View source for Cardiac surgery

{{Short description|Type of surgery performed on the heart}}
{{Use dmy dates|date=June 2021}}
{{more citations needed|date=November 2014}}
{{Infobox medical intervention
 | Name = Cardiac surgery
 | Image = Coronary artery bypass surgery Image 657B-PH.jpg
 | Caption = Two cardiac surgeons performing [[coronary artery bypass surgery]]. Note the use of a steel [[retractor (medical)|retractor]] to forcefully maintain the exposure of the heart.
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 | ICD9 = {{ICD9proc|35}}-{{ICD9proc|37}}
 | MeshID = D006348
 | OPS301 = {{OPS301|5-35...5-37}}
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{{Infobox medical intervention (new)
| name          = Cardiac surgery
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| specialty     = [[Cardiothoracic surgery]]<!-- from Wikidata, can be overwritten -->
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'''Cardiac surgery''', or '''cardiovascular surgery''', is a  [[surgery]] on the [[heart]] or [[great vessels]] performed by cardiac [[surgeon]]s. It is often used to treat complications of [[ischemic heart disease]] (for example, with [[coronary artery bypass grafting]]); to correct [[congenital heart disease]]; or to treat [[valvular heart disease]] from various causes, including [[endocarditis]], [[Rheumatic fever|rheumatic heart disease]],<ref name=Lee2012>{{cite journal|last1=Lee|first1=KY|last2=Rhim|first2=JW|last3=Kang|first3=JH|title=Kawasaki disease: laboratory findings and an immunopathogenesis on the premise of a "protein homeostasis system".|journal=Yonsei Medical Journal|date=March 2012|volume=53|issue=2|pages=262–75|pmid=22318812|doi=10.3349/ymj.2012.53.2.262|pmc=3282974}}</ref> and [[atherosclerosis]].<ref>{{Cite web|title=Arteriosclerosis / atherosclerosis - Symptoms and causes|url=https://www.mayoclinic.org/diseases-conditions/arteriosclerosis-atherosclerosis/symptoms-causes/syc-20350569|access-date=2021-05-06|website=Mayo Clinic|language=en}}</ref> It also includes [[heart transplantation]].<ref name="kilic2014">{{cite journal | vauthors = Kilic A, Emani S, Sai-Sudhakar CB, Higgins RS, Whitson BA|display-authors=etal | year = 2014 | title = Donor selection in heart transplantation | journal = Journal of Thoracic Disease | volume = 6 | issue = 8 | pages = 1097–1104 | doi = 10.3978/j.issn.2072-1439.2014.03.23 | pmid=25132976 | pmc=4133543}}</ref>

==History==

=== 19th century ===
The earliest operations on the [[pericardium]] (the sac that surrounds the heart) took place in the 19th century and were performed by [[Francisco Romero (surgeon)|Francisco Romero]] (1801) in the city of [[Almería]] (Spain),<ref>{{cite journal |author=Aris A. |title=Francisco Romero the first heart surgeon |journal=Ann. Thorac. Surg. |volume=64 |issue=3 |pages=870–871 |date=September 1997 |pmid=9307502 |doi=10.1016/S0003-4975(97)00760-1}}</ref> [[Dominique Jean Larrey]] (1810), [[Henry Dalton]] (1891), and [[Daniel Hale Williams]] (1893).<ref>{{cite web |title=Pioneers in Academic Surgery |publisher=U.S. National Library of Medicine |url=https://www.nlm.nih.gov/exhibition/aframsurgeons/pioneers.html}}</ref> The first surgery on the heart itself was performed by [[Axel Cappelen]] on 4 September 1895 at [[Rikshospitalet]] in Kristiania, now [[Oslo]]. Cappelen [[ligature (medicine)|ligated]] a bleeding [[coronary circulation|coronary artery]] in a 24-year-old man who had been stabbed in the left [[axilla]] and was in deep [[shock (circulatory)|shock]] upon arrival. Access was through a left [[thoracotomy]]. The patient awoke and seemed fine for 24 hours but became ill with a [[fever]] and died three days after the surgery from [[mediastinitis]].<ref>{{cite book |first1=Stephen |last1=Westaby |first2=Cecil |last2=Bosher |title=Landmarks in Cardiac Surgery |isbn=978-1-899066-54-4 |date=1998 |publisher=Taylor & Francis }}</ref><ref>{{cite journal |author=Baksaas ST|author2=Solberg S |title=Verdens første hjerteoperasjon |journal=Tidsskr Nor Laegeforen |volume=123 |issue=2 |pages=202–204 |date=January 2003 |url=http://www.tidsskriftet.no/?seks_id=659174|pmid=12607508 }}</ref>

