Heart surgery is used for both children and adults. This article discusses heart surgery for adults. For more information about heart surgery for children, go to the Health Topics articles about congenital heart defects , holes in the heart , and tetralogy of Fallot. The most common type of heart surgery for adults is coronary artery bypass grafting CABG. During CABG, a healthy artery or vein from the body is connected, or grafted, to a blocked coronary heart artery. The grafted artery or vein bypasses that is, goes around the blocked portion of the coronary artery.
This creates a new path for oxygen-rich blood to flow to the heart muscle. CABG can relieve chest pain and may lower your risk of having a heart attack. Traditional heart surgery, often called open-heart surgery, is done by opening the chest wall to operate on the heart. The surgeon cuts through the patient's breastbone or just the upper part of it to open the chest.
Once the heart is exposed, the patient is connected to a heart-lung bypass machine. The machine takes over the heart's pumping action and moves blood away from the heart. This allows the surgeon to operate on a heart that isn't beating and that doesn't have blood flowing through it. Another type of heart surgery is called off-pump, or beating heart, surgery. It's like traditional open-heart surgery because the chest bone is opened to access the heart. However, the heart isn't stopped, and a heart-lung bypass machine isn't used.
Off-pump heart surgery is limited to CABG. Surgeons can now make small incisions cuts between the ribs to do some types of heart surgery. The breastbone is not opened to reach the heart. This is called minimally invasive heart surgery. This type of heart surgery may or may not use a heart-lung bypass machine. Newer methods of heart surgery such as off-pump and minimally invasive may reduce risks and speed up recovery time.
Studies are under way to compare these types of heart surgery with traditional open-heart surgery. The results of heart surgery in adults often are excellent. Heart surgery can reduce symptoms, improve quality of life, and improve the chances of survival.
To understand heart surgery, it's helpful to know how a normal heart works. Coronary artery bypass grafting CABG is the most common type of heart surgery. CABG improves blood flow to the heart. CHD is a disease in which a waxy substance called plaque plak builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart. Over time, plaque can harden or rupture break open.
Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause chest pain or discomfort called angina an-JI-nuh or AN-juh-nuh. If the plaque ruptures, a blood clot can form on its surface.
A large blood clot can mostly or completely block blood flow through a coronary artery. This is the most common cause of a heart attack. Over time, ruptured plaque also hardens and narrows the coronary arteries. During CABG, a healthy artery or vein from the body is connected, or grafted, to the blocked coronary artery.
Figure A shows the location of the heart. Figure B shows how vein and artery bypass grafts are attached to the heart. A nonsurgical procedure that opens blocked or narrow coronary arteries is percutaneous coronary intervention PCI , also known as coronary angioplasty. During PCI, a thin, flexible tube with a balloon at its tip is threaded through a blood vessel to the narrow or blocked coronary artery.
Once in place, the balloon is inflated to push the plaque against the artery wall. This restores blood flow through the artery. During PCI, a stent might be placed in the coronary artery to help keep it open.
A stent is a small mesh tube that supports the inner artery wall. TMR is most often used when no other treatments work. During TMR, a surgeon uses lasers to make small channels through the heart muscle and into the heart's lower left chamber the left ventricle.
It isn't fully known how TMR relieves angina. The surgery may help the heart grow tiny new blood vessels. Oxygen-rich blood may flow through these vessels into the heart muscle, which could relieve angina. For the heart to work well, 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 one heart chamber into another or into the arteries. Then the leaflets close tightly to stop blood from flowing backward. Heart surgery is used 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. Heart surgery also is used to fix leaflets that don't close tightly.
This problem can cause blood to leak back 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 with a man-made or biological valve.
Biological valves are made from pig, cow, or human heart tissue and may have man-made parts as well. To repair a mitral MI-trul or pulmonary PULL-mun-ary valve that's too narrow, a cardiologist heart specialist will insert a catheter a thin, flexible tube through a large blood vessel and guide it to the heart.
The cardiologist will place the end of the catheter inside the narrow valve. He or she will inflate and deflate a small balloon at the tip of the catheter. This widens the valve, allowing more blood to flow through it. This approach is less invasive than open-heart surgery. Researchers also are testing new ways to use catheters in other types of valve surgeries. For example, catheters might be used to place clips on the mitral valve leaflets to hold them in place.
