Heart Surgery

Also called: Cardiac surgery

Each day, thousands of people in the U.S. have heart surgery. There are many different types of heart surgery. Surgeries may be used to

• Repair or replace the valves that control blood flow through the heart's chambers
• Bypass or widen blocked or narrowed arteries to the heart
• Repair aneurysms, or bulges in the aorta, which can be deadly if they burst
• Implant devices to regulate heart rhythms
• Destroy small amounts of tissue that disturb electrical flow through the heart
• Make channels in the heart muscle to allow blood from a heart chamber directly into the heart muscle
• Boost the heart's pumping power with muscles taken from the back or abdomen
• Replace the damaged heart with a heart from a donor

Outlook

The results of heart surgery in adults are often excellent. For very ill people with severe heart problems, heart surgery can reduce symptoms, improve quality of life, and increase lifespan.

Types of Heart 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 the United States. 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 (plak) 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.

Transmyocardial Laser Revascularization

Transmyocardial (tranz-mi-o-KAR-de-al) laser revascularization (re-VAS-kyu-lar-i-ZA-shun), 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 (ah-RITH-me-ah) 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 (AN-u-rism) 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.

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.

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.

Cholesterol-Lowering Medications

If you have an LDL level of 130 mg/dL or greater, you will generally need to take an LDL-lowering medicine. If your LDL level is 100 to 129 mg/dl, your doctor will consider all the facts of your case in deciding whether to prescribe medication for further LDL lowering or for high triglycerides and/or low HDL if they are present. If you have been hospitalized for a heart attack, your doctor will likely start you on a medication at discharge if your LDL-cholesterol is 130 mg/dl or greater. If your LDL-cholesterol is between 100 and 129 mg/dl during your hospitalization, your doctor may choose to start you on an LDL-lowering medication before you are discharged. Also, if your LDL-cholesterol is far above the goal level of less than 100 mg/dl when first measured, your doctor may choose to start a cholesterol-lowering medication together with diet and physical activity right from the beginning of treatment. If your doctor prescribes medicine, you also will need to:

• Follow your cholesterol-lowering diet.
• Be more physically active.
• Lose weight if overweight.
• Control all of your other heart disease risk factors, including smoking, high blood pressure, and diabetes.

Taking all these steps together may lessen the amount of medicine you need or make the medicine work better - and that reduces your risk for a heart attack. The following is a description of cholesterol-lowering medicines.

• Statins
• Bile Acid Sequestrants
• Nicotinic Acid
• Fibrates

Other Drugs

• Hormone Replacement Therapy
• Combination Drug Therapy
• Other medications commonly prescribed for heart disease

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