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
(chest pain or discomfort, pronounced an-JI-nuh or AN-juh-nuh), 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
(AN-jee-oh-plas-tee) to treat CAD. Talk to your doctor about these different
treatments.
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.
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.
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