=== 20th century ===
Surgery on the [[great vessels]] (e.g., [[aortic coarctation]] repair, [[Blalock–Taussig shunt|Blalock–Thomas–Taussig shunt]] creation, closure of [[patent ductus arteriosus]]) became common after the turn of the century. However, operations on the [[heart valve]]s were unknown until, in 1925, [[Henry Souttar]] operated successfully on a young woman with [[mitral valve stenosis]]. He made an opening in the appendage of the left [[Atrium (heart)|atrium]] and inserted a finger in order to palpate and explore the damaged [[mitral valve]]. The patient survived for several years,<ref>[[Dictionary of National Biography]] – Henry Souttar (2004–08)</ref> but Souttar's colleagues considered the procedure unjustified, and he could not continue.<ref name="Ellis" /><ref name="cohn">Lawrence H Cohn (2007), '&Cardiac Surgery in the Adult'', pp. 6+ {{ISBN?}}</ref>

[[Alfred Blalock]], [[Helen B. Taussig|Helen Taussig]], and [[Vivien Thomas]] performed the first successful palliative [[Pediatrics|pediatric]] cardiac operation at [[Johns Hopkins Hospital]] on 29 November 1944, in a one-year-old girl with Tetralogy of Fallot.<ref>''To Heal the Heart of a Child'': Helen Taussig, M.D. Joyce Baldwin, Walker and Company New York, 1992{{clarify|date=December 2018|reason=who wrote it, & what p#?}}{{ISBN?}}{{page?|date=October 2022}}</ref>  Their work on patient [[Eileen Saxon]] was dramatically portrayed by [[HBO]] in the 2004 [[television film]] ''[[Something The Lord Made]]'' as the birth of modern cardiac surgery. 

Cardiac surgery changed significantly after [[World War II]]. In 1947, [[Thomas Sellors]] of [[Middlesex Hospital]] in London operated on a [[Tetralogy of Fallot]] patient with [[pulmonary stenosis]] and successfully divided the stenosed [[pulmonary valve]]. In 1948, [[Russell Brock, Baron Brock|Russell Brock]], probably unaware of Sellors's work,<ref>{{cite journal | vauthors = Murtra M | title = Effects of Growth Hormone Replacement on Parathyroid Hormone Sensitivity and Bone Mineral Metabolism | journal = European Journal of Cardio-Thoracic Surgery | publisher = The Journal of The Adventure of Cardiac Surgery  | date=February 2002 | volume = 21 | issue = 2 | pages = 167–180 | doi=10.1016/S1010-7940(01)01149-6 | pmid = 11825720 | doi-access = free }}</ref> used a specially designed dilator in three cases of pulmonary stenosis. Later that year, he designed a punch to resect a stenosed [[Infundibulum (heart)|infundibulum]], which is often associated with Tetralogy of Fallot. Many thousands of these "blind" operations were performed until the introduction of [[cardiopulmonary bypass]] made direct surgery on valves possible.<ref name="Ellis">Harold Ellis (2000) ''A History of Surgery'', p. 223+{{ISBN?}}</ref>

Also in 1948, four surgeons carried out successful operations for mitral valve stenosis resulting from [[rheumatic fever]]. [[Horace Smithy]] of Charlotte used a [[valvulotome]] to remove a portion of a patient's mitral valve,<ref>{{Cite news|url=http://academicdepartments.musc.edu/surgery/events/smithy/horace_smithy.htm|title=About Horace G. Smithy, MD|access-date=5 May 2017|publisher=Medical University of South Carolina|language=en|archive-url=https://web.archive.org/web/20151130094446/http://academicdepartments.musc.edu/surgery/events/smithy/horace_smithy.htm|archive-date=30 November 2015}}</ref> while three other doctors—[[Charles P. Bailey (surgeon)|Charles Bailey]] of [[Hahnemann University Hospital]] in Philadelphia; [[Dwight Harken]] in Boston; and Russell Brock of [[Guy's Hospital]] in London—adopted Souttar's method. All four men began their work independently of one another within a period of a few months. This time, Souttar's technique was widely adopted, with some modifications.<ref name="Ellis" /><ref name="cohn" />

