What is Open heart surgery and how is it done?
By the time I started training in cardiac and thoracic surgery 20 years ago, most of the modern technologies used for correcting heart disease had been developed. With improvement in hardware, technology, medicines, skills of surgeons and our understanding of disease and management we have seen a consistent improvement of results and reduction of morbidity and mortality in the repair of congenital heart disease.
Any operation that involves opening the heart is called Open Heart Surgery.
Most of the structural heart diseases involve the need to operate inside the heart. Understandably, to work within the heart, we need to stop the heart. During this time to keep the patient alive we use a machine designed to deliver oxygenated blood to the body. This is called a Heart Lung Machine (HLM). The perfusionist is a technical person who runs the HLM and conducts the process of Cardiopulmonary bypass( CPB). The blood from the body bypasses the heart and lungs (hence Cardio-Pulmonary Bypass – CPB) comes to a reservoir and exchanges CO2 for O2, gets filtered, pressurised and delivered back to the body.
Once the organs of the body, especially the brain, liver and kidney are well perfused, we can stop the lung movement and then the heart function.
Stopping the heart is achieved by a Potassium rich cold blood solution (cardioplegia) delivered into the coronary arteries. The heart stops in diastole and is protected for variable durations as per the solution used. We are now ready to open any chamber of the heart and do the necessary corrective surgery. Depending on the complexity of the condition, we may use more than one dose of this cardio protective solution to maintain myocardial viability throughout the operation.
Once the surgery is done, we replace all the air from within the heart by letting blood fill the chambers and allow the heart to start beating. By allowing normal blood to perfuse through the coronary arteries, the heart slowly starts to beat. We wait for the heart to recover and until the heart shows that it capable of handling its full workload. The patient is then separated from the HLM and all connections are removed before closing the chest.
Most of these operations are done from the front, through the middle part of the sternum. Sometimes we may do the operation through a thoracotomy using special instruments.
Any operation that involves opening the heart is called Open Heart Surgery.