Open-heart vs Closed-heart Surgery

Heart surgery is performed to correct a defect in the heart and while most major heart defects can be treated with open-heart surgery, minor ones can be operated on with closed-heart surgery.

The majority of closed-heart surgeries tend to involve the major blood vessels that carry blood to the heart and other parts of the body. Examples of these procedures include the insertion of a Blalock-Taussig-Thomas shunt to create a pathway for blood to reach the lungs or pulmonary artery bands to correct congenital cardiac defects. Closed-heart surgery is typically performed on individuals with minor heart defects and in most cases, these operations are reserved for children, or paediatric patients.

Closed heart surgery in adults include pericardiectomy (surgical removal of a constricting heart sac and off-pump coronary artery bypass grafting (CABG), among others.

The one major difference between open- and closed-heart surgery is that closed-heart surgery does not require the support of a heart-lung bypass machine during the procedure, which means closed-heart surgery is commonly performed on a beating heart, whereas an open-heart surgery is performed on a non-beating heart, but can also be performed on a beating heart.

Open-heart surgery

As a brief overview of this “vital” organ, the heart is a muscle that pumps five to six litres of blood per minute in adults. If this process is hindered, all the other organs in the body would be depleted of oxygen and the person would not survive. Open-heart surgery is any type of surgery where the chest is opened up and the procedure is performed on the muscles, valves, or arteries of the heart. But to be able to operate on the structures inside it, the heart has to be stopped temporarily. To do this, a patient is put on a temporary artificial heart lung machine called a cardiopulmonary bypass machine so that the functions of the heart are taken over by the machine to divert blood from the heart into it. This allows the heart to be stopped, emptying it of blood and thus allowing it to be cut open to have the surgical procedure performed.

Why and when is open-heart surgery required?

Open-heart surgery may be done to perform a coronary artery bypass graft (CABG). A CABG is a procedure used to treat coronary heart disease by diverting blood around narrowed or clogged major arteries to improve blood flow and oxygen supply to the heart. CABG can also be done on a beating heart without the use of a heart-lung machine. We call this approach “off-pump CABG”, which is becoming popular for selected patients and routine in many heart care centres around the world.

Coronary heart disease refers to the blood vessels that provide blood and oxygen to the heart muscle becoming narrow and hard, often called “hardening of the arteries.” This hardening develops when fatty material forms a plaque on the walls of the arteries, narrowing them, which makes it difficult for blood to get through. When this happens it can lead to a heart attack.

Other reasons and conditions for open-heart surgery:

• repair or replace heart valves
• repair damage or defects in the heart
• implant medical devices that help the heart perform properly
• heart transplantation

Closed-heart surgery

Closed-heart surgery generally means that the patient will not need to be placed on a heart-lung bypass machine and the heart itself will not need to be opened up. This may also reduce the possibility of complications compared to open-heart surgery. In certain cases, however, closed-heart surgery may be the first stage of repair for a defect that will require additional surgeries.

This type of heart surgery may involve entry into the chest cavity from the front, known as sternotomy, or from the side between the ribs (thoracotomy). Many forms of closed-heart surgery revolve around the major arteries that carry blood to and from the heart rather than with the heart chambers themselves. Some examples include aortic coarctation (a narrowing of the aorta that leads away from the heart) repair, “shunt” operations to increase blood flow to the lungs, and pulmonary artery repair.

Some closed heart surgeries are palliative or temporary, rather than corrective, to deal with specific problems caused by a defect rather than correction of the defect itself. Palliative surgery is often performed on young children who may require multiple cardiac operations as they grow older.

Conclusion

Open-heart surgery refers to any type of operation in which the chest is cut open and surgery is performed on the muscles, valves, or arteries within the heart. This type of surgery requires the heart to be stopped and emptied of blood using a heart-lung bypass machine. In closed-heart surgery, it is still necessary to open the chest but not make use of a heart-lung bypass machine. Most closed-heart procedures deal with major blood vessels, such as the aorta or pulmonary arteries outside of the heart muscle.

For more information please contact William Manyilirah, Consultant Cardiovascular and Thoracic Surgeon at Bokamoso Private Hospital.
Tel: +267 369 4479 / +267 715 21215
Email: [email protected]

The Lenmed Group is a world-class group of Private Hospitals that brings quality healthcare to communities across Southern Africa.