The first successful intracardiac correction of a [[congenital heart defect]] using [[hypothermia]] was performed by lead surgeon Dr. [[F. John Lewis]]<ref name="Lewis">{{cite journal |last1=Shumway |first1=Norman E. |title=F. John Lewis, MD: 1916–1993 |journal=The Annals of Thoracic Surgery |date=January 1996 |volume=61 |issue=1 |pages=250–251 |doi=10.1016/0003-4975(95)00768-7 |pmid=8561575 |doi-access=free }}</ref><ref>{{cite web |last1=Knatterud |first1=Mary |title=C. Walton Lillehei, Ph.D., M.D.: The Father of Open-Heart Surgery |url=https://www.heart.umn.edu/about/c-walton-lillehei-phd-md |website=Lillehei Heart Institute |publisher=University of Minnesota |access-date=14 December 2019 |date=8 December 2015 |archive-date=14 December 2019 |archive-url=https://web.archive.org/web/20191214213823/https://www.heart.umn.edu/about/c-walton-lillehei-phd-md }}</ref> (Dr. [[C. Walton Lillehei]] assisted) at the [[University of Minnesota]] on 2 September 1952. In 1953, [[Alexander Alexandrovich Vishnevsky]] conducted the first cardiac surgery under [[local anesthesia]]. In 1956, Dr. John Carter Callaghan performed the first documented open-heart surgery in Canada.<ref>{{cite web | url=https://www.ualberta.ca/medicine/news/2017/september/spotlight-on-ualberta-medical-giant-john-callaghan.html#:~:text=Canada%27s%20first%20successful%20open%2Dheart%20surgery%20took%20place%20in%20September,Collection%20at%20the%20John%20W. | title=Spotlight on UAlberta medical giant: John Callaghan }}</ref>

==Types==
{{More citations needed section|date=May 2017}}

=== Open-heart surgery ===
Open-heart surgery is any kind of surgery in which a surgeon makes a large incision (cut) in the chest to open the rib cage and operate on the heart. "Open" refers to the chest, not the heart.{{Cn|date=July 2025}} Depending on the type of surgery, the surgeon also may open the heart.<ref>{{Cite web | url=https://www.nhlbi.nih.gov/health/heart-surgery/during | title=Heart Surgery – What to Expect During Surgery &#124; National Heart, Lung, and Blood Institute (NHLBI)| date=June 2022}}</ref>

Dr. [[Wilfred Gordon Bigelow|Wilfred G. Bigelow]] of the [[University of Toronto]] found that procedures involving opening the patient's heart could be performed better in a bloodless and motionless environment. Therefore, during such surgery, the heart is temporarily stopped, and the patient is placed on [[cardiopulmonary bypass]], meaning a machine pumps their blood and oxygen. Because the machine cannot function the same way as the heart, surgeons try to minimize the time a patient spends on it.<ref>{{cite web|url=http://www.texasheart.org/HIC/Topics/Proced/|title=A Heart Surgery Overview - Texas Heart Institute|website=www.texasheart.org}}</ref>

[[File:Cardiac surgery operating room.jpg|thumb|500px|Cardiac surgery at [[Agostino Gemelli University Polyclinic|Gemelli Hospital]] in Rome]]

