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Open Heart surgery

Valve surgery, coronary artery bypass grafting (CABG) and congenital l defect (“ birth defects”) repair are types of cardiac surgical procedures performed.

What are Heart Valves?

Valves are one-way gates in the heart that keep blood flowing between the chambers and in the same direction. There are four valves in the heart, and each one has flap-like “ doors” (called cusps or leaflets) that open and close with each heartbeat. The two most common heart valve conditions are:

  • Narrowing (” stenosis”) when a valve doesn’t open fully.
  • Leakage (“ insufficiency “ or “ regurgitation”) when the valve doesn’t close tightly.

Heart Valve surgery:- The goal of this operation is to Repair (mend the valve to help it work better) or Replace one or more malfunctioning heart valve with a new valve (Mechanical or Biological).

Types of prosthetic valves– The choice between the two types depends on certain patient characteristics and ability to take lifelong anticoagulant (blood thinner).

  1. Mechanical valves are created from man – made materials and are designed to last forever but have a higher risk of blood clot formation on them. Lifetime therapy with blood thinner is needed.
  2. Biological (tissue) valves are made of animal or human tissue. They don’t last as long as mechanical valves, degenerate (Wear out) typically lasting about 10-15 years and another open- heart operation to replace the valve may be needed. However, long-term use of an anticoagulant is often not needed.

What does Coronary artery bypass grafting (CABG) or Bypass Surgery Means?

Narrowing of the arteries that branch off from the body’s main blood supplier called the “ aorta” to feed the heart  is called coronary artery disease (CAD) CAD prevents the heart from getting the blood and oxygen it needs giving rise to chest pain or heart attack. The goal of coronary artery bypass grafting (GABG) is to improve blood flow to the heart. Bypass means and alternate route. In CABG operation healthy veins or arteries from another part of the body are taken and used to build a new road and “ bypass: the blockage in a diseased coronary artery.

How is open heart surgery performed?

  • Patient is put under general anesthesia (Completely asleep)
  • An incision is made in the sternum (breastbone) to open the chest and gain access to the heart
  • During valve surgery (& most CABG), the heart must not beat and is temporarily stopped using chemicals or cold (hypothermia).
  • When the heart is stopped, blood circulation is maintained with a heart-lung machine or a cardiopulmonary bypass machine. This functions like the heart and lungs, circulating blood and providing oxygen to the body. The body is connected to the machine through the vessels in the heart or groin
  • Unlike other kinds of heart surgery, the chambers of the heart are not opened during bypass surgery
  • Once the surgery is done, the heart and lungs take over again.

What are the risk of open heart surgery?

As no procedure can ever be truly free of risks, open heart surgery too has its sets of minor and major complications. The risks very from patient to patient as well as from one type of hear surgery to another possible complications include:

  • Bleeding at the incision site or from the area of the heart where srgery performed is common transfusion of >10 units may be necessary in 3-5%
  • Abnormal heart rhythm (up to 15-60%): in rare cases a temporary external, or permanent internal pacemaker may be necessary to correct this problem
  • An emergency surgery may be necessary to repair andy problems.
  • Heart attack (1-4)
  • Death (2-10.3%) in different types of heart surgeries
  • Stroke & deterioration in intellectual function (2-4%)
  • Wound breakdown
  • Respiratory complication
  • Kidney failure (up to 30%)
  • Infections may occur
  • Cardiac tamponade: A life- threatening condition where the pericardium, the sac surrounding the heart fills with bblood may also occur.