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What is heart surgery? Heart surgery includes major operations such as heart bypass surgery, transmyocardial revascularization, and cardiac surgery; the implanting of electronic devices such as a pacemaker and an implanted cardioverter defibrillator; and minimally invasive surgical procedures such as cardiac ablation and mini-maze. A brief history of heart surgery Advances were slow because surgeons faced the problem of operating on the beating heart. They eventually learned how to stop the heart. However, the heart and its blood-pumping action can be stopped for only 3 minutes. After that, the lack of blood to the brain causes permanent brain damage. In the mid-1970s, medical scientists perfected the heart-lung machine. This machine takes over the function of the heart, allowing surgeons to operate on the beating heart while blood continues to circulate throughout the body. Scientists have also discovered ways to cool the heart or the entire body, allowing more time for surgery without causing brain damage. With the help of these and other innovations, heart surgeons perform thousands of successful surgeries every day in the United States. Sacred Heart Medical Center began performing heart surgery in September 1971 and was the first hospital between Portland and San Francisco to offer heart surgery. The cardiac surgeons at Oregon Heart & Vascular Institute continue to keep pace with the latest innovations in heart surgery, helping to make this one of the busiest and most successful heart surgery centers in the Northwest. Who performs heart surgery? What are the risks? General risks of heart surgery include heart attack, stroke, kidney failure, and How do I prepare for heart surgery? What happens during heart surgery? What happens after the surgery? You then move to the Cardiac Surgery Unit to continue recovery. If there are no complications, you are discharged sometime between the 5th and 7th day after surgery. Before you leave the hospital, the nurse educator schedules a home instruction class. This class is for the person who will be helping you at home. Once you return home, you will need someone to help you for at least a week. That person should be with you most of the time. You should avoid strenuous activity, including lifting and driving, for 4 to 6 weeks, or until you no longer feel pain. You can take a normal shower, but avoid baths until the surgical wound heals. Your surgeon will see you about six weeks after you are discharged. HEART SURGERY: HOW THE HEART WORKS The heart The pump The blood vessels The veins that carry the oxygen-poor blood from the body to the heart are called the vena cava, which means “heart’s veins.” The pulmonary artery carries blood from the heart to the lungs. The pulmonary veins carry the oxygen-rich blood from the lungs back to the heart. The aorta, or main artery, carries the blood from the heart to the rest of the body. Problems arise when the veins and arteries are damaged or clogged. Clogged blood vessels can prevent the heart from supplying itself and the rest of the body with oxygen. The chambers The chambers on the right side are called the right atrium and right ventricle. The chambers on the left side are called the left atrium and left ventricle. Oxygen-rich blood from the lungs enters the left atrium, which pumps the blood into the left ventricle. The left ventricle pumps the blood into the aorta and then on to the rest of the body. The two atria are in the upper part of the heart; the two ventricles, in the lower part. Defects in the heart chambers — such as a enlarged ventricle or openings in the wall of an atrium — cause the heart to work harder than it should, which can lead to serious problems such as congestive heart failure. The valves The opening and closing of the valves creates the well-known “lub-dub” sound of the heartbeat. A damaged or clogged valve can interfere with blood flow from a heart chamber. In some cases, the blood leaks back into the chamber it just came from. This condition puts undue strain on the heart. The conduction system The electrical signal originates from the sinoatrial node, which is within the wall of the right atrium. The signal is carried by special conducting tissue, or nerve pathways, to the left and right atria (upper chambers). The signal causes the atria to contract, which forces blood into the ventricles (lower chambers). The signal then travels into the ventricles, by way of special conducting tissue, and into the atrioventricular node, a site between the atria and ventricles. The signal is then relayed through a pathway called the bundle of HIS, and branches off into pathways leading to the right and left ventricles. The signal causes the ventricles to contract, which forces the blood into the lungs and body and creates a heartbeat. From start to finish, the entire sequence, one heartbeat, takes about three-tenths of a second. HEART SURGERY: HEART-LUNG MACHINE What is a heart-lung machine? How does it work? The machine also removes carbon dioxide and other waste products from the blood and delivers anesthesia and medications into the recirculated blood. Also, in some cases, it cools the blood. Cool blood lowers the body’s temperature, which