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.
Who Needs Heart Surgery ?
Heart surgery is used to treat people who have severe heart diseases and conditions. If other treatments, such as lifestyle changes, medicines, and medical procedures, haven't worked or can't be used, heart surgery may be an option.
Heart surgery is used to treat heart failure and coronary artery disease. It's also used to fix heart valves that don't work right, to regulate heart rhythms, and to replace a damaged heart with a healthy one. Specialists Involved
Your primary care doctor, a cardiologist, and a cardiothoracic surgeon will decide whether you need heart surgery. A cardiologist specializes in treating heart problems. A cardiothoracic surgeon specializes in surgery on the heart and lungs.
These doctors will talk with you and do tests to learn about your general health and your heart problem. They'll discuss test results with you, and you will help make decisions about the surgery
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.
Cardiac Computed Tomography Scan :
A cardiac computed tomography (CT) scan provides computer-generated, x-ray images of your internal organs. A liquid dye that can be seen on an x ray is injected into a vein in your arm. The dye outlines arteries and veins in your heart on the CT scan. A cardiac CT scan can show whether plaque is narrowing your coronary arteries or whether you have an aneurysm. A CT scan also can find problems with heart function and heart valves.
Cardiac Magnetic Resonance Imaging :
Cardiac magnetic resonance imaging (MRI) is a safe and noninvasive test that uses magnets and radio waves to create images of the inside of your body. Cardiac MRI uses a computer to create images of your heart as it's beating. The computer makes both still and moving pictures of your heart and major blood vessels.
Cardiac MRI shows the structure and function of your heart. This test is very accurate at finding aneurysms and determining their size and exact location.
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.
Just before the surgery, you will be moved to the operating room. You will be given medicine so that you fall asleep and feel no pain during the surgery.
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.
The illustration shows a heart-lung bypass machine attached to a heart during surgery.
You're given medicines to stop your heartbeat once you're connected to the heart-lung bypass machine. A pipe is placed in your heart to drain blood to the machine. The machine removes carbon dioxide (a waste product) from your blood, adds oxygen, and then pumps the blood back into your body. Tubes are inserted into your chest to drain fluid.
Once the bypass machine begins to work, the surgeon performs the surgery to repair your heart problem. At the end of the surgery, your heart is restarted using mild electric shocks. The pipes and tubes are removed from your heart, and the heart-lung bypass machine is stopped. You're given medicine to allow your blood to clot again. Your chest bone is closed with wires. Stitches or staples are used to close the incision. The breathing tube is removed.
An advantage of traditional open-heart surgery is that it's easier for the surgeon to operate. This is very important for long and complex surgeries
Off-Pump Heart Surgery
This type of surgery is the same as traditional open-heart surgery, except you aren't connected to a heart-lung bypass machine. Instead, your heart is steadied with a mechanical device while the surgeon works on it. Your heart continues to pump blood to your body.
The advantages of off-pump heart surgery are : -
No complications related to using a heart-lung bypass machine
Faster recovery from the surgery
Minimally Invasive Heart Surgery
For this type of heart surgery, the surgeon makes small incisions in the side of your chest between the ribs. These incisions can be as small as 2 to 3 inches. Then the surgeon inserts surgical tools through these small incisions. A tool with a small video camera at the tip also is inserted through an incision. This allows the surgeon to see inside the body.
Some types of minimally invasive heart surgery use a heart-lung bypass machine; other types don't.
The advantages of minimally invasive heart surgery are : -
Less bleeding during surgery and a lower chance of needing a blood transfusion
Lower risk of infection
Smaller incisions and scars
A shorter hospital stay and faster recovery
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
You also will get information about followup appointments, medicines, and situations when you should call the doctor right away.
After-effects of heart surgery are normal, They may include : -
Swelling (especially if you have an incision in your leg from coronary artery bypass grafting, or CABG)
Other after-effects may include loss of appetite, difficulty sleeping, constipation, and mood swings and depression. After-effects gradually go away.
Recovery time varies with type of heart surgery. Full recovery from traditional open-heart CABG may take 6 to 12 weeks or more. Less recovery time is needed for off-pump heart surgery and minimally invasive heart surgery. Your doctor will let you know when you can go back to your daily activities, such as working, driving, and physical activity.
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