Cardiac surgery
Encyclopedia
Cardiovascular surgery is surgery
on the heart
or great vessels
performed by cardiac surgeon
s. 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
from various causes including endocarditis
, rheumatic heart disease and atherosclerosis. It also includes heart transplantation
.
(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 at Rikshospitalet
in Kristiania, now Oslo
. He ligated
a bleeding coronary artery
in a 24 year old man who had been stabbed in the left axillae and was in deep shock upon arrival. Access was through a left thoracotomy
. The patient awoke and seemed fine for 24 hours, but became ill with increasing temperature and he ultimately died from what the post mortem proved to be mediastinitis
on the third postoperative day. The first successful surgery of the heart, 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 in 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.
s were unknown. Henry Souttar
operated successfully on a young woman with mitral stenosis
. He made an opening in the appendage of the left atrium and inserted a finger into this chamber in order to palpate and explore the damaged mitral valve. The patient survived for several years but Souttar’s physician colleagues at that time decided the procedure was not justified and he could not continue.
Cardiac surgery changed significantly after World War II
. In 1948 four surgeons carried out successful operations for mitral stenosis
resulting from rheumatic fever
. Horace Smithy (1914–1948) of Charlotte
, revived an operation due to Dr Dwight Harken
of the Peter Bent Brigham Hospital
using a punch to remove a portion of the mitral valve
. Charles Bailey
(1910–1993) at the Hahnemann Hospital, Philadelphia, Dwight Harken
in Boston
and Russell Brock at Guy’s Hospital
all adopted Souttar’s method. All these men started work independently of each other, within a few months. This time Souttar’s technique was widely adopted although there were modifications.
In 1947 Thomas Holmes Sellors (1902–1987) of the Middlesex Hospital
operated on a Fallot’s Tetralogy patient with pulmonary stenosis and successfully divided the stenosed pulmonary valve
. In 1948, Russell Brock, probably unaware of Sellor’s work, used a specially designed dilator in three cases of pulmonary stenosis. Later in 1948 he designed a punch to resect the infundibular muscle
stenosis
which is often associated with Fallot’s Tetralogy. Many thousands of these “blind” operations were performed until the introduction of heart bypass made direct surgery on valves possible.
that the repair of intracardiac pathologies was better done with 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
.
Surgeons realized the limitations of hypothermia – complex intracardiac repairs take more time and the patient needs blood flow to the body, particularly to the brain
. The patient needs the function of the heart and lung
s 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.
Nazih Zuhdi performed the first total intentional hemodilution open heart surgery on Terry Gene Nix, age 7, on February 25, 1960, at Mercy Hospital, Oklahoma City, OK. The operation was a success; however, Nix died three years later in 1963. In March, 1961, Zuhdi, Carey, and Greer, performed open heart surgery on a child, age 3½, using the total intentional hemodilution machine. In 1985 Dr. Zuhdi performed Oklahoma's first successful heart transplant on Nancy Rogers at Baptist Hospital. The transplant was successful, but Rogers, a cancer
sufferer, died from an infection 54 days after surgery.
(EVH).
Some researchers believe that the off-pump approach results in fewer post-operative complications, such as postperfusion syndrome
, and better overall results. Study results are controversial as of 2007, the surgeon's preference and hospital results still play a major role.
performed the first successful pediatric cardiac operation at the Salt Lake General Hospital in March 1956, a total repair of tetralogy of Fallot
in a four-year-old girl.
occurs in 2–3% of all people undergoing cardiac surgery, and is higher in patients at risk for stroke. 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, but were shown to be transient with no permanent neurological impairment.
In order to assess the performance of surgical units and individual surgeons, a popular risk model has been created called the EuroSCORE
. This takes a number of health factors from a patient and using precalculated logistic regression coefficients attempts to give a percentage chance of survival to discharge. Within the UK this EuroSCORE was used to give a breakdown of all the centres for cardiothoracic surgery
and to give some indication of whether the units and their individuals surgeons performed within an acceptable range. The results are available on the CQC website. The precise methodology used has however not been published to date nor has the raw data on which the results are based.
