Definition & Overview
Cardiotomy is a surgical procedure that involves an incision into the heart wall. The surgical opening of the heart is meant to close any open wound caused by an injury, drain any blood clot (thrombus) and excess fluid that accumulated inside the heart, or remove any foreign material found in the area.
Compared to other open-heart surgeries, cardiotomy only requires a small incision into the heart wall. The practice of making small incisions to the heart has become a preferred technique because it avoids exposing the heart to more harmful disease-causing organisms and reduces the risk of further injuring the organ and other surrounding tissues and blood vessels.
Cardiotomy can be done with or without the use of cardiopulmonary bypass. Bypass refers to the use of a temporary channel or connection when the original or main one is closed or damaged. In this case, cardiopulmonary bypass refers to the use of a heart-lung machine that takes over the function of the organs during surgery.
Who Should Undergo and Expected Results?
Cardiotomy is a very useful medical procedure that is used in many cardiovascular surgeries. It is especially indicated for the repair of heart injuries and blood vessels in the heart.
Foreign bodies are rarely found in this area and they occur as a result of an accident, drug use, and injury caused by blunt objects piercing through the chest. Some medical records show some sewing needles lodged in the wall of the heart while some are glass or wood debris penetrating the heart due to accidents.
Meanwhile, blood clots in the heart can originate or settle in any chamber of the heart. They could be found lying in the atria or ventricles.
In summary, an incision into the heart can be performed to:
- Replace or repair damaged heart valves
- Remove blood clots and foreign bodies from the area
- Correct congenital or acquired heart defects
- Repair any damage caused by trauma or injury to the heart wall
Cardiotomy is an invasive surgery and requires the patient to stay in the hospital for days. It takes six to 8 weeks for the breastbone to heal but the skin where the incision is made can heal within a week or two. Full recovery is usually achieved in 6 months. However, older patients and those with other debilitating diseases typically require a longer recovery period.
After discharge, the patient is advised to adhere to follow-up schedules so the surgeon can look for early signs of infections or inflammation at the incision site. They are also required to report any feeling of pain that increases over time, discharges, shortness of breath, and other symptoms that do not subside.
How is the Procedure Performed?
As an invasive procedure, cardiotomy is performed under general anaesthesia. As much as possible, surgeons create as small incision as possible to minimise damage to an already injured heart. This is one way to protect the patient from further complications associated with invasive surgeries.
As soon as the injured or damaged site has been identified, the repair commences. Depending on the extent of the condition and the patient’s unique circumstances, the surgery can last for several hours. The wound is then sutured once the damage has been repaired.
Another use for cardiotomy is the creation of an area for suction. Cardiovascular surgeries are known to be bloody, which means that the area can become so messy and filled with blood.
With the creation of drainage area in the heart and the use of suction equipment, the surgical assistant can clear the surgery field so the surgeon will be able to see the heart and surrounding areas clearly. This speeds up the procedure and helps surgeons avoid committing life-threatening mistakes.
Possible Risks and Complications
Cardiac surgery is inherently risky because any damage or injury to the heart can be life-threatening. One of the serious risks associated with this procedure is infection since disease-causing microorganisms can enter the heart through the incision made during the operation.
In the past, the blood collected during surgery is reintroduced into the patient’s body. Recent studies have shown that this might not be a good medical practice because the blood could introduce clots, debris, and blocks of lipids, which could block blood vessels and cause stroke. This is now usually avoided in most cardiotomy procedures worldwide.
Other risks include the following:
- Wound rupture - The breaking or splitting of sutures can cause blood to leak. This can result in massive bleeding and other serious complications to surrounding blood vessels and organs.
- Severe pain
Damage to the heart or neighbouring structures
US National Library of Medicine National Institutes of Health; “Foreign Bodies in the Chest: How Come They Are Seen in Adults?; Intracardiac Foreign Bodies” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2718107/
Research Gate; “Foreign Bodies in the Heart”; https://www.researchgate.net/publication/266564388ForeignBodiesinthe_Heart