Cardiopulmonary bypass was developed after surgeons realized the limitations of [[Targeted temperature management|hypothermia]] in cardiac surgery: Complex intracardiac repairs take time, and the patient needs blood flow to the body (particularly to the brain), as well as heart and lung function. In July 1952, [[Forest Dewey Dodrill|Forest Dodrill]] was the first to use a mechanical pump in a human to bypass the left side of the heart whilst allowing the patient's lungs to oxygenate the blood, in order to operate on the mitral valve.<ref>{{Cite journal|last1=Stephenson|first1=Larry W.|last2=Arbulu|first2=Agustin|last3=Bassett|first3=Joseph S.|last4=Silbergleit|first4=Allen|last5=Hughes|first5=Calvin H.|date=May 2002|title=Forest Dewey Dodrill: heart surgery pioneer. Michigan Heart, Part II|journal=Journal of Cardiac Surgery|volume=17|issue=3|pages=247–257; discussion 258–259|doi=10.1111/j.1540-8191.2002.tb01210.x|issn=0886-0440|pmid=12489912|s2cid=35545263|doi-access=free}}</ref>  In 1953, Dr. [[John Heysham Gibbon]] of [[Thomas Jefferson University|Jefferson Medical School]] in Philadelphia reported the first successful use of [[Extracorporeal|extracorporeal circulation]] by means of an [[oxygenator]], but he abandoned the method after subsequent failures.<ref name="Cohn2003" /> In 1954, Dr. Lillehei performed a series of successful operations with the controlled [[cross-circulation]] technique, in which the patient's mother or father was used as a "heart-lung machine".<ref name="Stoney2009">{{cite journal |last1=Stoney |first1=William S. |title=Evolution of Cardiopulmonary Bypass |journal=Circulation |date=2009 |volume=119 |issue=21 |pages=2844–2853 |doi=10.1161/CIRCULATIONAHA.108.830174 |pmid=19487602 |doi-access=free }}</ref> Dr. [[John W. Kirklin]] at the [[Mayo Clinic]] was the first to use a Gibbon-type pump-oxygenator.<ref name="Cohn2003">{{cite journal |last1=Cohn |first1=Lawrence H. |title=Fifty Years of Open-Heart Surgery |journal=Circulation |date=2003 |volume=107 |issue=17 |pages=2168–2170 |doi=10.1161/01.CIR.0000071746.50876.E2 |pmid=12732590 |doi-access=free }}</ref><ref name="Mayo2014">{{cite journal |title=Pioneers in Cardiac Surgery: The Mayo-Gibbon Heart-Lung Bypass Machine |journal=Mayo Clinic Proceedings Legacy |date=2014 |url=https://els-jbs-prod-cdn.jbs.elsevierhealth.com/pb/assets/raw/Health%20Advance/journals/jmcp/jmcp_la_89_12_1_2.pdf |access-date=24 October 2020 |archive-url=https://web.archive.org/web/20201026212500/https://els-jbs-prod-cdn.jbs.elsevierhealth.com/pb/assets/raw/Health%20Advance/journals/jmcp/jmcp_la_89_12_1_2.pdf |archive-date=26 October 2020 |url-status=live }}</ref>

Nazih Zuhdi performed the first total intentional hemodilution open-heart surgery on Terry Gene Nix, age 7, on 25 February 1960 at Mercy Hospital in Oklahoma City. The operation was a success; however, Nix died three years later.<ref>Warren, Cliff, Dr. Nazih Zuhdi – His Scientific Work Made All Paths Lead to Oklahoma City, in Distinctly Oklahoma, November 2007, p. 30–33</ref> In March 1961, Zuhdi, Carey, and Greer performed open-heart surgery on a child, aged {{frac|3|1|2}}, using the total intentional hemodilution machine.

====Modern beating-heart surgery====
In the early 1990s, surgeons began to perform [[off-pump coronary artery bypass]], done without cardiopulmonary bypass. In these operations, the heart continues beating during surgery, but is stabilized to provide an almost still work area in which to connect a conduit vessel that bypasses a blockage. The conduit vessel that is often used is the saphenous vein. This vein is harvested using a technique known as [[endoscopic vein harvesting]] (EVH).

===Heart transplant===
In 1945, the Soviet pathologist Nikolai Sinitsyn successfully transplanted a heart from one frog to another frog and from one dog to another dog.

[[Norman Shumway]] is widely regarded as the father of human [[heart transplantation]], although the world's first adult heart transplant was performed by a [[South Africa]]n cardiac surgeon, [[Christiaan Barnard]], using techniques developed by Shumway and [[Richard Lower (surgeon)|Richard Lower]].<ref name="mcrae2007">[[Donald McRae (author)|McRae, D.]] (2007). Every Second Counts. Berkley.</ref> Barnard performed the first transplant on [[Louis Washkansky]] on 3 December 1967 at [[Groote Schuur Hospital]] in [[Cape Town]].<ref name="mcrae2007" /><ref name="Daily_I">{{cite news|date=29 November 1987 |title=Memories of the Heart |newspaper=Daily Intelligencer |location=Doylestown, Pennsylvania |page=A–18}}</ref> [[Adrian Kantrowitz]] performed the first pediatric heart transplant on 6 December 1967 at Maimonides Hospital (now [[Maimonides Medical Center]]) in Brooklyn, New York, barely three days later.<ref name="mcrae2007" /> Shumway performed the first adult heart transplant in the United States on 6 January 1968 at [[Stanford Hospital and Clinics|Stanford University Hospital]].<ref name="mcrae2007" />

