Closed-Heart Surgery
Clinical Trials / Research Studies
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 differentiate whether or not 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 1940's and 1950's). 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.
The terms "cardiopulmonary bypass" (the heart-lung machine) and "open-heart surgery" came to be used almost interchangeably.
Why would closed-heart surgery be recommended?
Most closed-heart operations are actually dealing with the major blood vessels arising directly from the heart such as the aorta or pulmonary arteries.
Many closed-heart procedures are not actually "corrective," but "palliative." Palliative surgeries are like temporary fixes. They are designed to deal with a specific problem caused by the heart defect to delay the need for complete repair until the child is older.
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, 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; still most infants leave the hospital on just ibuprofen and Tylenol after a closed heart procedure done through a thoracotomy.
Examples of closed-heart corrective 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.
What should be expected in terms of recovery?
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 6-8 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 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 set back. 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 6 to 8 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.
Revised 7/09
