Excerpted from “Heart Surgery,” by the National Heart,Lung, and Blood Institute (NHLBI, www.nhlbi.nih.gov), part of the National Institutes of Health, September 2007. 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 text discusses heart surgeries for adults.
Overview
The most common form of heart surgery for adults is coronary artery bypass grafting (CABG). throughout CABG, surgeons use healthy arteries or veins taken from another a part of the body to bypass (that is, go around) blocked arteries. CABG relieves chest pain and reduces the chance of heart attack.
Heart surgery is also done to perform the following:
• Repair or replace valves that management blood flow through the center
• Repair abnormal or broken structures within the heart
• Implant medical devices that regulate heart rhythms or blood flow
• Replace a broken heart with a healthy heart from a donor
(heart transplant) ancient heart surgery, typically referred to as “open heart surgery,” is finished by gap the chest wall to control on the center. nearly always, the chest is opened by cutting through a patient’s breastbone. Once the center is exposed, the patient is connected to a heart-lung bypass machine. The machine takes over the pumping action of the center. this permits surgeons to control on a still heart.
In recent years, new ways that of doing heart surgery are developed. One new manner is termed off-pump, or beating heart, surgery. It’s like ancient open-heart surgery, however it does not use a heart-lung by pass machine. Minimally invasive heart surgery uses smaller incisions (cuts) than ancient open-heart surgery. Some styles of minimally invasive heart surgery use a heart-lung bypass machine and others don’t.
These new ways could cut back risks and speed up recovery time. Studies are underneath thanks to compare these new styles of heart surgery to ancient open-heart surgery. The results of those studies can facilitate doctors decide the most effective procedure to use for every patient.
Outlook
The results of heart surgery in adults are typically wonderful. For terribly unwell folks with severe heart issues, heart surgery will cut back symptoms, improve quality of life, and increase lifespan.
Types of Heart Surgery
Different types of heart surgery are used to repair totally different heart issues.
Coronary Artery Bypass Grafting
Coronary artery bypass grafting (CABG) is that the most typical form of heart surgery. over five hundred,000 of those surgeries are done every year within the u. s.. CABG improves blood flow to the center. It’s used for folks with severe coronary artery disease (CAD). In CAD, a fatty material referred to as plaque builds up within your coronary (heart) arteries. It narrows the arteries and limits blood flow to your heart muscle. CAD will cause angina (chest pain or discomfort), shortness of breath, and might even result in a heart attack. throughout CABG, a surgeon takes a vein or an artery from your chest, your leg, or another a part of your body and connects, or grafts, it to the blocked artery. The grafted artery bypasses (that is, goes around) the blockage. this permits oxygen-rich blood to achieve the center muscle. Surgeons will bypass as several as four blocked coronary arteries throughout one surgery. generally you'll be able to choose from CABG and angioplasty to treat CAD. check with your doctor regarding these totally different treatments. Transmyocardial Laser Revascularization Transmyocardial laser revascularization, or TLR, could be a surgery used to treat angina when no alternative treatments work. as an example, if you've got already had one CABG procedure and can’t have another one, TLR could also be an choice. this kind of heart surgery isn’t common. During TLR, the surgeon uses lasers to create channels within the heart muscle. These channels permit oxygen-rich blood to flow from a heart chamber directly into the center muscle.
Valve Repair or Replacement
For the center to figure right, blood should flow in just one direction. The heart’s valves create this potential. Healthy valves open and shut in an exceedingly precise manner because the heart pumps blood. every valve contains a set of flaps referred to as leaflets. The leaflets open to permit blood to pass from the center chambers into the arteries. Then the leaflets shut tightly to prevent blood from flowing into the chambers.
Heart surgery is finished to repair leaflets that don’t open as wide as they ought to. this could happen once they become thick or stiff or fuse along. As a result, not enough blood flows through the valve into the artery. Heart surgery is also done to repair leaflets that don’t shut tightly. this implies blood will leak backward into the chambers, instead of solely moving forward into the artery because it ought to. to repair these issues, surgeons either repair the valve or replace it. Replacement valves are taken from animals, made up of human tissue, or made up of man-made substances.
Arrhythmia Treatment
An arrhythmia could be a downside with the speed or rhythm of the heart-beat. throughout an arrhythmia, the center will beat too quick, too slow, or with an irregular rhythm. Most arrhythmia's are harmless, however some may be serious or perhaps life threatening. When the center rate is abnormal, the center might not be able to pump enough blood to the body. Lack of blood flow will dam- age the brain, heart, and alternative organs. Arrhythmia's are sometimes treated with medication initial. If medicines don’t work well enough, you will want surgery. as an example, your doctor could use surgery to grant you a pacemaker or an implantable cardiovascular defibrillator (ICD).