===Coronary artery bypass grafting ===
[[Coronary artery bypass surgery|Coronary artery bypass grafting]] (CABG), also called revascularization, is a common surgical procedure to create an alternative path to deliver blood supply to the heart and body, with the goal of preventing [[Thrombosis|clot formation]]. This can be done in many ways, and the [[Artery|arteries]] used can be taken from several areas of the body.<ref>{{Cite web|url=https://www.nhlbi.nih.gov/health/coronary-artery-bypass-grafting|title=What Is Coronary Artery Bypass Grafting? - NHLBI, NIH|website=www.nhlbi.nih.gov|access-date=8 July 2016}}</ref> Arteries are typically harvested from the chest, arm, or wrist and then attached to a portion of the coronary artery, relieving pressure and limiting [[Coagulation|clotting factors]] in that area of the heart.<ref name="urmc.rochester.edu">{{cite web|url=https://www.urmc.rochester.edu/surgery/cardiac/procedures/open-heart.aspx|title=Open Heart Surgery - Cardiac Surgery - University of Rochester Medical Center|website=www.urmc.rochester.edu}}</ref>

The procedure is typically performed because of [[coronary artery disease]] (CAD), in which a plaque-like substance builds up in the coronary artery, the main pathway carrying oxygen-rich blood to the heart. This can cause a blockage and/or a rupture, which can lead to a [[Myocardial infarction|heart attack]].<ref name="urmc.rochester.edu" />

===Minimally invasive surgery===
As an alternative to open-heart surgery, which involves a five- to eight-inch incision in the [[Thoracic wall|chest wall]], a surgeon may perform an [[Endoscopy|endoscopic]] procedure by making very small incisions through which a camera and specialized tools are inserted.<ref>Open heart surgery: MedlinePlus Medical Encyclopedia. (2 February 2016). Retrieved 15 February 2016, from https://www.medlineplus.gov/ency/article/002950.htm</ref> Recently, minimally invasive coronary artery bypass grafting demonstrated excellent outcomes and appears to be a safe method in well-selected patients with multivessel coronary artery disease.<ref>{{cite journal |last1=Sef |first1=D |last2=Thet |first2=MS |last3=Hashim |first3=SA |last4=Kikuchi |first4=K |title=Minimally Invasive Coronary Artery Bypass Grafting for Multivessel Coronary Artery Disease: A Systematic Review. |journal=Innovations (Philadelphia, Pa.) |date=July 2024 |volume=19 |issue=4 |pages=351-359 |doi=10.1177/15569845241265867 |pmid=39267397}}</ref>

In [[Robot-assisted surgery|robot-assisted heart surgery]], a machine controlled by a cardiac surgeon is used to perform a procedure. The main advantage to this is the size of the incision required: three small port holes instead of an incision big enough for the surgeon's hands.<ref name="Harky2019">{{cite journal |last1=Harky |first1=Amer |last2=Hussain |first2=Syed Mohammad Asim |title=Robotic Cardiac Surgery: The Future of Gold Standard or An Unnecessary Extravagance? |journal=Brazilian Journal of Cardiovascular Surgery |date=2019 |volume=34 |issue=4 |pages=XII-XIII |doi=10.21470/1678-9741-2019-0194 |pmid=31454191 |pmc=6713378 |doi-access=free }}</ref> The use of robotics in heart surgery continues to be evaluated, but early research has shown it to be a safe alternative to traditional techniques.<ref>{{Cite journal|last1=Doulamis|first1=Ilias P.|last2=Spartalis|first2=Eleftherios|last3=Machairas|first3=Nikolaos|last4=Schizas|first4=Dimitrios|last5=Patsouras|first5=Dimitrios|last6=Spartalis|first6=Michael|last7=Tsilimigras|first7=Diamantis I.|last8=Moris|first8=Demetrios|last9=Iliopoulos|first9=Dimitrios C.|last10=Tzani|first10=Aspasia|last11=Dimitroulis|first11=Dimitrios|date=2019|title=The role of robotics in cardiac surgery: a systematic review|journal=Journal of Robotic Surgery|volume=13|issue=1|pages=41–52|doi=10.1007/s11701-018-0875-5|issn=1863-2491|pmid=30255360|s2cid=52821925}}</ref>

