Transplant

A heart transplantation is when a diseased heart is replaced with a healthy heart from a donor. In 1945, a Soviet scientist named Nikolai Sinitsyn successfully transplanted hearts between frogs and dogs.

The first human heart transplant was performed by a South African surgeon, Christiaan Barnard, on December 3, 1967. Just three days later, Adrian Kantrowitz performed the first heart transplant on a child in New York. Norman Shumway is often called the "father of human heart transplantation" because he developed many of the techniques that made these surgeries possible.

Coronary Artery Bypass Grafting (CABG)

Coronary artery bypass grafting (CABG), often called "bypass surgery," is a common operation. It creates a new path for blood to flow to the heart when the original arteries are blocked. Surgeons take healthy arteries or veins from other parts of the body, like the chest or leg. They then attach these new vessels to the heart, bypassing the blocked parts and helping prevent blood clots.

This surgery is usually done for coronary artery disease (CAD). In CAD, a sticky substance called plaque builds up in the coronary arteries, which are the main blood vessels supplying oxygen-rich blood to the heart. This buildup can cause blockages or even lead to a heart attack.

Minimally Invasive Surgery

Instead of a large cut, minimally invasive surgery uses very small cuts. The surgeon inserts a tiny camera and special tools through these small openings to perform the operation. This can lead to less pain and a faster recovery.

In robot-assisted heart surgery, a machine controlled by the surgeon performs the procedure. The main benefit is that it only needs three small holes instead of a large cut. This method is still being studied, but early results show it's a safe choice for some heart surgeries.

After Heart Surgery

After any surgery, especially heart surgery, it's important to follow certain steps to help you recover and avoid problems. Taking care of the incision (the cut) is key to prevent infection and reduce scarring. It's common to have some swelling and a temporary loss of appetite.

Recovery from open-heart surgery usually starts with about two days in an intensive care unit (ICU). Here, doctors and nurses closely watch your heart rate, blood pressure, and oxygen levels. Small tubes might be placed to drain any fluid around your heart and lungs. After leaving the hospital, you might be advised to wear compression socks to help with blood flow.

Possible Risks

Thanks to advances in heart surgery and the use of the cardiopulmonary bypass machine, the risks of these procedures have greatly decreased. For example, surgeries to fix heart problems present from birth now have a very low risk of death.

One concern with heart surgery can be damage to the brain, called neurological damage. About 2–3% of people having heart surgery might have a Stroke. This risk can be higher for patients who already have other stroke risk factors. Another less common issue is postperfusion syndrome, sometimes called "pumphead." This can cause temporary memory or thinking problems, but these usually go away and don't cause lasting brain damage.

To help doctors understand the risks for each patient, a tool called the EuroSCORE is used. It looks at different health factors to estimate how likely a patient is to recover well after surgery. This helps doctors and patients make informed decisions.

Sometimes, after open-heart surgery, people might experience emotional or psychological changes. For example, Victor Skumin described a condition called Skumin syndrome [fr] in 1978. This can happen after getting an artificial heart valve and might involve feeling very anxious, sad, having trouble sleeping, or feeling weak.

Reducing Risks

There are ways to help reduce the risks of complications after heart surgery.

Simple Steps to Help Recovery

Doing physical therapy before surgery can help prevent lung problems like pneumonia after the operation. It might also help you leave the hospital a few days sooner. Also, if you smoke, quitting at least four weeks before surgery can lower your risk of problems.

Medication Help

Sometimes, doctors prescribe certain medications called beta-blockers around the time of heart surgery. There's some evidence that these medications might help reduce the chance of irregular heartbeats after the operation.

See also

• Frank Gerbode (surgeon)