Heart or 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 arteries bypass grafting), correct congenital heart diseases, or treat valvular heart diseases created by various causes including endocarditis. It also includes heart transplantation.
Coronary Artery Bypass Grafting
Coronary artery bypass grafting (CABG) is the most common type of heart surgery. CABG improves blood flow to the heart. This surgery is used for people who have severe coronary heart disease (CHD), also called coronary artery disease.
In CHD, a fatty material called plaque (plak) builds up inside your coronary (heart) arteries. Plaque narrows the arteries and limits blood flow to your heart muscle. CHD can cause angina (an-JI-nuh or AN-juh-nuh), shortness of breath, and heart attack. (Angina is chest pain or discomfort.)
During CABG, a surgeon takes a vein or an artery from your chest, 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 multiple blocked coronary arteries during one surgery.
Sometimes you can choose between CABG and angioplasty (AN-jee-oh-plas-tee) to treat CHD. Angioplasty is a procedure in which a balloon is used to open a blocked coronary artery.
During angioplasty, your doctor may place a stent (a small mesh tube) in the treated portion of the coronary artery. The stent supports the artery wall and reduces the chance of the artery becoming blocked again. Talk with your doctor about these treatment options.
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, a 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.
Heart Valve Repair or Replacement
For the heart to work right, blood must flow in only one direction. The heart 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 flowing back into the chambers.
Heart surgery is done to fix leaflets that don't open as wide as they should. This can happen if they become thick or stiff or fuse together. As a result, not enough blood flows through the valve into the artery.
Heart surgery is also done to fix leaflets that don't close tightly. If the leaflets don't close tightly, blood can leak backward into the heart chambers, rather than only moving forward into the arteries as it should.
To fix these problems, surgeons either repair the valve or replace it. Replacement valves are taken from animals or made from human tissue or man-made materials.
To repair a mitral (MI-trul) or pulmonary (PULL-mun-ary) valve that's too narrow, a surgeon will insert a catheter (a thin, flexible tube) through a large blood vessel and guide it to the heart. This procedure is called cardiac catheterization (KATH-e-ter-i-ZA-shun).
The surgeon will place the end of the catheter inside the narrowed valve. He or she will rapidly inflate and deflate a small balloon at the tip of the catheter. This widens the valve, allowing blood to flow through it to the artery. This approach is less invasive than open-heart surgery.
Researchers are also testing new ways to use catheters in other types of valve surgeries. For example, catheters may be used to place clips on the mitral valve leaflets to hold them in place or to replace a valve that doesn't work well.
Only a few medical centers are doing these experimental procedures. However, the results may lead to improved heart surgery approaches.
Arrhythmia Treatment
An arrhythmia (ah-RITH-me-ah) is a problem with the rate 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 usually are treated with medicine first. If medicine doesn't work well enough, you may need surgery. For example, your doctor may use surgery to implant 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 connect the pacemaker to your heart chambers. The pacemaker sends electrical signals through the wires to control your heart rhythm. Most pacemakers have a sensor that activates the device only when your heart rhythm is abnormal.
An ICD is another small device that's placed in your chest or abdomen. This device will connect to your heart with wires. An ICD checks your heartbeat for dangerous arrhythmias. If it senses one, it sends an electric shock to your heart to restore a normal heart rhythm.
Another type of surgery for arrhythmia is called maze surgery. In this operation, the surgeon makes new paths 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.
Simpler, less invasive procedures also are used to treat atrial fibrillation. These procedures use high heat or intense cold to prevent abnormal electrical signals moving through the heart. This helps the heart's electrical signals move through the proper pathway.
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.
Over time, an aneurysm can grow and burst, causing dangerous, often fatal bleeding inside the body.
Aneurysms in the heart most often occur in the heart's lower left chamber (the left ventricle). Repairing an aneurysm involves surgery to replace the weak section of the artery or heart wall with a patch or graft.
Heart Transplant
A heart transplant is surgery to remove a person's diseased heart and replace it with a healthy heart from a deceased donor. Your doctor may recommend a heart transplant if your heart is so damaged or weak that it can't pump enough blood to meet your body's needs. This condition is called heart failure.
This type of surgery is a life-saving measure that's used when medical treatment and less drastic surgery have failed.
Patients on the waiting list for a donor heart receive ongoing treatment for heart failure and other medical conditions. Ventricular assist devices (VADs) may be used to treat these patients.
Ventricular Assist Devices
VADs are mechanical pumps that are used to support heart function and blood flow in people who have weakened hearts.
Your doctor may recommend 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.
Surgical Approaches
Depending on a patient's heart problem, general health, and other factors, he or she can have open-heart surgery or minimally invasive heart surgery.
Open-Heart Surgery
Open-heart surgery is any kind of surgery in which a surgeon makes a large incision (cut) in the chest to open the rib cage and operate on the heart. "Open" refers to the chest, not the heart. Depending on the type of surgery, the surgeon also may open the heart.
Open-heart surgery is used to bypass blocked arteries in the heart, repair or replace heart valves, treat atrial fibrillation, and do heart transplants.
Increasing numbers of 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 isn't right for all patients. Work with your doctor to decide whether this type of surgery may benefit you. Your doctor 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 makes small incisions in the side of the chest between the ribs. A heart-lung bypass machine sometimes is used for some types of minimally invasive heart surgery.
Minimally invasive heart surgery is used for some CABG and maze procedures. It's also used to repair or replace heart valves and insert pacemakers or ICDs.
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 the surgeon to do complex and highly precise surgery. The robotic arms are always in total control of surgeons ; they don't move on their own.