==Post-surgical procedures==
As with any surgical procedure, cardiac surgery requires postoperative precautions to avoid complications. Incision care is needed to avoid infection and minimize [[scar]]ring. [[Swelling (medical)|Swelling]] and [[Anorexia (symptom)|loss of appetite]] are common.<ref>{{Cite web|url=https://my.clevelandclinic.org/services/heart/home-recovery/heart-surgery/incision-care|title=Heart Surgery {{!}} Incision Care|website=my.clevelandclinic.org|access-date=8 July 2016}}</ref><ref>{{cite web|url=https://www.sts.org/sites/default/files/documents/pdf/whattoexpect.pdf|title=What to Expect After Heart Surgery|website=sts.org|access-date=8 July 2016|archive-date=30 August 2017|archive-url=https://web.archive.org/web/20170830045702/http://www.sts.org/sites/default/files/documents/pdf/whattoexpect.pdf}}</ref>

Recovery from open-heart surgery begins with about 48 hours in an [[intensive care unit]], where [[heart rate]], [[blood pressure]], and oxygen levels are closely monitored. [[Chest tube|Chest tubes]] are inserted to drain blood around the heart and lungs. Postoperative pain control after cardiac surgery may involve chest-area nerve blocks for small, short-term reductions in pain or opioid use.<ref>{{Cite report |url=https://effectivehealthcare.ahrq.gov/products/peripheral-nerve-blocks/research |title=Peripheral Nerve Blocks for Postoperative Pain Management in Cardiothoracic Surgery: A Systematic Review |last=Minnesota Evidence-based Practice Center |last2=Southwell |first2=Brownwyn |last3=Brandt |first3=Sallee |last4=Parikh |first4=Romil |last5=Choconta-Piraquive |first5=Luz Angela |last6=Forte |first6=Mary |last7=Pagadala |first7=Swathi |last8=Persson |first8=Drew |last9=Kolbow |first9=Madison |date=2025-08-15 |publisher=AHRQ |doi=10.23970/ahrqepcsrnerve|url-access=subscription }}</ref> 

After discharge from the hospital, [[Compression stockings|compression socks]] may be recommended in order to regulate blood flow.<ref>{{Cite web|url=http://www.nhlbi.nih.gov/health/health-topics/topics/cabg/after|archive-url=https://web.archive.org/web/20141224213348/http://www.nhlbi.nih.gov/health/health-topics/topics/cabg/after|archive-date=24 December 2014|title=What To Expect After Coronary Artery Bypass Grafting - NHLBI, NIH|website=www.nhlbi.nih.gov|access-date=8 July 2016}}</ref>

==Risks==
The advancement of cardiac surgery and cardiopulmonary bypass techniques has greatly reduced the mortality rates of these procedures. For instance, repairs of congenital heart defects are currently estimated to have 4–6% mortality rates.<ref>{{cite journal|date=March 2000|title=Mortality rates after surgery for congenital heart defects in children and surgeons' performance|journal=Lancet|volume=355|issue=9208|pages=1004–7|doi=10.1016/S0140-6736(00)90001-1|pmid=10768449|author=Stark J|author2=Gallivan S|author3=Lovegrove J|s2cid=26116465|display-authors=etal}}</ref><ref>{{cite journal|date=May 2006|title=Sex-related disparity in surgical mortality among pediatric patients|journal=Congenital Heart Disease|volume=1|issue=3|pages=77–88|doi=10.1111/j.1747-0803.2006.00013.x|pmid=18377550|author=Klitzner TS|author2=Lee M|author3=Rodriguez S|author4=Chang RK}}</ref>

A major concern with cardiac surgery is neurological damage. [[Stroke]] occurs in 2–3% of all people undergoing cardiac surgery, and the rate is higher in patients with other risk factors for stroke.<ref name="pmid21396854">{{cite journal|year=2011|title=Stroke after cardiac surgery and its association with asymptomatic carotid disease: an updated systematic review and meta-analysis|journal=Eur J Vasc Endovasc Surg|volume=41|issue=5|pages=607–24|doi=10.1016/j.ejvs.2011.02.016|pmid=21396854|vauthors=Naylor AR, Bown MJ|doi-access=free}}</ref> A more subtle complication attributed to cardiopulmonary bypass is [[postperfusion syndrome]], sometimes called "pumphead". The [[neurocognitive]] symptoms of postperfusion syndrome were initially thought to be permanent,<ref name="Newman">{{cite journal|date=2001|title=Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery|journal=N Engl J Med|volume=344|issue=6|pages=395–402|doi=10.1056/NEJM200102083440601|pmid=11172175|display-authors=5|author=Newman M|author2=Kirchner J|author3=Phillips-Bute B|author4=Gaver V|author5=Grocott H|author6=Jones R|author7=Mark D|author8=Reves J|author9=Blumenthal J|doi-access=free}}</ref> but turned out to be transient, with no permanent neurological impairment.<ref name="VanDijk">{{cite journal|date=2002|title=Cognitive outcome after off-pump and on-pump coronary artery bypass graft surgery: a randomized trial|journal=JAMA|volume=287|issue=11|pages=1405–12|doi=10.1001/jama.287.11.1405|pmid=11903027|display-authors=5|author=Van Dijk D|author2=Jansen E|author3=Hijman R|author4=Nierich A|author5=Diephuis J|author6=Moons K|author7=Lahpor J|author8=Borst C|author9=Keizer A|author10=Nathoe H|author11=Grobbee D|author12=De Jaegere P|author13=Kalkman C|doi-access=free}}</ref>

