Heart surgery comes full circle

Created date

January 29th, 2016

heart surgery

In the history of medicine, heart surgery is a very young specialty, having begun about 120 years ago. Prior to that, the heart was considered too delicate to even consider operating on. 

Surgery on a ‘closed’ heart

What is generally considered the first heart surgery was a “closed” procedure, which has since come to mean that the chest and heart don’t have to be opened significantly in order to operate. In the late 1890s, a German surgeon by the name of Ludwig Rehn repaired a stab wound to a beating heart by using stiches. After that success, other successful closed procedures typically involved major blood vessels or primitive heart valve repairs.

Today, closed heart surgery means the heart doesn’t need to be stopped, nor does a heart-lung bypass machine need to be used.   

Exposing the heart

While there were scant few successful surgeries involving opening the chest and heart before 1953, the medical community considers May 6 of that year the true dawn of open heart surgery. On that day, Dr. John Gibbon used a heart-lung (cardiopulmonary) bypass machine for 26 minutes to successfully repair a structural defect in an 18-year-old woman. She recovered well and went home 13 days later. 

Prior to that achievement, Gibbon had worked for years to develop the early version of the cardiopulmonary bypass machine, which essentially takes over the functions of the heart and lungs during an operation. The modern version of this machine has made it possible for doctors to correct congenital defects, valve disorders, aneurysms, and, of course, coronary atherosclerosis.

The bypass machine also opened the door to the possibility of heart transplants. In 1967, Dr. Christiaan Barnard of South Africa performed the first heart transplant by replacing a middle-aged man’s heart with that of a 23-year-old woman. That patient died after 18 days. But Barnard’s next transplant patient lived for 18 months, and that success kicked off a flurry of these surgeries. Unfortunately, by 1971, 146 of the first 170 heart transplant patients had died because of either rejection of the new organ or infections because of too-powerful anti-rejection drugs. Fortunately, an anti-rejection drug called cyclosporine was discovered, which helped all organ-transplant patients live much longer.

Today’s closed surgeries

Although open heart surgery has helped millions of patients since 1953, it remains a high-risk procedure that can have significant complications. In addition, many patients with heart disease were not candidates for the procedure because of other health problems. So surgeons are going back to the old days of closed heart techniques—with modern updates. “Many types of heart disease can now be treated using minimally invasive surgery, which allows more patients to have better outcomes,” says Ali Tabrizchi, D.O., board-certified clinical interventional cardiologist at LifeBridge Health Cardiovascular Institute in Baltimore, Md.

An example is coronary artery bypass graft (CABG) surgery, which is used to restore blood flow for many patients with coronary atherosclerosis, the number one type of heart disease in the U.S. Traditional CABG is an open procedure involving a 10- to 12-inch incision, use of a bypass machine, and a 5- to 10-day hospital stay. Now, thanks to medical advances and modern technology, a minimally invasive version of CABG is available. This version involves a 3- to 5-inch incision and a 2- to 3-day hospital stay. Sometimes the bypass machine is not necessary at all, which makes this procedure almost a closed surgery.

Diseases of the heart valves are considered by some experts to be the next epidemic of heart disease because of the overall rise in life expectancy and the aging of the population. In the U.S., about 13% of people age 75 and up have some sort of heart valve disease, according to a 2011 research study. Common forms of valve disease in seniors are regurgitation, when the valves do not operate properly and allow blood to flow backward into the heart chamber, and stenosis, when the valve stiffens because of deposits or narrows, which traps blood in the heart chamber. 

Medicines and lifestyle changes can help some people, but others need surgery to repair or replace the diseased valve. This surgery used to always involve an open heart, but now there are other options for some patients. One of the newest valve surgeries is called transcatheter aortic valve replacement (TAVR). “In TAVR, a catheter is used to replace the diseased valve,” Tabrizchi explains. “This catheter can be inserted into a blood vessel in your leg, chest, or neck.”

TAVR is a true closed procedure and is performed while the heart is still beating. “Patients have a lower risk of complications such as infection, and they tend to have shorter hospital stays,” Tabrizchi says.  

Making the most of your heart surgery

Early heart surgery patients knew little about heart health. Heart surgery patients in the 1960s, for example, may not have been scolded by their doctors for smoking.

But today, heart patients know a lot more. “Heart-healthy behaviors are mostly common sense,” says Jennifer Tam, M.D., medical director at Linden Ponds, an Erickson Living community in Hingham, Mass. “Your diet should include vegetables, fruits, whole grains, moderate amounts of lean meats, and healthy fats. Maintain a healthy weight and find ways to reduce stress in your life. Most of all, don’t smoke.”

As always, exercise is crucial, but follow your cardiologist’s advice about how much and what type of exercises are safe after surgery. “Some people need cardiac rehabilitation,” Tam says. “You’ll need to work back up to your post-surgery level of activity or learn how to start a new regimen.”