What Is Cardiac Surgery?
Cardiac surgery is done to correct problems with the heart. More than half a million heart surgeries are done each year in the United States for a variety of heart problems.
Cardiac surgery is used to correct heart problems in children and adults. This article discusses heart surgeries for adults.
Cardiac surgery is surgery on the heart and/or great vessels performed by a cardiac surgeon. Frequently, it is done to treat complications of ischemic heart disease (for example, coronary artery bypass grafting(CABG)), correct congenital heart disease, or treat valvular heart disease created by various causes including endocarditis. It also includes heart transplantation.
The most common type of Cardiac surgery for adults is Heart Attack/Caridac Arrest During CABG, surgeons use healthy arteries or veins taken from another part of the body to bypass (that is, go around) blocked arteries. CABG relieves chest pain and reduces the risk of heart attack.
Cardiac Surgery also is done to :
Repair or replace valves that control blood flow through the heart
Repair abnormal or damaged structures in the heart
Implant medical devices that regulate heart rhythms or blood flow
Replace a damaged heart with a healthy heart from a donor (heart transplant)
Cardiac surgeons at the WE CARE perform over 800 open heart procedures per year, including 600 coronary artery bypass grafting (CABG) procedures and 100 valve repair or replacement procedures each year. Pioneering work in the techniques of off-pump bypass procedures have made our program of minimally invasive heart surgery a national leader in this specialty.
Types of Cardiac Surgery :-
Different types of heart surgery are used to fix different heart problems : -
Coronary Artery Bypass Grafting :
Coronary artery bypass grafting (CABG) is the most common type of heart surgery. More than 500,000 of these surgeries are done each year in India. CABG improves blood flow to the heart. It's used for people with severe coronary artery disease (CAD).
In CAD, a fatty material called plaque builds up inside your coronary (heart) arteries. It narrows the arteries and limits blood flow to your heart muscle. CAD can cause angina , shortness of breath, and can even lead to a heart attack.
During CABG, a surgeon takes a vein or an artery from your chest, your leg, or another part of your body and connects, or grafts, it to the blocked artery. The grafted artery bypasses (that is, goes around) the blockage. This allows oxygen-rich blood to reach the heart muscle. Surgeons can bypass as many as four blocked coronary arteries during one surgery.
Sometimes you can choose between CABG and angioplasty to treat CAD. Talk to your doctor about these different treatments.
Transmyocardial Laser Revascularization :
Transmyocardial laser revascularization or TLR, is a surgery used to treat angina when no other treatments work. For example, if you've already had one CABG procedure and can't have another one, TLR may be an option. This type of heart surgery isn't common.
During TLR, the surgeon uses lasers to make channels in the heart muscle. These channels allow oxygen-rich blood to flow from a heart chamber directly into the heart muscle.
Valve Repair or Replacement :
For the heart to work right, blood must flow in only one direction. The heart's valves make this possible. Healthy valves open and close in a precise way as the heart pumps blood.
Each valve has a set of flaps called leaflets. The leaflets open to allow blood to pass from the heart chambers into the arteries. Then the leaflets close tightly to stop blood from flowing back into the chambers.
Heart surgery is done to fix leaflets that don't open as wide as they should. This can happen when they become thick or stiff or fuse together. As a result, not enough blood flows through the valve into the artery. Heart surgery also is done to fix leaflets that don't close tightly. This means blood can leak backward into the chambers, rather than only moving forward into the artery as it should.
To fix these problems, surgeons either repair the valve or replace it. Replacement valves are taken from animals, made from human tissue, or made from man-made substances.
Arrhythmia Treatment :
An arrhythmia is a problem with the speed or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm.
Most arrhythmias are harmless, but some can be serious or even life threatening. When the heart rate is abnormal, the heart may not be able to pump enough blood to the body. Lack of blood flow can damage the brain, heart, and other organs. Arrhythmias are usually treated with medicine first. If medicines don't work well enough, you may need surgery. For example, your doctor may use surgery to give you a pacemaker or an implantable cardioverter defibrillator (ICD).
A pacemaker is a small device that's placed under the skin of your chest or abdomen. Wires lead from the pacemaker to the heart's chambers. The pacemaker sends electrical signals through the wires to control the speed of the heartbeat. Most pacemakers have a sensor that activates the device only when the heartbeat is abnormal.
An ICD is another small device that's placed in your chest or abdomen. This device also is connected to the heart with wires. It checks your heartbeat for dangerous arrhythmias. If it senses one, it sends an electric shock to the heart to restore a normal heartbeat.
Another type of surgery for arrhythmia is called Maze surgery. In this operation, the surgeon makes new paths (a maze) for the heart's electrical signals to travel through. This type of surgery is used to treat atrial fibrillation, the most common type of serious arrhythmia.