Catheters also might be used to replace faulty aortic valves. For this procedure, the catheter usually is inserted into an artery in the groin upper thigh and threaded to the heart. In some cases, surgeons might make a small cut in the chest and left ventricle the lower left heart chamber.
They will thread the catheter into the heart through the small opening. The catheter has a deflated balloon at its tip with a folded replacement valve around it. The balloon is used to expand the new valve so it fits securely within the old valve. Currently, surgery to replace the valve is the traditional treatment for reasonably healthy people. However, catheter procedures might be a safer option for patients who have conditions that make open-heart surgery very risky.
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. Many arrhythmias are harmless, but some can be serious or even life threatening. Incision care is extremely important. Keep your incision site warm and dry, and wash your hands before and after touching it.
If your incision is healing properly and there is no drainage, you can take a shower. Pain management is also incredibly important, as it can increase recovery speed and decrease the likelihood of complications like blood clots or pneumonia.
You may feel muscle pain , throat pain , pain at incision sites, or pain from chest tubes. Your doctor will likely prescribe pain medication that you can take at home. Some doctors recommend taking the pain medication both before physical activity and before you sleep. To get better sleep, you can:. In the past, some have argued that open-heart surgery leads to a decline in mental functioning. However, most recent research has found that not to be the case. Some people do experience depression or anxiety after open-heart surgery.
A therapist or psychologist can help you manage these effects. This is usually done outpatient with visits several times a week. The components to the program include exercise, reducing risk factors, and dealing with stress , anxiety , and depression. Expect a gradual recovery. It may take up to six weeks before you start feeling better, and up to six months to feel the full benefits of the surgery.
However, the outlook is good for many people, and the grafts can work for many years. Nevertheless, surgery does not prevent artery blockage from happening again. You can help improve your heart health by:. Learn about the process of valve replacement surgery for heart disease, the types of replacement valves, the procedure, survival rate, and recovery. During a heart attack, blood supply that normally nourishes the heart with oxygen is cut off and the heart muscle begins to die.
A small incision is necessary. Most heart surgeries are major surgeries. Although often successful, they do entail risks. The risk is higher if you have other diseases or conditions, such as diabetes, peripheral artery disease, or kidney or lung disease. A specially trained physician anesthesiologist, called a cardiac, cardiothoracic, or cardiovascular anesthesiologist, is involved in your care before, during, and after surgery. A cardiac anesthesiologist is also a pain management specialist for conditions related to surgery.
Your anesthesiologist will talk to you about your options for managing post-operative pain. Before your surgery, the anesthesiologist may ask about your pain tolerance to help gauge how best to manage your post-operative pain, guiding decisions such as the proper narcotics dosage, the feasibility of nonnarcotic pain medication options, and the need for nerve blocks.
Although most heart surgeries are major surgeries, they are typically not a source of long-term pain. Even in the short term, the pain may be less severe than with operations on other areas of the body. Opioids are used when necessary, but there are many other pain management options, including:. Then you will be moved to another part of the hospital for several days until you go home. The National Heart, Lung, and Blood Institute notes that the length of your recovery time at home will depend on the type of surgery you had, your overall health before the surgery, and whether you experienced any complications from surgery.
For example, full recovery from a traditional coronary artery bypass may take six to 12 weeks or more. Physician anesthesiologists are the most highly skilled medical experts in anesthesia care, pain management, and critical care medicine. They have the education and training that, in some circumstances, can mean the difference between life and death. Skip to content. Step 4: Stitching Up the Skin. For Dr. Jai Raman , an open heart was love at first sight. Twenty years later, he vividly remembers when he was a surgical resident seeing his first open chest cavity, a beating heart before him.
Raman, who is a cardiac and thoracic surgeon at the University of Chicago Medical Center, helped develop "the wrap procedure," or ventricular containment.
This procedure uses a mesh bag to stop the heart from enlarging; it's mainly used in patients with heart failure.
He has performed more than heart operations and more than thoracic procedures such as removal of part of a lung. Here, Raman walks us through the basics of a surgical how-to. It should go without saying, but: Don't try this at home. Step 1: Sawing Through the Sternum. Anesthetic doses given for heart surgeries are standard for any major surgery—and have a component of analgesia, sedation and paralysis. All cardiac and respiratory parameters are carefully monitored and, once the patient is under, the surgeon gets out the saw.
The heart rests beneath the sternum--the organ's skeletal armor and the central bone to which ribs are attached. Cracking this bone requires pressure, power and precision but only about 30 seconds.
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