Closed-Heart Surgery

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What are the differences between "open-" and "closed-" heart operations?

Although many operations using cardiopulmonary bypass today do not require a cardiac chamber to actually be opened (such as coronary artery bypass surgery in adults), we use the terms "open-" or "closed-" heart surgery to describe whether a procedure uses the heart-lung bypass machine support.

The terms "open-heart surgery" and "closed-heart surgery" date from the early days of cardiac surgery (the 1940s and 1950s). The earliest cardiac operations were all for congenital heart disorders, and heart-lung bypass machine support was required to allow surgeons to open the heart to work on its internal deformities.

Closed-heart surgery does not use the cardiopulmonary bypass machine.

Most closed-heart operations are actually dealing with the major blood vessels coming directly from the heart such as the aorta or pulmonary arteries.

Often closed-heart procedures are done using a thoracotomy incision (from the side, between the ribs), though some are best done from the front (sternotomy incision). With a thoracotomy incision, the entry into the chest is in between the ribs. Because there are nerves running along these ribs and more muscle is divided, such an incision can lead to irritation of the nerves and cause pain. For that reason, a thoracotomy incision is more painful than a sternotomy incision. However, most infants leave the hospital on just ibuprofen and Tylenol after a thoracotomy.

Examples of closed-heart operations include repair of an aortic coarctation, division of a vascular ring, ligation or division of a patent ductus arteriosus, and repair of some pulmonary artery problems. 

In general, problems that can be corrected without the use of heart-lung bypass support may involve a shorter hospitalization and recovery time. Clearly, the length of recovery will depend partly on potential complications that may arise and partly on the health of the patient before surgery. A six- to eight-week recovery period is not uncommon. Nutrition is a critical component of this recovery period as well.

After surgery, most infants can be fed enterally (in the gut) after a day or two. But even when the child is not being fed formula or milk, nutrition is being delivered in an intravenous (IV) form. In more limited situations, simple IV fluids containing sugar-water will suffice. At other times, the IV nutrition can replace all the sugars, proteins and fats that the patient needs. That complex form of IV nutrition is called TPN (total parenteral nutrition).

Some babies can take a while to recover after surgery until they can be fed by mouth. This partly depends on how the child was feeding before surgery and whether there are any medical reasons affecting the ability of the gut to work. It is not unusual for even some kids who have been feeding normally before surgery to have a setback. They might require some sort of extra nutritional support. Nutrition is critical in the healing process. At times we place tubes, called feeding tubes, into the stomach (through the mouth or the nose) to make sure your child receives adequate calories to heal properly.

Often children are discharged home on some medications. Typically these include diuretics (water pills) and sometimes other heart medications. The dosage of these medications will be adjusted when you follow-up with your surgeon and cardiologist. Most patients are seen within a week to two weeks after discharge. We will provide you with a set of instructions before your discharge to guide you on your child's medicines and postoperative care. We will teach you how to assess the wounds and what problems to look for.

You should use common sense when your child is discharged home. Sick people should not visit for the first few days. Good and frequent hand washing is critical, especially before examining the wound. The wound should be kept clean and dry for the first couple of weeks. Generally we recommend avoiding immunizations within the first six to eight weeks after surgery.

Finally, as with any surgical incision, a rest period helps ensure good wound healing. There will be a period of time when activity will be somewhat restricted to help with healing.


Last Updated 11/2012