Surgery
Surgery is an ancient 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, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
on the heart
Heart
The heart is a myogenic muscular organ found in all animals with a circulatory system , that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions...
or great vessels
Great vessels
Great vessels is a term used to refer collectively to the four large vessels that bring blood to and from the heart. These are:*Superior vena cava*Inferior vena cava*Pulmonary artery*AortaAll four pulmonary veins are considered apart of the great vessels...
performed by cardiac surgeon
Surgeon
In medicine, a surgeon is a specialist in surgery. Surgery is a broad category of invasive medical treatment that involves the cutting of a body, whether human or animal, for a specific reason such as the removal of diseased tissue or to repair a tear or breakage...
s. 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
Valvular heart disease
Valvular heart disease is any disease process involving one or more of the valves of the heart . Valve problems may be congenital or acquired...
from various causes including endocarditis
Endocarditis
Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves . Other structures that may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, or even on intracardiac devices...
, rheumatic heart disease and atherosclerosis. It also includes heart transplantation
Heart transplantation
A heart transplant, or a cardiac transplantation, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease. As of 2007 the most common procedure was to take a working heart from a recently deceased organ donor and implant it into the...
.
History
The earliest operations on the pericardiumPericardium
The pericardium is a double-walled sac that contains the heart and the roots of the great vessels.-Layers:...
(the sac that surrounds the heart) took place in the 19th century and were performed by Francisco Romero Dominique Jean Larrey
Dominique Jean Larrey
Dominique Jean Larrey was a French surgeon in Napoleon's army and an important innovator in battlefield medicine.-Biography:...
, Henry Dalton
Henry Dalton
Henry C. Dalton was superintendent of the St. Louis City Hospital from 1886 to 1892, and later a professor of abdominal and clinical surgery at Marion Sims College of Medicine . He is noted for performing the first suturing of the pericardium on record...
, and Daniel Hale Williams
Daniel Hale Williams
Daniel Hale Williams was an American surgeon. He was the first African-American cardiologist,and performed one of the first successful open-heart surgeries in the United States. He also founded Provident Hospital, the first non-segregated hospital in the United States.-Career:Williams was among...
. The first surgery on the heart itself was performed by Norwegian
Norway
Norway , officially the Kingdom of Norway, is a Nordic unitary constitutional monarchy whose territory comprises the western portion of the Scandinavian Peninsula, Jan Mayen, and the Arctic archipelago of Svalbard and Bouvet Island. Norway has a total area of and a population of about 4.9 million...
surgeon Axel Cappelen on the 4th of September 1895 at Rikshospitalet
Rikshospitalet
Rikshospitalet is located in Oslo, Norway. From January 1, 2009, the hospital is part of Oslo University Hospital....
in Kristiania, now Oslo
Oslo
Oslo is a municipality, as well as the capital and most populous city in Norway. As a municipality , it was established on 1 January 1838. Founded around 1048 by King Harald III of Norway, the city was largely destroyed by fire in 1624. The city was moved under the reign of Denmark–Norway's King...
. He ligated
Ligature (medicine)
In surgery or medical procedure, a ligature consists of a piece of thread tied around an anatomical structure, usually a blood vessel or another hollow structure to shut it off. With a blood vessel the surgeon will clamp the vessel perpendicular to the axis of the artery or vein with a hemostat,...
a bleeding coronary artery
Coronary circulation
Coronary circulation is the circulation of blood in the blood vessels of the heart muscle . The vessels that deliver oxygen-rich blood to the myocardium are known as coronary arteries...
in a 24 year old man who had been stabbed in the left axillae and was in deep shock upon arrival. Access was through a left thoracotomy
Thoracotomy
Thoracotomy is an incision into the pleural space of the chest. It is performed by a surgeon, and, rarely, by emergency physicians, to gain access to the thoracic organs, most commonly the heart, the lungs, the esophagus or thoracic aorta, or for access to the anterior spine such as is necessary...
. The patient awoke and seemed fine for 24 hours, but became ill with increasing temperature and he ultimately died from what the post mortem proved to be mediastinitis
Mediastinitis
Mediastinitis is inflammation of the tissues in the mid-chest, or mediastinum. It can be either acute or chronic.Acute mediastinitis is usually bacterial and due to rupture of organs in the mediastinum. As the infection can progress rapidly, this is considered a serious condition...
on the third postoperative day. The first successful surgery of the heart, performed without any complications, was by Dr. Ludwig Rehn
Ludwig Rehn
Ludwig Wilhelm Carl Rehn was a German surgeon. Rehn was born in 1849, in the village of Allendorf, the youngest of five children...
of Frankfurt
Frankfurt
Frankfurt am Main , commonly known simply as Frankfurt, is the largest city in the German state of Hesse and the fifth-largest city in Germany, with a 2010 population of 688,249. The urban area had an estimated population of 2,300,000 in 2010...