A pacemaker could be a little device that’s placed underneath 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 regulate the speed of the heartbeat. Most pacemakers have a sensor that activates the device solely when the heartbeat is abnormal. An ICD is another little device that’s placed in your chest or abdomen. This device is also connected to the center with wires. It checks your heartbeat for dangerous arrhythmia's. If it senses one, it sends an electrical shock to the center to revive a traditional heartbeat. Another form of surgery for arrhythmia is termed Maze surgery. during this operation, the surgeon makes new methods (a maze) for the heart’s electrical signals to travel through. this kind of surgery is employed to treat atrial fibrillation, the foremost common form of serious arrhythmia.
Aneurysm Repair
An aneurysm is an abnormal bulge or “ballooning” within the wall of an artery or the center muscle. This bulge happens when the wall weakens. Pressure from blood moving through the artery or heart causes the weak space to bulge out. Over time an aneurysm will grow and might burst, inflicting dangerous, typically fatal bleeding within the body. Aneurysms within the heart most frequently occur within the heart’s lower left chamber. they'll develop when a heart attack. Repairing an aneurysm involves surgery to switch 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 will want a VAD if you have got heart failure or if you’re watching for a heart transplant. you'll be able to use a VAD for a brief time or for months or years, betting on your scenario.
Heart Transplant
A heart transplant is surgery within which a diseased heart is replaced with a healthy heart from a deceased donor. Heart transplants are done on patients whose hearts are therefore broken or weak that they can’t pump enough blood to satisfy the body’s desires. this kind of surgery could be a life-saving live that’s used when medical treatment and fewer drastic surgery have failed. as a result of donor hearts are briefly provide, patients who want a heart transplant undergo a careful choice method. they have to be sick enough to wish a brand new heart, nevertheless healthy enough to receive it.
Patients on the waiting list for a donor heart receive ongoing treatment for heart failure and alternative medical conditions. VADs could also be used to treat these patients.
Surgical Approaches
In recent years, new ways that of doing heart surgery are developed. betting on a patient’s heart downside, general health, and alternative factors, he or she will currently have open-heart surgery or minimally invasive heart surgery.
Open-heart surgery:
Open-heart surgery is any quite surgery where the chest wall is opened and surgeons operate on the center. “Open” refers to the chest, not the center. betting on the kind of surgery, the center could also be opened, too. Open-heart surgery is employed to bypass blocked arteries within the heart, repair or replace heart valves, fix atrial fibrillation, and transplant hearts.
In recent years, additional surgeons have began to use off-pump, or beating heart, surgery to try and do CABG. This approach is like ancient open-heart surgery, however surgeons don’t use a heart-lung bypass machine. Off-pump heart surgery could cut back complications that may occur when a heart-lung bypass machine is employed. It additionally could speed up recovery time. Off-pump heart surgery is not right for all patients. Your doctor can decide whether or not you must have this kind of surgery. He or she's going to rigorously think about your heart downside, age, overall health, and alternative factors that will have an effect on the surgery.
Minimally invasive heart surgery:
For minimally invasive heart surgery, a surgeon does not create an oversized incision (cut) down the middle of the chest to open the rib cage. Instead, he or she makes little incisions within the aspect of the chest between the ribs. A heart-lung bypass machine is employed in some styles of minimally invasive heart surgery, however not others. This newer heart surgery is employed for a few CABG and Maze procedures. It’s additionally used to repair or replace heart valves and insert pace-makers. One form of minimally invasive heart surgery that’s still being developed is robotic-assisted surgery. For this surgery, a surgeon uses a laptop to regulate surgical tools on skinny robotic arms. The tools are inserted through little incisions within the chest. this permits surgeons to perform complicated and highly precise surgery. The surgeon is usually in total management of the robotic arms; they don’t move on their own. advantages of minimally invasive heart surgery compared to open heart surgery embrace smaller incisions and scars, lower risk of infection, less pain, a shorter hospital keep, and a faster recovery.
What to Expect before Heart Surgery
There are many sorts of heart surgery. the kind you would like depends on your scenario. One person’s expertise before an operation may be terribly totally different from another’s. Some folks rigorously arrange their surgeries with their doctors. They apprehend precisely when and the way it'll happen. people want emergency heart surgery. Others are diagnosed with blocked coronary arteries and are admitted to the hospital promptly for surgery as soon as potential. If you’re having a planned surgery, you will be admitted to the hospital the afternoon or morning before your surgery. Your doctors and others on your health care team can meet with you to clarify what's going to happen. they'll offer you directions on the way to prepare for the surgery.