Aneurysm Repair :
An aneurysm is an abnormal bulge or "ballooning" in the wall of an artery or the heart muscle. This bulge happens when the wall weakens. Pressure from blood moving through the artery or heart causes the weak area to bulge out. Over time an aneurysm can grow and can burst, causing dangerous, often fatal bleeding inside the body.
Aneurysms in the heart most often occur in the heart's lower left chamber. They can develop after a heart attack. Repairing an aneurysm involves surgery to replace the weak section of the artery or heart wall with a patch or graft. Ventricular Assist Devices
Ventricular assist devices (VADs) are mechanical pumps that support your heart or take over your heart's pumping action. VADs are used when your heart can't pump enough blood to support your body. You may need a VAD if you have heart failure or if you're waiting for a heart transplant. You can use a VAD for a short time or for months or years, depending on your situation.Read More...
Heart Transplant :
A heart transplant is surgery in which a diseased heart is replaced with a healthy heart from a deceased donor. Heart transplants are done on patients whose hearts are so damaged or weak that they can't pump enough blood to meet the body's needs.
This type of surgery is a life-saving measure that's used when medical treatment and less drastic surgery have failed.
Because donor hearts are in short supply, patients who need a heart transplant go through a careful selection process. They need to be sick enough to need a new heart, yet healthy enough to receive it. Patients on the waiting list for a donor heart receive ongoing treatment for heart failure and other medical conditions. VADs may be used to treat these patients. Surgical Approaches
In recent years, new ways of doing heart surgery have been developed. Depending on a patient's heart problem, general health, and other factors, he or she can now have open-heart surgery or minimally invasive heart surgery.
Open-Heart Surgery :
Open-heart surgery is any kind of surgery where the chest wall is opened and surgeons operate on the heart. "Open" refers to the chest, not the heart. Depending on the type of surgery, the heart may be opened too. Open-heart surgery is used to bypass blocked arteries in the heart, repair or replace heart valves, fix atrial fibrillation, and transplant hearts.
In recent years, more surgeons have started to use off-pump, or beating heart, surgery to do CABG. This approach is like traditional open-heart surgery, but surgeons don't use a heart-lung bypass machine. Off-pump heart surgery may reduce complications that can occur when a heart-lung bypass machine is used. It also may speed up recovery time.
Off-pump heart surgery isn't right for all patients. Your doctor will decide whether you should have this type of surgery. He or she will carefully consider your heart problem, age, overall health, and other factors that may affect the surgery.
Minimally Invasive Heart Surgery :
For minimally invasive heart surgery, a surgeon doesn't make a large incision (cut) down the center of the chest to open the rib cage. Instead, he or she makes small incisions in the side of the chest between the ribs. A heart-lung bypass machine is used in some types of minimally invasive heart surgery, but not others. This newer heart surgery is used for some CABG and Maze procedures. It's also used to repair or replace heart valves and insert pacemakers.
One type of minimally invasive heart surgery that's still being developed is robotic-assisted surgery. For this surgery, a surgeon uses a computer to control surgical tools on thin robotic arms. The tools are inserted through small incisions in the chest. This allows surgeons to perform complex and highly precise surgery. The surgeon is always in total control of the robotic arms; they don't move on their own.
Benefits of minimally invasive heart surgery compared to open-heart surgery include smaller incisions and scars, lower risk of infection, less pain, a shorter hospital stay, and a faster recovery.
Medical Evaluation :-
Your doctors will talk with you about : -
- The kind of heart problem you have, the symptoms it's causing, and how long you have had symptoms
- Your history and past treatment for heart problems, including surgeries, procedures, and medicines
- Your family's history of heart problems
- Your history of other health problems and conditions, such as diabetes or high blood pressure
- Your age and general health
The doctors also may do blood tests, such as a complete blood count, a cholesterol test, and other tests as needed.
Diagnostic Tests :-
Medical tests are done to find out more about your heart problem and your general health. This helps your doctors decide whether you need heart surgery, what type of surgery you need, and when to do it.
EKG (Electrocardiogram) :
An EKG is a simple and painless test that records the electrical activity of your heart. This test is used to help detect and locate the source of heart problems. A technician attaches sticky patches, called electrodes, to the skin of your chest, arms, and legs. The electrodes are attached with wires to a machine that records your heart's electrical signals.An EKG shows how fast your heart is beating and whether its rhythm is steady or irregular. It also shows where in your heart the electrical activity starts, and whether it's traveling through your heart in a normal way.
Stress Test :
Some heart problems are easier to diagnose when your heart is working harder and beating faster than when it's at rest. During stress testing, you exercise (or are given medicine if you're unable to exercise) to make your heart work hard and beat fast. During the stress test, your blood pressure is checked and an EKG is done. Other heart tests also may be performed.
Echocardiography is a painless, noninvasive test. "Noninvasive" means that no surgery is done and no instruments are inserted into your body.
This test uses sound waves to create a moving picture of your heart. Echocardiography provides information about the size and shape of your heart and how well your heart chambers and valves are working. The test also can show areas of poor blood flow to your heart, areas of heart muscle that aren't contracting normally, and previous injury to your heart muscle caused by poor blood flow.
