Heart surgery

Overview

Cardiac surgery, also known as cardiovascular or heart surgery, encompasses procedures involving the heart and its associated blood vessels, performed by specialized cardiac surgeons. It serves as a crucial intervention for various heart-related issues, including congenital heart diseases and acquired conditions that may develop over time. The specific type of heart surgery required depends on the underlying problem or a combination of issues. While some heart problems can be managed with lifestyle changes, medications, or non-surgical techniques like catheter ablation and coronary angioplasty, surgery becomes necessary in cases such as heart failure, significant coronary artery blockages, faulty heart valves, diseased major blood vessels, and abnormal heart rhythms, offering a potential opportunity for improved heart function and overall well-being.

Types

There are many types of heart surgery. The type of heart surgery you have depends on the condition being treated.

• Coronary artery bypass grafting (CABG): Coronary artery bypass grafting, commonly known as CABG or “cabbage,” is a surgical procedure aimed at treating coronary artery disease (CAD) by bypassing blockages in one or more coronary arteries. The terms “double bypass,” “triple bypass,” or “quadruple bypass” indicate the number of arteries and branches requiring rerouting. In CABG, a healthy blood vessel, often from the arms, chest, or legs, is used to create a new pathway for blood to reach the heart, bypassing the damaged section of the coronary artery. This grafted vessel provides an alternate route for blood flow, supplying oxygen to the heart muscle. Frequently, multiple coronary arteries are addressed in a single surgery, making CABG the most common type of heart surgery, also known as heart bypass or coronary artery bypass surgery.
• Heart valve repair or replacement: Surgeons address heart valve issues through either repair or replacement, using artificial or biological valves derived from pig, cow, or human heart tissue. A repair approach involves inserting a catheter into a major blood vessel, guiding it to the heart, and utilizing a small balloon at the catheter’s tip to widen a narrow valve. Heart valve surgery is employed to manage heart valve disease, ensuring that malfunctioning valves can open more extensively or close more securely. This enables proper blood flow, ensuring it travels in the correct direction to reach its intended destination.
• Aneurysm repair surgery: Aneurysm repair surgery is utilized to address aortic aneurysms in the abdominal and chest areas by replacing the damaged portion of the aorta with a special graft, creating a new, secure pathway for blood flow. On the other hand, left ventricular reconstructive surgery is employed to treat aneurysms that develop within the heart muscle, often stemming from a heart attack. This procedure involves the removal of the aneurysm and any adjacent scar tissue, alleviating symptoms like angina and improving the heart’s pumping function. Both surgeries aim to rectify weak areas in the artery or heart wall, employing patches or grafts to repair balloon-like bulges within the artery or heart muscle.
• Septal myectomy: A septal myectomy is a procedure designed to assist individuals suffering from hypertrophic cardiomyopathy, a condition characterized by the excessive thickening of the heart muscle, often affecting the septum, which is the muscular partition dividing the left and right sides of the heart. During this surgery, a portion of the septum is surgically removed, facilitating increased blood flow from the left ventricle to the aorta and effectively alleviating associated symptoms.
• Heart surgery for atrial fibrillation: In cases where conventional treatments for atrial fibrillation (AFib) prove ineffective, some individuals undergoing heart surgery for other conditions may opt for the MAZE procedure, which can simultaneously address AFib. This sophisticated surgical technique involves creating scar tissue in the heart, effectively obstructing the abnormal electrical signals responsible for AFib and restoring a normal heart rhythm. Notably, the MAZE procedure can be performed using minimally invasive approaches for AFib patients without additional heart issues. By strategically forming scar tissue in the heart’s upper chambers, the procedure redirects electrical signals along a controlled pathway to the lower chambers, effectively preventing the stray electrical signals that lead to atrial fibrillation, the most prevalent form of serious arrhythmia.
• Insertion of a cardiac device: Surgical procedures involving cardiac devices can provide significant benefits to individuals with arrhythmias or heart failure. Different types of devices are designed to address specific cardiac issues:
  • Permanent pacemaker: A permanent pacemaker assists in regulating your heart’s electrical system, ensuring it functions properly. Equipped with sensors, the pacemaker can detect irregular heart rhythms and restore a normal rhythm when necessary.
  • Implantable cardioverter defibrillator (ICD): An ICD is designed to detect potentially life-threatening arrhythmias. When it identifies such rhythms, it administers a safe electric shock to your heart, restoring a normal rhythm and preventing a cardiac crisis.
  • Left ventricular assist device (LVAD): The LVAD aids the left ventricle in pumping blood to your aorta and throughout your body. It is utilized when other treatments for heart failure prove ineffective. Additionally, it enhances the quality of life for individuals with heart failure as they await a heart transplant
  • Total artificial heart (TAH): The TAH temporarily assumes the functions of both your right and left ventricles. This device serves as a short-term solution, often referred to as a “bridge to transplant,” allowing individuals to maintain their strength while awaiting a heart transplant surgery.
• Heart transplant surgery: Heart transplant surgery represents a final option for individuals in the advanced stages of heart failure, necessitating the replacement of their own failing heart with a healthy one from a donor. Due to the scarcity of available donor hearts and the intricate nature of the procedure, heart transplants are relatively rare. The process entails the removal of the diseased heart and its replacement with a healthy heart obtained from a deceased donor.

