An Overview of Heart Surgery

If your child has congenital heart disease, the team may decide that she requires heart surgery. The child then has a clinic appointment to be seen by the health care professionals from the hospital who look after children with cardiac conditions. During this pre-operative visit, you and your child will meet with a number of health professionals including surgeons, anaesthesiologists, nurses, and others.

The anaesthesiologist will discuss general issues around having an anaesthetic and specific issues about your child. These will include things like pre-operative sedation, blood transfusion, and monitoring procedures during the surgery.

Most children who need heart surgery will need blood products during their surgery. This can involve transfusing red blood cells (to improve the amount of oxygen in the blood), platelets (to help blood clotting), and plasma. It is sometimes possible for parents to donate blood for their child, but it does need to be arranged ahead of time and should be discussed with the doctor.

The surgeons will discuss with you the specific type of surgery that your child needs and the risks and benefits of the procedure. They will tell you if the operation will require the use of cardiopulmonary bypass (heart-lung machine).

My child is having open-heart surgery; what does that mean?

Open-heart surgery involves using a machine to support the child while the heart is prevented from beating, opened, and repaired. This is major surgery and most children require blood transfusions for this kind of surgery.

Throughout the procedure, the anesthesiologist monitors your child's airway, heart rate, and breathing, and provides other drugs as needed. During all this, the surgeon concentrates on the actual operation and the perfusionist takes care of putting your child on the bypass machine. Children on bypass also need blood-thinning drugs.

What happens during the surgery?

The anaesthesiologist looking after your child will speak to you on the morning of surgery and answer any last-minute questions. The operating room nurse will also meet you and check your child. Generally parents do not accompany children into the Cardiac Operating Room for heart surgery for safety reasons.

Once your child is asleep, the IV and other catheters are put in place, medications are given, and the area where the incision will be made (usually the sternum) is cleaned with antiseptic.

During the surgery, the anaesthesiologist watches your child and the monitors, while communicating with other members of the surgery team, to make sure everything is stable. Heparin (an anticoagulant or "blood thinner") is given if the child needs to be supported with cardiopulmonary bypass (CPB). During this time the heart is stopped while the surgeon repairs the defect. The child is managed on the heart-lung machine by the perfusionist, along with the anaesthesiologist and surgeon.

Rare and serious complications of anaesthesia and heart surgery include bleeding and clotting, drug reactions, heart rhythm problems, cardiac arrest, reactions to a blood transfusion, brain injury, and breathing problems. Many children have minor complications such as nausea, feeding problems (such as trouble swallowing), and bruising from IV sites.

When the repair is complete, the heart is allowed to beat again and the cardiopulmonary bypass machine is turned down and off. If the heart is not quite functioning the way it should, medicines are used to improve heart function. An echocardiogram is done by the cardiologist to make sure that the repair is working the way it should. The surgeons then make sure there is no bleeding and close the incision.

Is it possible that your child will wake up or feel pain during the procedure?

No. The drugs given to children put them into a very deep sleep. Very rarely, some older children may hear things but even if this is the case, they will not feel any pain because of the pain medication.

Will your child have a lot of tubes and lines?

Various tubes and procedures are needed to support your child and monitor their condition:

  • an endotracheal tube (breathing tube) through the nose or mouth
  • an arterial catheter to continuously measure blood pressure
  • a central line, often in the neck to measure pressures in the heart and give drugs
  • a catheter in the bladder to monitor kidney function

What happens after the surgery?

When the team is happy that the repair is good, heart function is adequate and stable, and your child is doing well on the ventilator, the child is transferred to the cardiac critical care unit (CCCU) by the anaesthesiologist and care is handed over to the team in that unit. For some simpler procedures, the child is taken to the recovery room and then the cardiac ward after surgery without the need for a ventilator or stay in the CCCU.

Most heart surgery takes between 3 and 6 hours.

Jennifer Russell, MD, FRCPC

12/11/2009


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