Heart Surgery , or cardiovascular surgery , is an operation on the heart or large vessels performed by a cardiac surgeon. It is often used to treat complications of ischemic heart disease (eg, by coronary artery grafting bypass); to improve congenital heart disease; or to treat heart valve disease from a variety of causes, including endocarditis, rheumatic heart disease, and atherosclerosis. It also includes heart transplantation.
Video Cardiac surgery
History
19th century
The earliest surgery on the pericardium (sac surrounding the heart) occurred in the 19th century and was done by Francisco Romero (1801), Dominique Jean Larrey (1810), Henry Dalton (1891), and Daniel Hale Williams (1893). The first operation on the heart itself was done by Axel Cappelen on 4 September 1895 at Rikshospitalet in Kristiania, now Oslo. Cappelen binds a bleeding coronary artery to a 24-year-old man who is stabbed in the left armpit and very surprised when it arrives. Access is through the left thoracotomy. The patient woke up and looked fine for 24 hours, but became ill with fever and died three days after the surgery of mediastinitis.
The first successful surgery on the heart, without any complications, was done by Dr. Ludwig Rehn from Frankfurt, Germany, who repaired a stab wound into the right ventricle on September 7, 1896.
20th century
Surgery in large blood vessels (eg, repair of aortic coarctation, Blalock-Thomas-Taussig shunt formation, patent ductal arteriosus closure) became common after the turn of the century. However, surgery on the heart valve was not known until, in 1925, Henry Souttar operated successfully in young women with mitral valve stenosis. He makes an opening in the additional portion of the left atrium and inserts a finger to feel and explore the damaged mitral valve. The patient survived for several years, but Souttar's colleagues considered the procedure unjustifiable, and he could not continue.
Cardiac surgery changed significantly after World War II. In 1947, Thomas Holmes Sellors (1902-1987) of Middlesex Hospital in London operated the Tetralogy of Fallot patients with pulmonary stenosis and successfully divided the pulmonary valve stenosis. In 1948, Russell Brock, probably not knowing the work of the Seller, used a specially designed dilator in three cases of pulmonary stenosis. Later that year, he designed a blow to reconstruct stenosed infundibulum, which is often associated with Tetralogy of Fallot. Many thousands of these "blind" operations were performed until the introduction of cardiopulmonary bypass made immediate operation on possible valves.
Also in 1948, four surgeons performed successful surgery for mitral valve stenosis due to rheumatic fever. Horace Smithy (1914-1948) from Charlotte used valvulotome to partially remove the patient's mitral valve, while three other doctors - Charles Bailey (1910-1993) of Hahnemann University Hospital in Philadelphia; Dwight Harken in Boston; and Russell Brock from Guy's Hospital in London - adopted the Souttar method. The four men began their work independently of each other within a few months. This time, Souttar's technique was widely adopted, with some modifications.
Correction of the first successful intracardiac of congenital heart defect using hypothermia is done by Drs. C. Walton Lillehei and F. John Lewis at the University of Minnesota on 2 September 1952. In 1953, Alexander Alexandrovich Vishnevsky performed the first heart surgery under local anesthesia. In 1956, Dr. John Carter Callaghan performed the first documented open heart surgery in Canada.
Alfred Blalock, Helen Taussig and Vivien Thomas performed the first successful pediatric heart surgery at Johns Hopkins Hospital on November 29, 1944, the total improvement of Tetralogy of Fallot in a one-year-old girl.
Maps Cardiac surgery
Type of heart operation
Open heart operation
Open heart surgery is any type of surgery in which a surgeon makes a large incision (cut) across the chest to open the ribs and operate on the heart. "Open" refers to the chest, not the heart. Depending on the type of surgery, the surgeon may also open the heart.
Dr Wilfred G. Bigelow of the University of Toronto found that procedures involving the heart opening of patients can be performed better in a non-bloody and immobile environment. Therefore, during such surgery, the heart is temporarily stopped, and the patient is placed on a cardiopulmonary bypass, which means the machine pumps their blood and oxygen. Since the machine can not function in the same way as the heart, the surgeon tries to minimize the time spent by the patient.
Cardiopulmonary bypass is developed after surgeons are aware of the limitations of hypothermia in heart surgery: Complex intracardiac repair takes time, and patients need blood flow to the body (especially to the brain), as well as heart and lung function. In 1953, Dr. John Heysham Gibbon of Jefferson Medical School in Philadelphia reported the successful first use of extracorporeal circulation by using oxygenator, but he abandoned the method after subsequent failure. In 1954, Dr. Lillehei conducts a series of successful operations with controlled circulation techniques, in which the mother or father of the patient is used as a "heart-lung machine". Dr. John W. Kirklin at Mayo Clinic is the first to use Gibbon-type oxygenator.
Nazih Zuhdi undertook a total open-heart operation of intentional hemodilution on Terry Gene Nix, age 7, on 25 February 1960 at Mercy Hospital in Oklahoma City. The operation was a success; However, Nix died three years later. In March 1961, Zuhdi, Carey, and Greer performed an open heart surgery on a child, aged 1 / 2 , using a total intentional hemodilution machine.