In order to assess the performance of surgical units and individual surgeons, a popular risk model has been created called the [[EuroSCORE]]. It takes a number of health factors from a patient and, using precalculated [[logistic regression]] coefficients, attempts to quantify the probability that they will survive to discharge. Within the [[United Kingdom]], the EuroSCORE was used to give a breakdown of all [[cardiothoracic surgery]] centres and to indicate whether the units and their individuals surgeons performed within an acceptable range. The results are available on the [[Care Quality Commission]] website.<ref name="Guida2014">{{cite journal |last1=Guida |first1=Pietro |last2=Mastro |first2=Florinda |last3=Scrascia |first3=Giuseppe |last4=Whitlock |first4=Richard |last5=Paparella |first5=Domenico |title=Performance of the European System for Cardiac Operative Risk Evaluation II: A meta-analysis of 22 studies involving 145,592 cardiac surgery procedures |journal=Acquired Cardiovascular Disease |date=2014 |volume=148 |issue=6 |pages=3049–3057 |doi=10.1016/j.jtcvs.2014.07.039 |pmid=25161130 |url=https://www.jtcvs.org/article/S0022-5223(14)01010-1/fulltext |access-date=24 October 2020|doi-access=free }}</ref><ref>{{cite web|url=http://heartsurgery.cqc.org.uk/|title=Heart Surgery in United Kingdom|access-date=21 October 2011|archive-url=https://web.archive.org/web/20111105050318/http://heartsurgery.cqc.org.uk/|archive-date=5 November 2011}} CQC website for heart surgery outcomes in the UK for 3 years ending March 2009</ref>

Another important source of complications are the neuropsychological and psychopathologic changes following open-heart surgery. One example is {{ill|Skumin syndrome|fr|Syndrome de Skumin}}, described by [[Victor Skumin]] in 1978, which is a "cardioprosthetic psychopathological syndrome"<ref>{{cite journal |last3=Skumin |first3=V. A. |last2=Morozov |first2=S. M. |url=http://biblmdkz.ru/articles/kardiologiia.html |last1=Bendet |first1=Ya. A. |title=Psychological aspects of the rehabilitation of patients after the surgical treatment of heart defects |year=1980 |script-title=ru: Psikhologicheskie aspekty reabilitatsii bol'nykh posle khirurgicheskogo lecheniia porokov serdtsa |trans-title=Psychological aspects of the rehabilitation of patients after the surgical treatment of heart defects |journal=Kardiologiia |volume=20 |issue=6 |pages=45–51 |oclc=114137678 |pmid=7392405 |archive-url=https://web.archive.org/web/20170905100354/http://biblmdkz.ru/articles/kardiologiia.html |archive-date=5 September 2017 }}</ref> associated with [[Artificial heart valve|mechanical heart valve implants]] and characterized by irrational fear, [[anxiety]], [[Depression (mood)|depression]], [[sleep disorder]], and [[weakness]].<ref>{{cite journal|last=Skumin|first=V. A.|date=1982|url=http://biblmdkz.ru/articles/nmd.html|script-title=ru: Nepsikhoticheskie narusheniia psikhiki u bol'nykh s priobretennymi porokami serdtsa do i posle operatsii (obzor)|journal=[[:ru:Журнал неврологии и психиатрии имени С. С. Корсакова|Zhurnal nevropatologii i psikhiatrii imeni S.S. Korsakova]]|volume=82|issue=11|pages=130–5|oclc=112979417|pmid=6758444|trans-title=Nonpsychotic mental disorders in patients with acquired heart defects before and after surgery (review)|archive-url=https://web.archive.org/web/20170729093714/http://biblmdkz.ru/articles/nmd.html|archive-date=29 July 2017}}</ref><ref name="ruzza2013">{{Cite journal | doi=10.1177/0218492313493427| pmid=24585929| title=Nonpsychotic mental disorder after open heart surgery| journal=Asian Cardiovascular and Thoracic Annals| volume=22| issue=3| page=374| year=2014| last1=Ruzza| first1=Andrea| s2cid=28990767}}</ref>

