For a variety of reasons, surgery may be required on the heart or inside of the heart. This is commonly called Open-Heart Surgery, or Cardiac Surgery. Common reasons for cardiac surgery may include Coronary Artery Bypass Grafting (CABG), valve surgery or the repair of congenital malformations, (birth defects.) Although there are a variety of types of cardiac surgeries there a few things that are common to all procedures.
Sternotomy
Cardiac surgery has come a long way since the first heart operations were performed in World War II. While it is possible to use less invasive surgical techniques, many open heart surgeries require gaining access to the heart by opening up the chest at the breastbone. There are three basic incisions used to gain access to the heart. These are full sternotomy, partial sternotomy and thorocotomy. The type of incision used depends on the procedure and the general health of the patient. Your doctor will discuss with you which type he will plan to use prior to surgery. The most common incision is a full sternotomy. During a full sternotomy the surgeon makes an incision down the center of the chest. The breastbone is divided and held open with a device called a retractor. The surgeon has now exposed the beating heart and has good access to work on repairing the damage.
Sternotomy Precautions Necessary For Proper Healing
After the surgery the doctor will reattach the breastbone with stainless steel wire and suture (sew together) the skin. The incision is covered with sterile dressings. It will be important to keep the incision from getting infected or from coming apart. In order to heal propoerly, there are a few precautions necessary for any post sternotomy patient. First of all, patients must not lift, push or pull any objects over 10 pounds, this includes not lifting your own weight. Patients will be instructed on how to support their chest when they cough. This procedure is called splinting and is accomplished by gently hugging a pillow while coughing. Patients must also be careful when getting in and out of bed. Rolling down to bed on one's side instead of lying directly back will put less stress on the chest incision. Patients need to be careful when walking to avoid falling forward, as the natural instinct is to put one's arms out to catch oneself. This could damage the healing breastbone. The breastbone is usually healed solidly after 6 weeks. At the post-operative visit with the surgeon, he will check the breastbone and give further instructions about sternotomy care.
Care of the Lungs
After any surgery involving anesthesia, good care of the lungs is important in order to avoid pneumonia. But, after heart surgery, it is especially important. This is because the surgery itself sometimes involves the lungs or the sacs around the lungs. Also it is important because if a patient is on the Heart-Lung Machine (see below), the lungs are deflated during the surgery. This means that they tend to create more mucous and that the small air sacs on the outside of the lungs can be closed more easily. What is necessary in recovery is coughing and deep breathing. Patients are asked to use an incentive spirometer, or a gadget that encourages them to take deep breaths. They will also be instructed on coughing with the support of a pillow over their breastbone. This helps open the small airsacs, and helps to remove the extra mucous. If the airsacs stay closed and mucous builds up, pneumonia can easily develop. With good coughing and deep breathing, a patient gets on the road to recovery quickly.
Cardiopulmonary Bypass Machine
During an open-heart surgery procedure it is often necessary to stop the heart from beating. Although the heart is not pumping, the rest of the cells in the body still need oxygen rich blood. A cardiopulmonary bypass machine, often called a heart lung machine is used to circulate the blood while the heart is being repaired. This machine is frequently used in coronary artery bypass surgery and in valve surgeries. A heart lung machine's primary function is to warm, oxygenate and circulate the blood. After the work on the heart is complete, the patient's own heart starts beating again, and the patient is taken off of the heart-lung machine.
|