About open heart surgery

Sunday, June 28, 2009

The term open-heart surgery generally refers to an operation in which the heart-lung machine is used to support the patient’s circulation while the surgeon opens and makes changes to the heart. The definition, however, is somewhat fluid. The term may also be used to describe bypass surgery, which is used to treat coronary artery disease (CAD) – a chronic disease in which there is a “hardening” (atherosclerosis) of the arteries on the surface of the heart, resulting in an obstruction of the flow of blood to the heart muscle. During bypass surgery, the surgeon places a conduit vessel to the blocked coronary arteries, which lie on the surface of the heart, and the heart is not opened. Open-heart surgery has also been used to describe procedures that do not involve the use of the heart-lung machine (e.g., off pump bypass surgery).

According to the American Heart Association (AHA), approximately 666,000 open-heart surgeries were performed in 2003. Following is the breakdown of that statistic:

• Coronary artery bypass graft (CABG): 467,000. CABG is a treatment for CAD, in which the arteries become clogged with built-up plaque, obstructing blood flow. In this procedure, the surgeon takes a segment of a healthy blood vessel from another part of the body and uses it to create a detour around the blocked portion of a blood vessel in the heart. A patient may require one, two, three or more bypasses depending on how many coronary arteries (and their main branches) are blocked.
  
  
• Heart valve procedures: 95,000. Depending on the goals of therapy, heart valve repair may be performed either as a catheter-based procedure or a surgery that corrects a defective heart valve. Heart valve replacement is an open-heart surgery in which a defective valve that cannot be repaired is replaced with either a biological or a mechanical valve. The types of valvular heart disease most often addressed by heart valve procedures are narrowed valves (stenosis) or improperly closing valves that allow blood to leak back in the wrong direction (regurgitation). Valvular atresia is another type of valvular heart disease, in which a valve is totally closed at birth. Neither heart valve repair nor replacement is a treatment for this condition. Instead, other surgeries may be necessary
  
  
• Heart transplants: In 2004, 2,016 heart transplants were performed. A heart transplant is an open-heart surgery in which a severely diseased or damaged heart is replaced with a healthy heart from a recently deceased organ donor. Although this surgery is effective in up to 90 percent of patients, there is a serious shortage of donor hearts. Researchers are working to develop equipment to improve the comfort of heart patients waiting for a donor organ and, ideally, to develop a total artificial heart that could permanently solve the shortage problem.
  
  

• Other: Almost 100,000. These “other” open-heart surgeries include procedures such as:

  • Surgery for treatment of heart failure (including the SVR procedure)
    
    
  • Surgery for treatment of atrial fibrillation
    
    
  • Removal of a tumor in the heart
    
    
  • Repair of a congenital heart disease (a heart defect that is present since birth)
    
    
  • Treatment of cardiac trauma (e.g., from an injury or a knife/gunshot wound)

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