You also may have to own some tests, like an EKG (electrocardiogram), chest x-ray, or blood tests. An intravenous (IV) line are placed in your arm to grant you fluids and medicines. Hair close to the incision website could also be shaved. Your skin could also be washed with special soap to scale back the chance of infection. simply before the surgery, you'll be moved to the operating area. you'll be given medication so you go to sleep and feel no pain throughout the surgery.
What to Expect throughout Heart Surgery
Heart surgery is finished in an exceedingly hospital. A team of specialists is concerned. Cardiothoracic surgeons perform the surgery with a team of alternative doctors and nurses who assist. The length of your time for the surgery depends on the kind of surgery. CABG, the foremost common form of heart surgery, sometimes takes three to five hours.
Traditional Open-Heart Surgery
For this kind of surgery, you’re given medication to create you go to sleep. A doctor checks your heartbeat, blood pressure, oxygen levels, and respiratory throughout the surgery. A respiratory 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 middle of your chest wall. Your chest bone is cut and your rib cage is opened so the surgeon will get to your heart. You’re given medication to skinny 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 permits the surgeon to control on a heart that won't moving and filled with blood. You’re given medicines to prevent your heartbeat once you’re connected to the heart-lung bypass machine. A pipe is placed in your heart to empty blood to the machine. The machine removes carbon dioxide (a waste product) from your blood, adds oxygen, and then pumps the blood into your body. Tubes are inserted into your chest to empty fluid. Once the bypass machine begins to figure, the surgeon performs the surgery to repair your heart downside. At the top of the surgery, your heart is restarted using gentle electrical shocks. The pipes and tubes are faraway from your heart, and also the heart-lung bypass machine is stopped. You’re given medication to permit your blood to clot once more.
Your chest bone is closed with wires. Stitches or staples are used to shut the incision. The respiratory tube is removed. a plus of ancient open-heart surgery is that it’s easier for the surgeon to control. this can be important for long and sophisticated surgeries.
Off-Pump Heart Surgery
This type of surgery is that the same as ancient open-heart surgery, except you are not connected to a heart-lung bypass machine. Instead, your heart is steadied with a machine whereas the surgeon works on it. Your heart continues to pump blood to your body. the benefits of off-pump heart surgery are that there aren't any complications associated with employing a heart-lung bypass machine and there's faster recovery from the surgery.
Minimally Invasive Heart Surgery
For this kind of heart surgery, the surgeon makes little incisions within the aspect of your chest between the ribs. These incisions may be as little as two to three inches. Then the surgeon inserts surgical tools through these little incisions. A tool with alittle video camera at the tip is also inserted through an incision. this permits the surgeon to check within the body.
Some styles of minimally invasive heart surgery use a heart-lung bypass machine; alternative sorts don’t.
The advantages of minimally invasive heart surgery are the following:
• Less bleeding throughout surgery and a lower likelihood of needing a blood transfusion
• Lower risk of infection
• Less pain
• Smaller incisions and scars
• A shorter hospital keep and faster recovery
Patients who don’t want the heart-lung bypass machine aren’t in danger for the complications that the machine could cause.
What to Expect when Heart Surgery
Recovery within the Hospital
Depending on the kind of heart surgery, you will pay one day or additional within the hospital’s intensive care unit. Then you'll be moved to a different a part of hospital for many days before you go home. whereas you’re within the hospital, doctors and nurses can closely watch your heart rate, blood pressure, breathing, important signs, and incision site(s). you will have an intravenous (IV) needle inserted in your arm to grant you fluids till you’re able to drink on your own. you furthermore mght could also be given further oxygen through a face mask or nasal prongs that match simply within your nose. These items of apparatus are removed after you don’t want them to any extent further.
Recovery at Home
Each person responds differently to heart surgery. Your recovery at home additionally can depend upon what quite heart downside and surgery you had. Your doctor can offer you specific directions regarding the way to look after your healing incisions, acknowledge signs of infection or alternative complications, and address after-effects of surgery. you furthermore mght can get info regarding followup appointments, medicines, and things after you ought to decision the doctor promptly. After-effects of heart surgery are traditional. they will embrace the following:
• Muscle pain
• Chest pain
• Swelling (especially if you have got an incision in your leg from coronary artery bypass grafting, or CABG) alternative after-effects could embrace loss of appetite, issue sleeping, constipation, and mood swings and depression. After-effects gradually depart. Recovery time varies with form of heart surgery. Full recovery from ancient open-heart CABG could take half dozen to twelve weeks or additional. Less recovery time is required for off-pump heart surgery and minimally invasive heart surgery. Your doctor can allow you to apprehend after you will return to your daily activities, like operating, driving, and physical activity.
