History

• During World War II, Dr. Dwight Harken, a U.S. Army surgeon, was one of the first doctors to gain access to the heart. Starting with many unsuccessful operations on animals, Harken finally succeeding in performing heart surgery on human soldiers. In 1948, Harken and a surgeon in Philadelphia, Dr. Charles Bailey, independently began performing a type of closed-heart surgery on patients suffering from mitral stenosis. Although most of the initial recipients of this surgery died, the procedure became considerably safer once the technique was improved. This surgery also opened the door for open-heart surgery, as doctors began looking for a way to see and operate inside the heart to correct more complex heart conditions. The primary obstacles in performing open-heart surgery were preventing patients from bleeding to death and ensuring oxygenation to the brain and other vital organs was maintained. An apparent answer to these obstacles was hypothermia. A Canadian surgeon named Dr. Bill Bigelow first presented this idea.
  Then, on September 2, 1952, Dr. Walton Lillehei and Dr. john Lewis of the University of Minnesota attempted open-heart surgery using hypothermia on a 5-year-old girl. The operation was successful, and the "hypothermic approach" became common practice when treating small heart defects. However, this approach only allowed approximately 10 minutes of surgical time, which was not adequate for more complex procedures. In 1958, the heart-lung machine was developed. This invention enabled surgeons to repair more complex heart damage and defects. Dr. Dennis Melrose soon pioneered an injection that caused the heart to stop beating during open-heart surgery, dramatically increasing the success rate of cardiac surgery and paving the way for even further medical advancements in cardiac medicine. Since the 1990s, cardiac surgeons have increasingly performing off-pump bypass surgeries, or bypass surgeries without the use of a heart-lung machine. This type of surgery is proving to be safer and results in fewer serious complications than traditional bypass surgeries.
  
  

Significance

• Open-heart surgery is one of the most commonly performed operations each year in the United States, and boasts a high survival rate considering the complexity of the procedure. The surgery has come a long way over the years, and is now used to treat many conditions that were once strictly fatal. Performed by a cardiac surgeon, open-heart surgery repairs complications of ischemic heart disease, corrects congenital defects, treats valvular heart disease, and makes heart transplantation a possibility. Without this advancement in medicine, many people with heart conditions would not have a second chance at life.
  
  

Function

• Open-heart surgery is a fairly broad term used to describe any cardiac surgery involving opening of the chest cavity. The term typically refers to any operation in which a heart-lung machine is used during surgery to support circulation while changes are made to the heart. A heart-lung machine, also known as cardiopulmonary bypass, provides oxygen-rich blood to vital organs, including the brain. The bypass machine also administers anesthesia to the patient and removes carbon dioxide from the blood. The term open-heart surgery is also used to describe off pump bypass surgeries, during which a surgeon opens the chest and works on outer areas of the heart and the cardiac arteries. This type of surgery is less invasive and does not involving opening of the heart itself. Open-heart surgery is used to perform surgery on the heart muscle, the cardiac valves, surrounding arteries and other cardiac structures.
  
  

Types

• There are several types of open-heart surgeries and which kind a patient receives depends on the heart condition being treated and the patient's overall health. Most types of open-heart surgery are performed while the patient's blood is diverted through a heart-lung machine, but some forms of minimally invasive heart surgery are also available. Robotic-assisted heart surgery is one type of minimally invasive heart surgery that is used as an alternative to open-heart surgery requiring the use of a heart-lung machine. All open-heart surgeries involve an incision in the middle of the chest and exposure of the heart. According to the American Heart Association, the most commonly performed open-heart surgeries in the United States are valve replacements, bypass procedures, and heart transplants. Coronary artery bypass graft, or CABG, involves taking a portion of a healthy blood vessel from another site in the body and using it to create a new route around a blocked blood vessel in the heart. Common reasons for open-heart surgery include treatment of heart failure, treatment of atrial fibrillation, tumor removal, repairs of congenital defects, and treatment of cardiac traumas.
  
  

Warning

• Although open-heart surgery is a relatively common procedure with a high survival rate, the surgery does carry a risk of complications and mortality. Older people and those with other serious medical conditions are more prone to developing complications, and about 5 to 10 percent of all open-heart surgery patients experience strokes or transient ischemic attacks during or following open-heart surgery. The most significant risk of open-heart surgery is neurological damage, and cardiopulmonary bypass is associated with a group of neurocognitive deficits known as postperfusion syndrome. While the symptoms of postperfusion syndrome were once believed to be permanent, in most cases the symptoms are transient and no permanent neurological impairment is usually experienced. Other complications of open-heart surgery include infection and bleeding.