, Germany
Germany
Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...
, who repaired a stab wound to the right ventricle
Ventricle (heart)
In the heart, a ventricle is one of two large chambers that collect and expel blood received from an atrium towards the peripheral beds within the body and lungs. The Atria primes the Pump...
on September 7, 1896.
Surgery in great vessels
Great vessels
Great vessels is a term used to refer collectively to the four large vessels that bring blood to and from the heart. These are:*Superior vena cava*Inferior vena cava*Pulmonary artery*AortaAll four pulmonary veins are considered apart of the great vessels...
(aortic coarctation
Aortic coarctation
Coarctation of the aorta, or aortic coarctation, is a congenital condition whereby the aorta narrows in the area where the ductus arteriosus inserts.-Types:There are three types:...
repair, Blalock-Taussig shunt creation, closure of patent ductus arteriosus
Patent ductus arteriosus
Patent ductus arteriosus is a congenital disorder in the heart wherein a neonate's ductus arteriosus fails to close after birth. Early symptoms are uncommon, but in the first year of life include increased work of breathing and poor weight gain...
), became common after the turn of the century and falls in the domain of cardiac surgery, but technically cannot be considered heart surgery.
Early approaches to heart malformations
In 1925 operations on the heart valveHeart valve
A heart valve normally allows blood flow in only one direction through the heart. The four valves commonly represented in a mammalian heart determine the pathway of blood flow through the heart...
s were unknown. Henry Souttar
Henry Souttar
Sir Henry Sessions Souttar, , was a surgeon with a wide breadth of interests. He trained first as a mathematician and engineer. His engineer’s training enabled him to design and make new types of surgical instrument. His mathematical training made him a leader in setting out the first British...
operated successfully on a young woman with mitral stenosis
Mitral stenosis
Mitral stenosis is a valvular heart disease characterized by the narrowing of the orifice of the mitral valve of the heart.-Signs and symptoms:Symptoms of mitral stenosis include:...
. He made an opening in the appendage of the left atrium and inserted a finger into this chamber in order to palpate and explore the damaged mitral valve. The patient survived for several years but Souttar’s physician colleagues at that time decided the procedure was not justified and he could not continue.
Cardiac surgery changed significantly after World War II
World War II
World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...
. In 1948 four surgeons carried out successful operations for mitral stenosis
Mitral stenosis
Mitral stenosis is a valvular heart disease characterized by the narrowing of the orifice of the mitral valve of the heart.-Signs and symptoms:Symptoms of mitral stenosis include:...
resulting from rheumatic fever
Rheumatic fever
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection, such as strep throat or scarlet fever. Believed to be caused by antibody cross-reactivity that can involve the heart, joints, skin, and brain, the illness typically develops two to three weeks after...
. Horace Smithy (1914–1948) of Charlotte
CHARLOTTE
- CHARLOTTE :CHARLOTTE is an American blues-based hard rock band that formed in Los Angeles, California in 1986. Currently, they are signed to indie label, Eonian Records, under which they released their debut cd, Medusa Groove, in 2010. Notable Charlotte songs include 'Siren', 'Little Devils',...
, revived an operation due to Dr Dwight Harken
Dwight Harken
Dwight Emary Harken was an American surgeon. He was an innovator in heart surgery and introduced the concept of the intensive care unit.-Life:Dwight Harken was born in Osceola, Iowa. He received his Bachelor's and Medical degrees from Harvard...
of the Peter Bent Brigham Hospital
Brigham and Women's Hospital
Brigham and Women's Hospital is the largest hospital of the Longwood Medical and Academic Area in Boston, Massachusetts. It is directly adjacent to Harvard Medical School of which it is the second largest teaching affiliate with 793 beds...
using a punch to remove a portion of the mitral valve
Mitral valve
The mitral valve is a dual-flap valve in the heart that lies between the left atrium and the left ventricle...
. Charles Bailey
Charles P. Bailey
Charles Philamore Bailey was an American cardiac surgeon.. His methods were the focus of a 1957 Time magazine article. He was a graduate of Rutgers University, Hahnemann Medical College and the University of Pennsylvania....
