Open heart surgery is a term used to describe how surgeons at Norton Children’s Heart Institute repair children’s hearts with congenital heart defects.  Following an incision in the middle of the chest, a patient’s heart is opened through a skilled incision allowing the pediatric cardiothoracic surgeon to look into the heart and make the repair. During open heart surgery, the patient is placed on a heart-lung (cardiopulmonary) bypass machine, which does the heart’s work of pumping blood to the brain and body while the surgeons operate.

A bypass machine is not used in every open heart surgery. Norton Children’s Heart Institute surgeons can complete some open heart operations while the heart is beating, but not pumping blood. Sometimes, this is possible when the repair is on the right side of the heart and there are no holes between the left and right sides of the heart.

When surgeons do use a bypass machine, surgeons can stop the heart once the heart-lung bypass machine has taken over doing the work of the heart and lungs so the complex repair can be best performed.. When the heart is stopped, the surgeons use a cold, high-potassium solution called cardioplegia solution that stops the heart and protects the heart muscle.

When the repair is complete, the surgeons can safely remove the bypass machine and restart the heart. When does a child need open heart surgery?

Open heart surgery is used to repair numerous congenital heart defects including, but not limited to:, such as:

• Defects where there are holes between the right and left sides of the heart like atrial and ventricular septal defects, atrioventricular canals, and tetralogy of fallot
• Complex repairs of valves as seen in atrioventricular canals, Ebstein’s anomaly, the Ross procedure, mitral valve, tricuspid valve, aortic valve and pulmonary valve abnormalities
• Defects involving the coronary arteries like D-type transposition of the great arteries and an anomalous coronary artery
• Complex congenital heart surgeries like the Norwood procedure associated with hypoplastic left heart syndrome, a truncus arteriosus repair, and the Damus-Kaye-Stansel procedure

Children who need open heart surgery will have a complete exam from the Norton Children’s Heart Institute team. The exam usually includes blood work, a chest X-ray, an electrocardiogram, an echocardiogram and possibly heart catheterization prior to surgery. The information gathered from these tests helps guide the surgery plan and after-surgery care.

The board-certified and fellowship-trained cardiothoracic surgeons at Norton Children’s Heart Institute have the sophisticated tools, experience and training to identify which cases require open heart surgery and when they can use less-invasive treatments.

Norton Children’s Heart Institute, affiliated with the University of Louisville, is the leading provider of pediatric heart care in Louisville and Southern Indiana.

The Society of Thoracic Surgeons has ranked Norton Children’s Heart Institute’s pediatric heart care among the best in the region. Norton Children’s has a network of outreach diagnostic and treatment services conveniently located throughout Kentucky and Southern Indiana.

What happens during open heart surgery?

The surgeon will:

• Open the chest and cut through the middle of the breastbone (sternum) to reach the heart.
• Remove part (or all) of the thymus gland, which sits behind the breastbone. Removing it allows the surgeon to see and operate on the heart.
• Place the patient on a heart-lung bypass machine
• Open the pericardial sac, a thin membrane that surrounds the heart.
• Perform the required repair inside the heart and/or to the arterial and venous vessels surrounding the heart.
• Take the patient off bypass
• Put the breastbone back together with steel wires.
• Close the skin.

Open heart surgery complications and after-care

Heart-lung (cardiopulmonary) bypass safety has improved over the years. Serious complications are very rare now. Patients can be on a heart-lung machine for four to eight hours and recover well.

Bypass risks include:

• Air or particles creating a clot that could lead to stroke or a seizure
• Low blood flow to the body’s organs or tissue
• Inflammation

Bleeding also is a risk after open heart surgery. A blood-thinning medication called heparin is used while the patient is on the heart-lung machine. Bleeding sometimes happens where surgeons have placed stitches. This bleeding usually is not severe and is controlled directly by the surgeon, or with medications and blood products.  Occasionally, post-op bleeding may require another operation.

Complications during and after surgery can include:

• Heart Rhythm abnormalities. Certain repairs require many stitches inside the heart.These stitches can disrupt the invisible electrical system of the heart.  This can be a temporary complication or a permanent complication.  If permanent, your child’s normal rhythm can be restored with a pacemaker.

Decreased heart function..  After surgery, the heart needs time to recover from the incisions that were made and the time it was not beating.  Also, the heart may need to adapt to its new structure and workload.  During this recovery period, the heart may have decrease function and not pump effectively.  Doctors can use medications that help the heart pump, use fluids to keep the heart filled, use external pacing to help the heart beat faster, and give sedation and pain medicines to keep your child calm during this period of time.

Your child will be monitored very closely after surgery. Every child’s heals at their own pace. Each day your child is in the hospital, the care team will talk to you about how your child is doing and help you create a care plan to get you closer to going home.

Why choose Norton Children’s Heart Institute

No other congenital heart surgery program in Kentucky, Ohio or Southern Indiana is ranked higher by the Society of Thoracic Surgeons than the Norton Children’s Pediatric Cardiothoracic Surgery Program.

• Norton Children’s Hospital has been a pioneer in pediatric cardiothoracic surgery, performing Kentucky’s first pediatric heart transplant in 1986 and becoming the second site in the United States to perform an infant heart transplant.
• Our board-certified and fellowship-trained pediatric cardiovascular surgeons are leaders in the field as clinicians and researchers.
• More than 5,000 children a year visit Norton Children’s Heart Institute, affiliated with the University of Louisville, for advanced heart care.
• Norton Children’s Heart Institute successfully performs more than 17,500 procedures a year.
• The Society of Thoracic Surgeons ranked Norton Children’s Heart Institute among the best in the region after studying years of our patients’ outcomes and our ability to handle a range of pediatric heart conditions, including the most severe.
• Norton Children’s Heart Institute has satellite outpatient centers in Bowling Green, Frankfort, Owensboro and Paducah; 28 tele-echocardiography locations in Kentucky and Southern Indiana; and six fetal echocardiography locations across Kentucky.
• The American Board of Thoracic Surgery has certified the cardiothoracic surgeons at Norton Children’s Hospital with subspecialty certification in congenital heart surgery.
• The Jennifer Lawrence Cardiac Intensive Care Unit is under construction to give our patients the most advanced cardiac intensive care unit available.
• Our multidisciplinary approach to pediatric heart surgery brings together our specialists in cardiothoracic surgery, cardiology, anesthesiology, cardiac critical care and other areas to create a complete care plan tailored for your child.