Reasons for undergoing the procedure

Heart surgery can be planned or needed in emergency situations to treat various heart conditions. These conditions can affect the heart’s structure, rhythm, or blood vessels. Here are some common heart issues that may require surgery:

• Aneurysms: These are bulges in the arterial walls or heart muscles. Aortic aneurysms, which can occur in the large artery carrying blood from the heart (the aorta), can be abdominal or thoracic (in the chest).
• Arrhythmias: These involve irregular heartbeats, which can be too slow (bradycardia), too fast (tachycardia), or irregular in rhythm. Atrial fibrillation is a common abnormal rhythm that can weaken the heart over time.
• Congenital heart disease: Some people are born with heart abnormalities. While some require immediate surgical intervention, others may not show symptoms until later in life, like atrial septal defects.
• Coronary artery disease (CAD): CAD results from the narrowing of coronary arteries due to plaque buildup. These arteries supply oxygen-rich blood to the heart, and surgery may be necessary if there’s a sudden blockage.
• Heart attack: In the event of a heart attack, emergency surgery may be needed to restore blood flow to the heart muscle.
• Heart failure: This condition occurs when the heart can’t effectively pump blood throughout the body. It’s a common reason for hospitalization among older adults and may require surgery if other treatments aren’t effective.
• Heart valve disease: Any of the heart’s four valves (tricuspid, pulmonary, mitral, or aortic) can be affected. Aortic valve issues are the most serious, often requiring surgery. Valves act like little doors, opening to let blood flow through and closing to prevent backflow.

Risk

While heart surgery generally has favorable outcomes, it is not without potential risks and complications, as is the case with any surgical procedure. Some of these possible risks and complications include:

• Stroke
• Bleeding.
• An allergic reaction to anesthesia.
• Development of arrhythmias (irregular heart rhythms).
• Damage to nearby blood vessels or organs.
• Infection at the surgical incision site or within the chest.
• Confusion or cognitive impairment.

It’s important to note that the likelihood of encountering these risks may be elevated if you have pre-existing health conditions such as:

• Obesity.
• Diabetes.
• Kidney disease.
• Peripheral artery disease.
• Chronic obstructive pulmonary disease (COPD).

Furthermore, the use of tobacco and smoking can also heighten the risk of complications both during and after the surgical procedure.

Procedure

Depending on the specific heart condition, surgical intervention may not always be necessary, as advances in medical technology have introduced innovative alternatives. Procedures like percutaneous coronary intervention (PCI) can address blocked coronary arteries, while endovascular aneurysm repair (EVAR) can treat abdominal aortic aneurysms through a leg artery, reducing hospitalization time and facilitating smoother recoveries, particularly for individuals at elevated surgical risks. However, continuous advancements in heart surgery techniques have also made traditional procedures safer and more effective. Optimal outcomes are typically achieved in high-volume hospitals, where surgeons and specialists possess extensive training and experience, equipping them to handle complex cases in high-risk patients. From pre-operative planning to recovery, your care is placed in the capable hands of experts in these specialized institutions.