(1910–1993) at the Hahnemann Hospital, Philadelphia, Dwight Harken
Dwight Harken
Dwight Emary Harken was an American surgeon. He was an innovator in heart surgery and introduced the concept of the intensive care unit.-Life:Dwight Harken was born in Osceola, Iowa. He received his Bachelor's and Medical degrees from Harvard...
in Boston
Boston
Boston is the capital of and largest city in Massachusetts, and is one of the oldest cities in the United States. The largest city in New England, Boston is regarded as the unofficial "Capital of New England" for its economic and cultural impact on the entire New England region. The city proper had...
and Russell Brock at Guy’s Hospital
Guy's Hospital
Guy's Hospital is a large NHS hospital in the borough of Southwark in south east London, England. It is administratively a part of Guy's and St Thomas' NHS Foundation Trust. It is a large teaching hospital and is home to the King's College London School of Medicine...
all adopted Souttar’s method. All these men started work independently of each other, within a few months. This time Souttar’s technique was widely adopted although there were modifications.
In 1947 Thomas Holmes Sellors (1902–1987) of the Middlesex Hospital
Middlesex Hospital
The Middlesex Hospital was a teaching hospital located in the Fitzrovia area of London, United Kingdom. First opened in 1745 on Windmill Street, it was moved in 1757 to Mortimer Street where it remained until it was finally closed in 2005. Its staff and services were transferred to various sites...
operated on a Fallot’s Tetralogy patient with pulmonary stenosis and successfully divided the stenosed pulmonary valve
Pulmonary valve
The pulmonary valve is the semilunar valve of the heart that lies between the right ventricle and the pulmonary artery and has three cusps. Similar to the aortic valve, the pulmonary valve opens in ventricular systole, when the pressure in the right ventricle rises above the pressure in the...
. In 1948, Russell Brock, probably unaware of Sellor’s work, used a specially designed dilator in three cases of pulmonary stenosis. Later in 1948 he designed a punch to resect the infundibular muscle
Conus arteriosus
The conus arteriosus is a conical pouch formed from the upper and left angle of the right ventricle in the chordate heart, from which the pulmonary trunk arises....
stenosis
Stenosis
A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure.It is also sometimes called a stricture ....
which is often associated with Fallot’s Tetralogy. Many thousands of these “blind” operations were performed until the introduction of heart bypass made direct surgery on valves possible.
Open heart surgery
Open heart surgery is a surgery in which the patient's heart is opened and surgery is performed on the internal structures of the heart. It was soon discovered by Dr. Wilfred G. Bigelow of the University of TorontoUniversity of Toronto
The University of Toronto is a public research university in Toronto, Ontario, Canada, situated on the grounds that surround Queen's Park. It was founded by royal charter in 1827 as King's College, the first institution of higher learning in Upper Canada...
that the repair of intracardiac pathologies was better done with 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
Congenital heart defect
A congenital heart defect is a defect in the structure of the heart and great vessels which is present at birth. Many types of heart defects exist, most of which either obstruct blood flow in the heart or vessels near it, or cause blood to flow through the heart in an abnormal pattern. Other...
using hypothermia
Hypothermia
Hypothermia is a condition in which core temperature drops below the required temperature for normal metabolism and body functions which is defined as . Body temperature is usually maintained near a constant level of through biologic homeostasis or thermoregulation...
was performed by Dr. C. Walton Lillehei
C. Walton Lillehei
Clarence Walton Lillehei , was an American surgeon who pioneered open-heart surgery, as well as numerous techniques, equipment and prostheses for cardiothoracic surgery.-Background:...
and Dr. F. John Lewis at the University of Minnesota
University of Minnesota
The University of Minnesota, Twin Cities is a public research university located in Minneapolis and St. Paul, Minnesota, United States. It is the oldest and largest part of the University of Minnesota system and has the fourth-largest main campus student body in the United States, with 52,557...
on September 2, 1952. The following year, Soviet
Soviet Union
The Soviet Union , officially the Union of Soviet Socialist Republics , was a constitutionally socialist state that existed in Eurasia between 1922 and 1991....
surgeon Aleksandr Aleksandrovich Vishnevskiy
Aleksandr Aleksandrovich Vishnevskiy
Alexander Alexandrovich Vishnevsky was a Soviet surgeon of Ukrainian descent, member of the Academy of Medical Sciences of the USSR , honoured worker of science of the RSFSR , Colonel General of Medical Corps , and a Hero of Socialist Labor...
conducted the first cardiac surgery under local anesthesia
Local anesthesia
Local anesthesia is any technique to induce the absence of sensation in part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It allows patients to undergo surgical and dental procedures with...
