Surgery on the great vessels was followed by the development of closed heart surgery, where the surgeon blindly worked on the beating heart. It left a great deal to be desired, but had much to offer for great risk. Palliation of severe mitral valve stenosis, which was common in the past due to rheumatic fever, could be accomplished by poking a finger into the (mitral) valve through an incision in the left atrium. If a finger didn't do, a knife was passed through the incision to cut out tissue. Following successful treatment of mitral stenosis, a special cutter for aortic valve stenosis was developed, that maneuvered through an incision in the left atrium, accomplished much the same thing as the surgeon's finger in a stenosed mitral valve.
It was soon discovered that the repair of intracardiac pathologies required a bloodless and motionless environment, which means that the heart should be stopped and drained of blood.
"off-pump bypass surgery" - coronary artery bypass surgery without the aforementioned cardiopulmonary bypass. In these operations, the heart is beating during surgery, but is stabilized to provide a (almost) still work area. Some researchers believe this approach results in fewer post-operative complications (such as postperfusion syndrome) and better overall results (studies results are controversial as of 2007, surgeon's preference and hospital results still play a major role).
Elderly patients (patients over 75 years of age) who have coronary artery bypass grafting (CABG) receive as much benefit as younger patients. Patients were monitored for 12 months after surgery, and the outcome for the elderly patients were compared to the outcome for younger patients. The two groups showed similar improvements in overall physical function, reduction in angina, and improvement in quality of life. Elderly patients did require more time to recover from surgery, and had a higher rate of complications - including neurological deficits and kidney failure.
The development of cardiac surgery and cardiopulmonary bypass technique has reduced the mortality rates of these surgeries to relatively low levels. For instance, repairs of continental heart defects are currently estimated to have 4-6% morality rates.
The special treatment and service that we have at Damansara Specialist Hospital has performed more complex surgeries in 2007 which involved Bentall. It is the procedure in a cardiac surgery operation involving composite graft replacement of the ascending aorta and aortic valve, with anatomizes of the coronary arteries into the graft.
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