Coronary Angiography :
Coronary angiography (an-jee-OG-ra-fee) uses a special dye to show the insides of your coronary arteries on x-ray pictures. An angiogram shows the location and severity of blockages in blood vessels. To get the dye to your coronary arteries, a procedure called cardiac catheterization is used. Cardiologists usually do cardiac catheterizations in a hospital. You're awake during the procedure, and it usually causes little to no pain.
During this procedure, a catheter (a thin, flexible tube) is passed through an artery in your leg or arm and threaded to your heart. The dye is injected into your bloodstream through the tip of the catheter.
An aortogram is an angiogram of the aorta. The aorta is the main artery that carries blood from your heart to your body. An aortogram may show the location and size of an aortic aneurysm and the arteries that are involved.
Chest X Ray :
A chest x ray provides a picture of the organs and structures inside your chest, including the heart, lungs, and blood vessels. This test gives your doctor information about the size and shape of your heart. A chest x ray also shows the position and shape of the large arteries around your heart.
What To Expect Before Heart Surgery ?
There are many types of heart surgery. The type you need depends on your situation. One person's experience before an operation can be very different from another's.
Some people carefully plan their surgeries with their doctors. They know exactly when and how it will happen. Other people need emergency heart surgery. Others are diagnosed with blocked coronary arteries and are admitted to the hospital right away for surgery as soon as possible. If you're having a planned surgery, you may be admitted to the hospital the afternoon or morning before your surgery. Your doctors and others on your health care team will meet with you to explain what will happen. They will give you instructions on how to prepare for the surgery.
You also may need to have some tests, such as an EKG (electrocardiogram), chest x ray, or blood tests. An intravenous (IV) line will be placed in your arm to give you fluids and medicines. Hair near the incision site may be shaved. Your skin may be washed with special soap to reduce the risk of infection
What To Expect During Heart Surgery ?
Heart surgery is done in a hospital. A team of experts is involved. Cardiothoracic surgeons perform the surgery with a team of other doctors and nurses who assist. The length of time for the surgery depends on the type of surgery. CABG, the most common type of heart surgery, usually takes 3 to 5 hours
Traditional Open-Heart Surgery
For this type of surgery, you're given medicine to make you fall asleep. A doctor checks your heartbeat, blood pressure, oxygen levels, and breathing during the surgery. A breathing tube is placed in your lungs through your throat and connected to a ventilator (breathing machine).
A surgeon makes a 6- to 8-inch incision (cut) down the center of your chest wall. Your chest bone is cut and your rib cage is opened so that the surgeon can get to your heart. You're given medicine to thin your blood and keep it from clotting. A heart-lung bypass machine is connected to your heart. This machine takes over for your heart by replacing the heart's pumping action. A specialist oversees the machine. The bypass machine allows the surgeon to operate on a heart that isn't moving and full of blood.
Recovery in the Hospital ?
Depending on the type of heart surgery, you may spend 1 day or more in the hospital's intensive care unit. Then you will be moved to another part of hospital for several days before you go home.
While you're in the hospital, doctors and nurses will closely watch your heart rate, blood pressure, breathing, vital signs, and incision site(s). You may have an intravenous (IV) needle inserted in your arm to give you fluids until you're ready to drink on your own.
You also may be given extra oxygen through a face mask or nasal prongs that fit just inside your nose. These pieces of equipment are removed when you don't need them any more.
Recovery at Home
Each person responds differently to heart surgery. Your recovery at home also will depend on what kind of heart problem and surgery you had.
Your doctor will give you specific instructions about how to : -
Care for your healing incisions
Recognize signs of infection or other complications
Cope with after-effects of surgery
After-effects of heart surgery are normal. They may include : -
- Muscle pain
- Chest pain
- Swelling (especially if you have an incision in your leg from coronary artery bypass grafting, or CABG)
What Are the Risks of Heart Surgery ?
Heart surgery has risks, even though its results often are excellent. Risks can be from the surgery itself or from the heart-lung bypass machine.
They include : -
Infection, fever, swelling, and other signs of inflammation.
Reaction to the medicine used to make you sleep.
Arrhythmias (irregular heartbeats).
Memory loss and difficulty concentrating or thinking clearly.
Damage to tissues in the heart, kidneys, and lungs.
Death (People who are very sick before the surgery are at higher risk.)
In general, the risks of heart surgery are higher for people who : -
Are older than 70
Have had previous heart surgery
Have diseases or conditions such as high blood pressure, diabetes, kidney disease, lung disease, or peripheral arterial disease
The use of a heart-lung bypass machine increases the risk of blood clots forming in your blood vessels. Clots can travel to the brain or other parts of the body and block the flow of blood. This can cause stroke or other problems. Recent improvements in heart-lung bypass machines are helping to reduce the risk of blood clots forming.
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