.
Surgeons realized the limitations of hypothermia – complex intracardiac repairs take more time and the patient needs blood flow to the body, particularly to the brain
Brain
The brain is the center of the nervous system in all vertebrate and most invertebrate animals—only a few primitive invertebrates such as sponges, jellyfish, sea squirts and starfishes do not have one. It is located in the head, usually close to primary sensory apparatus such as vision, hearing,...
. The patient needs the function of the heart and lung
Lung
The lung is the essential respiration organ in many air-breathing animals, including most tetrapods, a few fish and a few snails. In mammals and the more complex life forms, the two lungs are located near the backbone on either side of the heart...
s provided by an artificial method, hence the term cardiopulmonary bypass. Dr. John Heysham Gibbon
John Heysham Gibbon
John Heysham Gibbon Jr., AB, MD, a surgeon best known for inventing the heart-lung machine and performing the first open heart surgery . He was the son of Dr...
at Jefferson Medical School in Philadelphia reported in 1953 the first successful use of extracorporeal circulation by means of an oxygenator
Oxygenator
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 or cessation of blood flow in the body, a critical organ or great blood vessel...
, 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
Heart-lung machine
Cardiopulmonary bypass is a technique that temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and the oxygen content of the body. The CPB pump itself is often referred to as a heart–lung machine or "the pump"...
'. Dr. John W. Kirklin
John W. Kirklin
John Webster Kirklin was born in Muncie, Indiana, United States. After graduating from Harvard Medical School in 1942 he made several important contributions to heart surgery while practicing at the Mayo Clinic, in Rochester, Minnesota...
at the Mayo Clinic
Mayo Clinic
Mayo Clinic is a not-for-profit medical practice and medical research group specializing in treating difficult patients . Patients are referred to Mayo Clinic from across the U.S. and the world, and it is known for innovative and effective treatments. Mayo Clinic is known for being at the top of...
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.
Nazih Zuhdi performed the first total intentional hemodilution open heart surgery on Terry Gene Nix, age 7, on February 25, 1960, at Mercy Hospital, Oklahoma City, OK. The operation was a success; however, Nix died three years later in 1963. In March, 1961, Zuhdi, Carey, and Greer, performed open heart surgery on a child, age 3½, using the total intentional hemodilution machine. In 1985 Dr. Zuhdi performed Oklahoma's first successful heart transplant on Nancy Rogers at Baptist Hospital. The transplant was successful, but Rogers, a cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
sufferer, died from an infection 54 days after surgery.
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 in which to connect the conduit vessel that bypasses the blockage; in the U.S., most conduit vessels are harvested endoscopically, using a technique known as endoscopic vessel harvestingEndoscopic vessel harvesting
Endoscopic vessel harvesting is a surgical technique that may be used in conjunction with coronary artery bypass surgery . For patients with coronary artery disease, a physician may recommend a bypass to reroute blood around blocked arteries to restore and improve blood flow and oxygen to the heart...
(EVH).
Some researchers believe that the off-pump approach results in fewer post-operative complications, such as postperfusion syndrome
Postperfusion syndrome
Postperfusion syndrome, also known as "pumphead" is a constellation of neurocognitive impairments attributed to cardiopulmonary bypass during cardiac surgery. Symptoms of postperfusion syndrome are subtle and include defects associated with attention, concentration, short term memory, fine motor...
, and better overall results. Study results are controversial as of 2007, the 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 surgeon 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.Pediatric cardiovascular surgery
Pediatric cardiovascular surgery is surgery of the heart of children. Russell M. NelsonRussell M. Nelson
Russell Marion Nelson is a member of the Quorum of the Twelve Apostles of the Church of Jesus Christ of Latter-day Saints and an internationally renowned cardiothoracic surgeon.-Medical career:...
performed the first successful pediatric cardiac operation at the Salt Lake General Hospital in March 1956, a total repair of tetralogy of Fallot
Tetralogy of Fallot
Tetralogy of Fallot is a congenital heart defect which is classically understood to involve four anatomical abnormalities...
in a four-year-old girl.