Before the procedure

Preparing for heart surgery can be a lengthy process, involving an evaluation by your medical team. This team typically consists of your primary care doctor, cardiologist, and cardiothoracic surgeon. During this evaluation, you’ll discuss your symptoms and medical history. Additionally, you will undergo various diagnostic tests to assess your heart’s condition.

These diagnostic tests may include a cardiac computed tomography scan (cardiac CT), cardiac magnetic resonance imaging (heart MRI), chest X-ray, coronary angiography, echocardiogram (echo), electrocardiogram (ECG/EKG), and a stress test. These tests help determine the necessity and type of surgery required.

If surgery is recommended, your care team will provide specific preparation instructions. You should follow their guidance on medication cessation, fasting (not eating or drinking anything) before surgery, and making lifestyle changes such as quitting smoking and reducing alcohol consumption to minimize complications. Don’t hesitate to ask any questions to ensure you’re well-prepared for your surgery.

During the procedure

Before your surgery, you will receive medication to induce relaxation, and you’ll be transported to the operating room on a rolling bed. Once in the operating room, anesthesia will be administered to ensure you feel no pain and have no memory of the procedure. The specifics of what occurs during your surgery will depend on the type of surgery you are undergoing and the method chosen by your surgeon, which can include open-heart surgery, off-pump bypass surgery, or minimally invasive heart surgery. Your healthcare team will thoroughly discuss with you the most suitable approach for your case and provide reasons for their recommendation.

• Open-heart surgery: Open-heart surgery involves a 6-to 8-inch chest incision, with your ribcage spread to access your heart. During the procedure, a heart-lung bypass machine maintains circulation as your heart is temporarily stopped. The duration of this surgery, such as CABG surgery (a common type), typically ranges from three to six hours.
• Off-pump bypass surgery: Off-pump bypass surgery, also known as “beating heart” surgery, is similar to traditional open-heart surgery but excludes the use of a heart-lung bypass machine. It is specifically applicable to CABG surgery and is most suitable when bypassing only one or two coronary arteries is required.
• Minimally invasive heart surgery: Minimally invasive heart surgery, often referred to as “keyhole surgery,” involves smaller incisions to access the heart. It can take two main forms: a partial sternotomy, which entails a 3- to 4-inch incision through a portion of the breastbone (sternum), or a mini-thoracotomy, which avoids the breastbone and utilizes small incisions between the ribs. In some cases, this approach incorporates robotics, where a surgeon, aided by computer and imaging technology, directs pencil-sized robotic arms equipped with surgical tools. These precise robotic movements can reduce both surgery and recovery time while requiring smaller incisions compared to other methods.

After the procedure

Following your heart surgery, you will initially be transferred to the intensive care unit (ICU) for a minimum of one day, after which you will transition to a standard hospital room for ongoing recovery and care. The duration of your hospital stay will be determined by the specific surgery performed and your individual response to it, as each person’s recovery varies. Your dedicated medical team will closely monitor your progress, ensuring proper healing, and promptly addressing any potential issues that may arise during your hospitalization.

Outcome

Recovery from open-heart surgery varies depending on the procedure and individual health factors. Typically, it takes six to 12 weeks, but some may need more time. Follow your medical team’s guidance on resuming activities like driving, work, and heavy lifting, and caring for your incision. Be patient with your body’s healing process.

During recovery, you may experience:

• Chest clicking (usually temporary).
• Bruising or slight swelling at the incision site.
• Constipation.
• Sleep difficulties.
• Reduced appetite and possible nausea.
• Shoulder and upper back pain.
• Emotional changes, such as sadness or moodiness.

These responses are normal, but don’t hesitate to share your feelings with loved ones. If pain persists or worsens, contact your healthcare team.

Long-term, your life expectancy depends on various factors, including overall health and risk factors. Maintaining a healthy lifestyle, adhering to medication regimens, and attending medical appointments are crucial for longevity.

Remember that heart surgery improves your health but doesn’t eliminate risks entirely. If you notice concerning signs like persistent chest pain, fever, nausea, shortness of breath, incision-related issues, or stroke symptoms, contact your healthcare team promptly. When in doubt, seek medical advice rather than ignoring potential complications.