Modern heart-surgery
In the early 1990s, surgeons began to bypass the coronary artery off-pump, performed without a cardiopulmonary bypass. In this operation, the heart continues to beat during surgery, but is stabilized to provide an almost permanent work area in which to connect the vessels that pass through the blockage. The most commonly used vessel is the saphenous vein. This vein is harvested using a technique known as endoscopic vessel harvesting (EVH).
Heart transplant
In 1945, Soviet pathologist Nikolai Sinitsyn successfully transplanted the heart from one frog to another and from one dog to another.
Norman Shumway is widely regarded as the father of human heart transplants, although the world's first adult heart transplant was performed by a South African heart surgeon, Christiaan Barnard, using techniques developed by Shumway and Richard Lower. Barnard performed the first transplant on Louis Washkansky on December 3, 1967 at Groote Schuur Hospital in Cape Town. Adrian Kantrowitz performed the first pediatric heart transplant on December 6, 1967 at Maimonides Hospital (now Maimonides Medical Center) in Brooklyn, New York, almost three days later. Shumway performed the first adult heart transplant in the United States on January 6, 1968 at Stanford University Hospital.
Coronary artery bypass cut
Coronary artery bypass cutting, also called revascularization, is a common surgical procedure for creating alternative pathways for sending blood supply to the heart and body, with the aim of preventing clot formation. This can be done in many ways, and the arteries used can be taken from several areas of the body. Arteries are usually taken from the chest, arms, or wrists and then attached to the coronary artery, reducing the pressure and limiting the clotting factor in the heart area.
This procedure is usually done because of coronary artery disease (CAD), where substances such as plaque accumulate in the coronary arteries, the main pathway that carries oxygen-rich blood to the heart. This can cause blockage and/or rupture, which can lead to a heart attack.
Minimally invasive surgery
As an alternative to open heart surgery, which involves a five to eight inch incision in the chest wall, a surgeon can perform an endoscopic procedure by making a very small incision in which the camera and special tools are inserted.
In heart surgery with the help of robots, machines controlled by a cardiac surgeon are used to perform the procedure. The main advantage to this is the required incision size: three small holes in exchange for a large incision for the surgeon's hand.
Post-surgical procedure
As with any surgical procedure, heart surgery requires postoperative precautions to avoid complications. Treatment of the incision is necessary to avoid infection and minimize scarring. Swelling and loss of appetite are common.
Recovery from open heart surgery begins with about 48 hours in the intensive care unit, where the heart rate, blood pressure, and oxygen levels are closely monitored. The chest tube is inserted to drain the blood to the heart and lungs. After discharge from the hospital, compression socks may be recommended to regulate blood flow.
Risk
The progress of cardiac surgery and cardiopulmonary bypass techniques has greatly reduced the mortality rate of this procedure. For example, improvements in congenital heart defects are currently estimated to have mortality rates of 4-6%.
The main concern for heart surgery is nerve damage. Stroke occurs in 2-3% of all people who undergo heart surgery, and this figure is higher in patients with other risk factors for stroke. The more subtle complications associated with cardiopulmonary bypass are postperfusion syndrome, sometimes called a "pumphead". Neurocognitive symptoms Postperfusion syndrome was initially considered permanent, but it proved temporary, without permanent neurological disorders.
To assess the performance of individual surgical and surgeon units, a popular risk model has been created called EuroSCORE. It takes a number of health factors from a patient and, using the calculated logistic regression coefficients, tries to gauge the probability that they will survive to be discarded. In the United Kingdom, EuroSCORE is used to provide details of all cardiothoracic surgical centers and to indicate whether individual units and surgeons are conducted within an acceptable range. The results are available on the Quality Care Commission website.
Another important source of complications is neuropsychological and psychopathological changes after open heart surgery. One example is the Skumin syndrome, described by Victor Skumin in 1978, which is a "cardioprosthetic psychopathological syndrome" associated with mechanical heart valve implants and characterized by irrational fears, anxiety, depression, sleep disturbances, and weakness.
Risk reduction
A systematic review of Cochrane 2012 found evidence that preoperative physical therapy reduces postoperative pulmonary complications, such as pneumonia and atelectasis, in patients undergoing elective heart surgery. In addition, the researchers found that preoperative physical therapy reduced hospital stay for more than three days on average.
The 2013 Cochrane Review shows that prevention both pharmacologically and nonpharmacologically reduces the risk of atrial fibrillation after surgery and reduces hospital stay. There is no difference in the mortality that can be shown.
There is evidence that quitting smoking at least four weeks before surgery can reduce the risk of postoperative complications.
See also
- Cardioplegia
- Eagle Score
- Chest tube
References
Further reading
- Cohn, Lawrence H.; Edmunds, Jr., L. Henry, eds. (2003). Heart surgery in adults . New York: McGraw-Hill, Medical Pub. Division. ISBN: 0-07-139129-0. Archived from the original in 2016-06-14.
External links
- An overview at the American Heart Association
- "Corrective Surgical Procedure of Congenital Heart Disease", a list of surgical procedures at learningradiology.com
- "Heart Surgery in Adults", Specialist at Narayahahealth.org
- What to expect before, during, and after cardiac surgery from Children's Hospital and Regional Medical Center (Seattle)
- MedlinePlus Encyclopedia Minimally invasive heart surgery
Source of the article : Wikipedia
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