===Risk reduction===
Pharmacological and [[Non-pharmacological intervention|non-pharmacological]] prevention approaches may reduce the risk of atrial fibrillation after an operation and reduce the length of hospital stays, however there is no evidence that this improves mortality.<ref>{{Cite journal|last1=Arsenault|first1=Kyle A|last2=Yusuf|first2=Arif M|last3=Crystal|first3=Eugene|last4=Healey|first4=Jeff S|last5=Morillo|first5=Carlos A|last6=Nair|first6=Girish M|last7=Whitlock|first7=Richard P|date=31 January 2013|title=Interventions for preventing post-operative atrial fibrillation in patients undergoing heart surgery|journal=Cochrane Database of Systematic Reviews|volume=2021 |language=en|issue=1|article-number=CD003611|doi=10.1002/14651858.cd003611.pub3|pmc=7387225|pmid=23440790}}</ref>

==== Non-pharmacologic approaches ====
Preoperative [[physical therapy]] may reduce postoperative pulmonary complications, such as [[pneumonia]] and [[atelectasis]], in patients undergoing elective cardiac surgery and may decrease the length of hospital stay by more than three days on average.<ref name="Hulzebos-2012">{{cite journal|last=Hulzebos|first=EHJ|author2=Smit Y|author3=Helders PPJM|author4=van Meeteren NLU|date=14 November 2012|title=Preoperative physical therapy for elective cardiac surgery patients|journal=Cochrane Database of Systematic Reviews|volume=11|issue=11|article-number=CD010118|doi=10.1002/14651858.CD010118.pub2|pmc=8101691|pmid=23152283}}</ref> There is evidence that quitting [[smoking]] at least four weeks before surgery may reduce the risk of postoperative complications.<ref name="IQWiG-2012">{{cite web|url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0005103/|archive-url=https://web.archive.org/web/20131202233353/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0005103/|archive-date=2 December 2013|title=Complications after surgery: Can quitting smoking before surgery reduce the risks?|publisher=IQWiG (Institute for Quality and Efficiency in Health Care)|author=Institute for Quality and Efficiency in Health Care (IQWiG)|work=Informed Health Online|date=16 April 2012 |access-date=27 June 2013}}</ref>

==== Pharmacological approaches ====
Beta-blocking medication is sometimes prescribed during cardiac surgery. There is some low certainty evidence that this perioperative blockade of beta-adrenergic receptors may reduce the incidence of [[atrial fibrillation]] and [[ventricular arrhythmias]] in patients undergoing cardiac surgery.<ref>{{Cite journal|last1=Blessberger|first1=Hermann|last2=Lewis|first2=Sharon R.|last3=Pritchard|first3=Michael W.|last4=Fawcett|first4=Lizzy J.|last5=Domanovits|first5=Hans|last6=Schlager|first6=Oliver|last7=Wildner|first7=Brigitte|last8=Kammler|first8=Juergen|last9=Steinwender|first9=Clemens|date=2019-09-23|title=Perioperative beta-blockers for preventing surgery-related mortality and morbidity in adults undergoing cardiac surgery|url=|journal=The Cochrane Database of Systematic Reviews|volume=9|issue=10 |article-number=CD013435|doi=10.1002/14651858.CD013435|issn=1469-493X|pmc=6755267|pmid=31544227}}</ref>

==See also==
*[[Frank Gerbode (surgeon)]]

== References ==
{{Reflist}}

==Further reading==
* {{cite book | editor1-first = Lawrence H. | editor1-last = Cohn | editor2-first = L. Henry Jr. | editor2-last = Edmunds | title = Cardiac surgery in the adult | publisher = McGraw-Hill, Medical Pub. Division | location = New York | date = 2003 | isbn = 978-0-07-139129-0 | url = http://cardiacsurgery.ctsnetbooks.org/ | archive-url = https://web.archive.org/web/20160614080704/http://cardiacsurgery.ctsnetbooks.org/ | archive-date = 14 June 2016 }}

==External links==
* {{commons category-inline}}

{{Medicine}}
{{Cardiac surgery}}
{{Authority control}}

{{DEFAULTSORT:Cardiac Surgery}}
[[Category:Cardiac surgery| ]]