A cardiotomy is a cut into the heart to access it for surgical procedures or provide a route for suction. This may be necessary in a variety of cardiovascular surgeries to repair the heart and neighboring blood vessels. Surgeons perform the incision with care so it will be easy to suture at the end of the procedure, and to reduce the risks of post-surgical complications for the patient. Cutting into the cardiac wall requires an advanced knowledge of anatomy and experience with cardiovascular surgery, because proper placement can be critical.
Some surgeries require a cardiotomy so the surgeon can access the necessary anatomical structures. This may be required to repair a birth defect or acquired problem with the heart. Surgeons make incisions as small as possible to protect the patient, and focus on careful work inside the limited space. Once the procedure is done and the repair appears to be satisfactory, the site can be sutured. If the cut is too deep or placed at the wrong angle, it can present risks to the patient, so the surgeon plans ahead to make sure it is used appropriately.
Another use for a cardiotomy is to create an area for suction. Cardiovascular surgeries can cause flows of blood in and around the heart, which obscures the surgical field and makes it hard to work. With suction equipment, surgical assistants clear the field so the surgeon can clearly see. It is important to have easy access for suction that won’t get in the surgeon’s way or endanger the patient, and a surgeon may consider an incision for this purpose.
Historically, blood collected at a cardiotomy site was filtered and recycled, replacing some of the patient’s lost blood. Research indicated that this might not be the best medical practice, because the blood could introduce cellular debris, including small chunks of lipids, which might cause strokes and other problems. In addition, it appeared to contribute to coagulation problems which led to the need for more transfused blood from a donor than would otherwise be necessary. In some procedures, routine recycling of cardiotomy blood is no longer recommended.
Like other measures taken during surgery, a cardiotomy can carry risks. Patients could experience inflammation and infection that might lead to pain, fever, and nausea. Poor placement could damage the heart or neighboring structures, while a rupture of the sutures could cause bleeding and other complications. After surgery on the heart, patients may need to stay in the hospital for monitoring and observe precautions upon being discharged to prevent complications and identify them early if they develop.