There are two types of cardiac surgery: open heart surgery and closed heart surgery. The heart surgery may be considered to be minimally invasive surgery if the size of the incision is small.
There is also a very specialized type of surgery performed before a baby is born. This is called fetal surgery. The majority of heart surgery is open heart.
All of these surgeries involve the use of anaesthesia, and all are performed by surgeons. These surgeries are intended to correct heart defects. Some children may undergo staged repair, which means they will need to have a number of surgeries to correct or treat, step by step, a given defect. This may involve a combination of open, closed, and minimally invasive surgery.
Palliative surgery, which can be any of the above-mentioned types of surgery, refers to procedures that do not correct a defect but are intended to minimize the symptoms associated with it.
How safe is heart surgery?
There are risks associated with any type of surgery, most commonly bleeding and infection. Risks also depend on the age of the child, the type of condition they have, and the severity of the condition.
Open heart surgery
What is open heart surgery?
In open heart surgery, the chest is opened up by way of a sternotomy. This is a cut into the sternum or breast bone designed to fully expose the heart. For a defect to be repaired, the heart has to be completely still. To do this, the heart is stopped temporarily by cooling it down (circulatory arrest) and by injecting a special substance called cardioplegia into it. Once the heart has stopped, it can no longer pump blood to the body, so a special machine takes over this role: the heart-lung bypass machine. This is known as cardiopulmonary bypass (CPB).
Open heart surgery is done to correct problems like a ventricular septal defect, transposition of the great arteries, and tetralogy of Fallot. The surgery is very successful with fairly straightforward defects; more risks are associated with more complex conditions.
What are the neurological risks of open heart surgery?
Time spent on the heart-lung bypass machine brings a risk to the child’s brain. There have been improvements since the original development of open heart surgery, and the incidence of serious neurological complications continues to decline as years go by. It is generally thought that serious acute complications affecting the brain occur in less than 5% of paediatric open heart operations. Seizures, which can be a sign of brain injury, are considered to be the most common complication.
Closed heart surgery
Closed heart surgery often deals with the major blood vessels attached to the heart. The heart does not need to be completely exposed, as in open heart surgery, so cooling and cardiopulmonary bypass are generally not needed. The need for CPB is the main difference between open and closed heart surgery. Because there is no need for CPB, the time spent in hospital and time to recover may be shorter than with open heart procedures.
Closed heart surgery can be used to correct patent ductus arteriosus and coarctation of the aorta. It can also be used, for example, to place a Blalock-Thomas-Taussig shunt (BTT shunt) to improve blood flow to the lungs. The heart is accessed through a sternotomy or thoracotomy incision (which is made between the ribs, on the side of the body). A number of closed heart operations are palliative.
Minimally invasive surgery
In minimally invasive surgery, the surgeon does not need to completely open up the child's heart and may not need to use cardiopulmonary bypass, depending on the heart defect being repaired. A mini-sternotomy (a small cut into the sternum or breast bone) is made and tiny instruments and telescopic devices are inserted into the body so the surgeon can see the parts of the heart in order to operate.
This type of surgery, which is also known as thorascopic surgery, is usually used to correct fairly straightforward defects, like patent ductus arteriosus (a closed heart procedure) or atrial septal defect (an open heart procedure). Generally, children who undergo minimally invasive surgery spend less time recovering in hospital and recover slightly more quickly.