Every heart operation is tailored for the patient.
Multiple factors are taken into consideration when planning your procedure including which operation to offer you and how best to undertake the surgery.
These guides are designed to give a broad overview of the types of operations that are performed, but for specific details of your procedure, please discuss with your surgeon and anaesthetist how the operation is intended to be performed for you.
All surgery on the heart in Liverpool is undertaken with a general anaesthetic. This means that you will be drifted off to sleep with a sedative before a breathing tube is placed through your mouth and into you airway. This is connected to a ventilator to control your breathing while you are asleep. Several drips and lines are used to monitor you and give an medications you need whilst you are asleep. You will almost always have a catheter placed in your bladder to monitor the kidneys. This is also usually done when you are asleep.
Every heart operation is a little different and even if you’re having the same operation as someone else, the experiences you have may not be the same. Have a look at our Patient Journey pages for a rough idea of what most people who have heart surgery can expect, but please be aware that the experience is individual.
The majority of heart operations in the UK and worldwide are performed through the front of the chest. This is called a median sternotomy. The scar runs from below the notch at the base of your neck between the collarbones to just underneath the end of the breastbone. The breastbone is opened lengthways and, at the end of the operation, is closed using heavy steel wires that are left in permanently. The sutures used to close the overlying layers of soft tissue will dissolve and do not need to be removed.
The vast majority of cardiac surgery will require the work of the heart to be temporarily stopped whilst it is operated on. In order to do this a heart-lung machine called a cardiopulmonary bypass circuit is used (NB this bypass is not to be confused with the bypass of coronary artery bypass). These require blood to be drained as it returns to the heart from the body, sent for processing (pumping, temperature control, filtration, oxygenation and other controls) before being returned to the circulation. A drug given directly to the heart once the blood supply to the body has been established this way allows the heart to stop safely until the operation is over. This involves isolating the circulation of the bypass machine with that of the heart using a clamp across the aorta (aortic cross-clamp).
Advantages of cardiopulmonary bypass
- * Allow the heart to be still and empty for the surgeons to operate on unfettered
- * Has been around for a long time and has become safer
- * Protects the body and brain as well as the heart whilst operations that would otherwise be impossible are carried out
- * Long periods of time on the bypass machine can cause organ problems including confusion, kidney failure, gut ischaemia (poor blood supply to the gut) and bleeding problems
- * It requires punctures to be made in the heart or major blood vessels and usually requires the aorta to be clamped which can cause increase the
risk of strokes
- * Stopping the heart for long periods can leave it stunned and temporarily weakened
- * Rare (1:5000 in valve operations; fewer in other types of surgery) but serious infections caused by mycobacterium chimerae which can lay dormant
in the bypass machines (these were identified a number of years ago and a new disinfection process has been instituted)
Many people worry that if their heart is stopped, it will not start again. Most of the time, the opposite is true - the heart will often spontaneously restart as the drug given to stop it (called cardioplegia) wears off in the operation. Multiple doses of cardioplegia are usually given in order to complete heart surgery.
Once the drug wears out or is washed out with fresh blood, the heart will get going itself. It is rare for the heart to be so weak that it cannot come off the heart-lung machine support.
Overall, cardiopulmonary bypass is a well established technique