Open heart surgery is a term used to describe how surgeons at Norton Children’s Heart Institute, affiliated with the UofL School of Medicine, repair children’s hearts with congenital heart defects. Following an incision in the middle of the chest, a patient’s heart is opened through an incision, allowing the pediatric cardiothoracic surgeon to look into the heart and make the repair. During pediatric 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 pediatric heart surgeries 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, they 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 Is Pediatric Heart Surgery Needed?

Open heart surgery is used to repair numerous congenital heart defects, such as:

• Defects in which there are holes between the right and left sides of the heart, such as atrial and ventricular septal defects, atrioventricular canals and tetralogy of Fallot
• Complex repairs of valves as seen in atrioventricular canals, Ebstein 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 is the leading provider of pediatric heart care in Louisville and Southern Indiana.

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. 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, postoperative bleeding may require another operation.

Complications during and after pediatric heart 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, the 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 decreased 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 the child calm during this period of time.

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