Heart surgery performed in awake patients

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Heart surgery is a frightening prospect for many people, but now imagine undergoing the operation completely awake! That’s what seven patients treated at a hospital in Turkey went though—in a planned, deliberate study.

This wasn’t some anesthesia horror story, but a procedure that was designed by the surgeons. The results indicate that coronary bypass surgery can be safely performed in awake patients, even if they have relatively severe heart disease.

Although the patients did not receive general anesthesia, they felt no pain during the surgery thanks to epidural anesthesia—the type usually given to pregnant women during labor.

So why would anyone want to undergo heart surgery awake? For one thing, general anesthesia carries its own risks. Also, unlike conventional bypass surgery, the awake version of the operation used in these cases did not require the use of mechanical devices to do the work of the heart and lungs, which can cause serious complications.

The technique of awake heart surgery was actually developed a few years ago, but Dr. Kaan Kirali and colleagues, from the Kosuyolu Heart and Research Hospital in Istanbul, modified the procedure slightly and tested it on seven patients with blockages in two or three of their coronary arteries, the blood vessels that feed the heart.

The researchers’ findings appear in the Annals of Thoracic Surgery.

All of the patients remained conscious throughout the operation and none had to be switched over to a more conventional procedure, the authors note. Moreover, none of the patients experienced a heart attack or died during or shortly after surgery.

Three patients developed a collapsed lung during surgery, but it was repaired in two. The other patient completed the operation with the collapsed lung.

While the findings may stimulate interest in awake heart surgery, don’t expect an immediate upsurge in such operations. As Dr. John Puskas, from Emory University in Atlanta, notes in a related editorial, the popularity of this procedure will be limited until a study is performed comparing its benefits with that of conventional heart surgery.

SOURCE: Annals of Thoracic Surgery, November 2004.

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