What Is Heart Surgery?
Heart 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.
Heart surgery is used to correct heart problems in
children and adults. This article discusses heart surgeries for adults. For
more information about heart surgeries for children, see the Diseases and
Conditions Index articles on
congenital
heart defects,
holes
in the heart, and
tetralogy
of Fallot.
Overview
The most common type of heart surgery for adults is
coronary
artery bypass grafting (CABG). During CABG, surgeons use healthy arteries
or veins taken from another part of the body to bypass (that is, go around)
blocked arteries. CABG relieves chest pain and reduces the risk of
heart
attack.
Heart surgery also is done to:
- Repair or replace valves that control blood flow
through the heart
- Repair abnormal or damaged structures in the
heart
- Implant medical devices that regulate heart
rhythms or blood flow
- Replace a damaged heart with a healthy heart from
a donor (heart
transplant)
Traditional heart surgery, often called "open heart
surgery," is done by opening the chest wall to operate on the heart. Almost
always, the chest is opened by cutting through a patient's breastbone. Once the
heart is exposed, the patient is connected to a heart-lung bypass machine. The
machine takes over the pumping action of the heart. This allows surgeons to
operate on a still heart.
In recent years, new ways of doing heart surgery
have been developed. One new way is called off-pump, or beating heart, surgery.
It's like traditional open-heart surgery, but it doesn't use a heart-lung
bypass machine.
Minimally invasive heart surgery uses smaller
incisions (cuts) than traditional open-heart surgery. Some types of minimally
invasive heart surgery use a heart-lung bypass machine and others don't.
These new methods may reduce risks and speed up
recovery time. Studies are under way to compare these new types of heart
surgery to traditional open-heart surgery. The results of these studies will
help doctors decide the best procedure to use for each patient.
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.
To understand heart surgery, it's helpful to know
how a normal heart works. See the Diseases and Conditions Index article on
How
the Heart Works for more information.
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.
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 (KAR-de-o-tho-RAS-ik) 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
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 (KATH-e-ter-i-ZA-shun) 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.
Aortogram
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.
Heart-Lung Bypass Machine
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
- Less pain
- Smaller incisions and scars
- A shorter hospital stay and faster recovery
Patients who don't need the heart-lung bypass
machine aren't at risk for the complications that the machine may cause.
What To Expect After Heart Surgery
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:
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.
Ongoing Care
Care after your surgery may include periodic
checkups with your doctor. During these visits, you may have blood tests, an
EKG
(electrocardiogram), an
echocardiography,
or a
stress
test. These tests will show how your heart is working after the
surgery.
Your doctor also may talk to you about lifestyle
changes and medicines to help you stay healthy. Lifestyle changes may include
quitting smoking, making changes in your diet, getting regular physical
activity, and lowering and managing stress.
You doctor may refer you to a cardiac rehabilitation
(rehab) program. Cardiac rehab includes counseling, education, and exercise
training to help you recover. The program also will help you learn how to make
choices that can lower your risk for future heart problems.
What Are the Risks of Heart Surgery?
Heart surgery has risks, even though its results
often are excellent. Risks can be from the surgery itself or from the
heart-lung bypass machine. They include:
- Bleeding.
- Infection, fever, swelling, and other signs of
inflammation.
- Reaction to the medicine used to make you
sleep.
- Arrhythmias
(irregular heartbeats).
- Memory loss and difficulty concentrating or
thinking clearly.
- Damage to tissues in the heart, kidneys, and
lungs.
- Death. (People who are very sick before the
surgery are at higher risk.)
In general, the risks of heart surgery are higher
for people who:
The use of a heart-lung bypass machine increases the
risk of blood clots forming in your blood vessels. Clots can travel to the
brain or other parts of the body and block the flow of blood. This can cause
stroke or other problems. Recent improvements in heart-lung bypass machines are
helping to reduce the risk of blood clots forming.
Key Points
- Heart 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.
- The most common type of heart surgery in adults
is coronary
artery bypass grafting (CABG). During CABG, surgeons use healthy arteries
or veins taken from another part of the body to bypass (that is, go around)
blocked arteries.
- Heart surgery also is done to repair or replace
valves that control blood flow through the heart, repair structures in the
heart, implant devices to regulate heart rhythms, or replace a damaged heart
with a healthy heart from a donor.
- Traditional open-heart surgery is done by opening
the chest wall to operate on the heart. The patient is connected to a
heart-lung bypass machine. This machine takes over the pumping action of the
heart, makes sure the blood gets enough oxygen, and allows surgeons to operate
on a still heart.
- In recent years, new ways of doing heart surgery
have been developed. One new way is off-pump, or beating heart, surgery. This
is like traditional open-heart surgery, but it doesn't use a heart-lung bypass
machine. Minimally invasive heart surgery uses smaller incisions (cuts) than
traditional open-heart surgery. Some types of minimally invasive heart surgery
use a heart-lung bypass machine and others don't.
- Studies are under way to compare new types of
heart surgery to traditional heart surgery.
- Different types of heart surgery are used to fix
different heart problems. Heart surgery is used to bypass blocked arteries,
repair or replace heart valves, treat
arrhythmias
(irregular heartbeats), repair
aneurysms,
treat
angina
(chest pain or discomfort), and replace a diseased heart with a healthy
one.
- Heart surgery is used to treat people who have
severe heart diseases and conditions when other treatments have failed.
- Your doctors will determine whether you need
heart surgery based on the kind of heart problem you have, your history and
past treatment for heart problems, your family's history of heart problems,
whether you have other health conditions, your age, and your general
health.
- What happens before, during, and after heart
surgery depends on the type of surgery you have. CABG, the most common type of
heart surgery, usually takes 3 to 5 hours.
- After surgery, your doctor will let you know how
to care for yourself. You may need followup medical care, lifestyle changes,
medicines, or cardiac rehabilitation.
- The risks of heart surgery include bleeding,
infection, fever, reaction to the medicine used to make you sleep, irregular
heartbeats, and death. (The risk of death is higher in people who are already
very sick.) Use of a heart-lung bypass machine can cause blood clots to form in
your blood vessels and block blood flow.
- The results of heart surgery often are excellent.
For very ill people who have severe heart problems, heart surgery can reduce
symptoms, improve quality of life, and increase lifespan.
Links to Other Information About Heart Surgery
NHLBI Resources
Non-NHLBI Resources
Clinical Trials
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