Risks
The development of cardiac surgery and cardiopulmonary bypass techniques has reduced the mortality rates of these surgeries to relatively low ranks. For instance, repairs of congenital heart defects are currently estimated to have 4–6% mortality rates. A major concern with cardiac surgery is the incidence of neurological damage. StrokeStroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
occurs in 2–3% of all people undergoing cardiac surgery, and is higher in patients at risk for stroke. A more subtle constellation of neurocognitive deficits attributed to cardiopulmonary bypass is known as postperfusion syndrome
Postperfusion syndrome
Postperfusion syndrome, also known as "pumphead" is a constellation of neurocognitive impairments attributed to cardiopulmonary bypass during cardiac surgery. Symptoms of postperfusion syndrome are subtle and include defects associated with attention, concentration, short term memory, fine motor...
, sometimes called "pumphead". The symptoms of postperfusion syndrome were initially felt to be permanent, but were shown to be transient with no permanent neurological impairment.
In order to assess the performance of surgical units and individual surgeons, a popular risk model has been created called the EuroSCORE
EuroSCORE
EuroSCORE is a risk model which allows the calculation of the risk of death after a heart operation. The model asks for 17 items of information information about the patient, the state of the heart and the proposed operation, and uses logistic regression to calculate the risk of death. It is free...
. This takes a number of health factors from a patient and using precalculated logistic regression coefficients attempts to give a percentage chance of survival to discharge. Within the UK this EuroSCORE was used to give a breakdown of all the centres for cardiothoracic surgery
Cardiothoracic Surgery
Cardiothoracic surgery is the field of medicine involved in surgical treatment of diseases affecting organs inside the thorax —generally treatment of conditions of the heart and lungs .-Cardiac / Thoracic:...
and to give some indication of whether the units and their individuals surgeons performed within an acceptable range. The results are available on the CQC website. The precise methodology used has however not been published to date nor has the raw data on which the results are based.
See also
- Cardiac surgeonCardiac surgeonA cardiac surgeon is a surgeon who performs cardiac surgery—operative procedures on the heart and great vessels.-Training:A cardiac surgery residency typically comprises anywhere from six to nine years of training to become a fully qualified surgeon...
- Cardiothoracic surgeryCardiothoracic SurgeryCardiothoracic surgery is the field of medicine involved in surgical treatment of diseases affecting organs inside the thorax —generally treatment of conditions of the heart and lungs .-Cardiac / Thoracic:...
- Vascular surgeryVascular surgeryVascular surgery is a specialty of surgery in which diseases of the vascular system, or arteries and veins, are managed by medical therapy, minimally-invasive catheter procedures, and surgical reconstruction. The specialty evolved from general and cardiac surgery...
- Cardiothoracic anesthesiologyCardiothoracic anesthesiologyCardiothoracic anesthesiology is a subspeciality of the medical practice of anesthesiology devoted to the preoperative, intraoperative, and postoperative care of adult patients undergoing cardiothoracic surgery and related invasive procedures...
External links
- Overview at American Heart AssociationAmerican Heart AssociationThe American Heart Association is a non-profit organization in the United States that fosters appropriate cardiac care in an effort to reduce disability and deaths caused by cardiovascular disease and stroke. It is headquartered in Dallas, Texas...
- "Congenital Heart Disease Surgical Corrective Procedures", a list of surgical procedures at learningradiology.com
- What to expect before, during and after heart surgery from Children's Hospital and Regional Medical Center (Seattle)Children's Hospital and Regional Medical Center (Seattle)Seattle Children's, formerly Children's Hospital and Regional Medical Center, is a 250-bed children's hospital in the Laurelhurst neighborhood of Seattle, Washington. Currently ranked as one of the top 10 children's hospitals in the country by U.S...
- Minimally invasive heart surgery. Medical Encyclopedia, MedlinePlusMedlinePlusMedlinePlus is a free Web site that provides consumer health information for patients, families, and Health care providers. The site brings together information from the United States National Library of Medicine, the National Institutes of Health , other U.S. government agencies, and...
- Heart surgery slideshow from Children's Hospital and Regional Medical Center (Seattle)Children's Hospital and Regional Medical Center (Seattle)Seattle Children's, formerly Children's Hospital and Regional Medical Center, is a 250-bed children's hospital in the Laurelhurst neighborhood of Seattle, Washington. Currently ranked as one of the top 10 children's hospitals in the country by U.S...