Cardiac surgery

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Cardiac surgery is surgery on the heart and/or great vessels. Frequently, it is done to treat complications of ischemic heart disease (e.g. coronary artery bypass grafting), correct congenital heart disease, or treat valve problems created by various causes including endocarditis. It also includes heart transplantation, which is covered in the article heart transplant.

1 History
2 Risks
3 See Also
4 References
5 External links

[edit] History

The earliest operations that can be considered cardiac surgery were limited to the pericardium, and were pioneered by, among others, Francisco Romero,<ref>Aris A. Francisco Romero, the first heart surgeon. Ann Thorac Surg 1997 Sep;64(3):870-1. PMID 9307502</ref> 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.

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 by-passed by use of an extracorporeal circulation technique, hence the term of cardiopulmonary bypass. 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. Dr. John Heysham Gibbon at Jefferson Medical School in Philadelphia reported in 1953 the first successful use of extracorporeal circulation by means of a pump-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.

Recently, however, doctors have begun to perform "beating heart surgery," a phrase used to describe cardiac surgery done without the aforementioned bypass pump mechanism. In these operations, the heart is beating during surgery. Some researchers believe this approach results in fewer post-operative complications (such as pumphead syndrome) and better overall results. The Heart Surgery USA website provides a summary of recent work in this area.

[edit] 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. <ref>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 Mar 18;355(9208):1004-7. PMID 10768449</ref><ref>Klitzner TS, Lee M, Rodriguez S, Chang RR. Sex-related Disparity in Surgical Mortality among Pediatric Patients. Congenital Heart Disease 2006 May;1(3):77. Abstract</ref>

The biggest risk associated with cardiac surgery is brain damage. Despite the advances in CPB techniques, it is estimated that as many as 60% of all patients demonstrate varying levels of brain damage following the surgery; in 25% of patients this damage becomes permanent. It can range from fine motor skill dysfunctions to mental retardation.<ref>Taylor KM. Brain damage during cardiopulmonary bypass. Ann Thorac Surg 1998 Apr;65(4 Suppl):S20-6; discussion S27-8. PMID 9563398</ref>