helps to further protect the brain and other vital organs during surgery. Who operates the heart-lung machine? HEART SURGERY: DISEASES Coronary Artery Disease What is coronary artery disease? Coronary artery disease is the leading cause of death in the United States for both women and men. The risk of CAD increases in middle age. What causes it? High cholesterol, high blood pressure, obesity, smoking, lack of exercise, diabetes, and genetics (family history) can contribute to CAD. What are the symptoms of coronary artery disease? Other symptoms include shortness of breath and heart attack. In some cases, however, there are no symptoms to warn you of CAD. How is it diagnosed? How is coronary artery disease treated? In some cases, doctors prescribe aspirin, nitroglycerin, beta-blockers, or medications to lower blood pressure, lower cholesterol, thin the blood, or relax the coronary arteries. In more serious cases of CAD, surgery may be called for. Three common types of surgery are
heart bypass surgery, transmyocardial
revascularization, and catheter
ablation, a minimally invasive procedure. Aortic Valve Disease What is aortic valve disease? Aortic regurgitation — also called aortic insufficiency and aortic incompetence — occurs when the aortic valve weakens or bulges, which prevents the valve from closing tightly. This causes blood to leak back into the ventricle instead of flowing into the aorta as it should. Aortic valve stenosis is a narrowing or blockage of the aortic valve that prevents it from opening properly. This cuts off the flow of blood from the left ventricle to the aorta. What causes it? What are the symptoms of aortic valve disease? No symptoms may appear until late in the course of the disease, and they can be sudden or gradual. How is it diagnosed? How is aortic valve disease treated? In more serious cases of aortic valve disease, heart-valve
surgery may be called for to repair or replace the valve. Mitral Valve Disease What is mitral valve disease? Mitral regurgitation — also called chronic mitral regurgitation and mitral valve Mitral stenosis is a narrowing or blockage of the mitral valve that prevents it from opening properly. This cuts off the flow of blood between the two left heart chambers. Pressure may also build up in the atrium (upper heart chamber) and cause blood to flow back into the lungs. Mitral valve disease usually develops between the ages of 20 and 50. Mitral valve prolapse — also called Barlow’s syndrome, floppy mitral valve, and
What causes it? Mitral stenosis is most commonly caused by rheumatic fever. Other causes are infections, atrial fibrillation, and other heart disorders. What are the symptoms of mitral valve disease? With mitral stenosis, there may be no warning signs. When symptoms occur, they include shortness of breath, cough, fatigue, frequent respiratory infections, irregular heartbeat, and swollen ankles or feet. How is it diagnosed? How is mitral valve disease treated? Atrial Septal Defect What is atrial septal defect? What causes it? What are the symptoms of atrial septal defect? Symptoms in childhood include frequent respiratory infections, tiring easy when playing, and slow growth. Symptoms in adults include difficulty breathing; shortness of breath; and rapid, pounding, or fluttering heartbeat. If untreated, ASD can lead to a number of other problems, including bacterial infection of the heart, [abnormal heart rhythm], and heart failure. How is it diagnosed? How is atrial septal defect treated? Thoracic Aortic Aneurysm What is a thoracic aortic aneurysm? If untreated, the aneurysm could rupture (burst). Ruptured aneurysms are often fatal and one of the leading causes of death in the United States. The risk of developing a TAA increases with age and is more common in men than in women. What causes it? High cholesterol, high blood pressure, obesity, smoking, lack of exercise, diabetes, and genetics (family history) can contribute to TAA. What are the symptoms of a thoracic aortic aneurysm? When an aneurysm ruptures, the symptoms include sudden intense pain in the upper chest or back, heavy sweating, rapid heartbeat, dry mouth, nausea and vomiting, fainting, and shock. A ruptured aneurysm is a life-threatening situation and calls for immediate medical care. How is it diagnosed? How is a thoracic aortic aneurysm treated? HEART SURGERY: SURGICAL TREATMENTS Heart Bypass Surgery
What is heart bypass surgery? What are grafts? In the wrist, the radial artery is one of two arteries that carries blood to your hand. It can be removed without cutting off the blood supply to the hand. The saphenous vein runs from the groin to the ankle on the inside of your leg. It can be removed without harming the leg. The internal mammary artery is inside the chest wall and connected to the aorta. To use it, the surgeon needs only to detach one end of it from the chest wall. Who performs the surgery? How is heart bypass surgery done? The surgeon first takes the graft from your radial artery, saphenous vein, or mammary artery. The surgeon then makes an incision in the middle of the chest and separates the breastbone to reach the heart. The surgeon stitches one end of the graft to an opening below the blockage in the coronary artery. If the radial artery or saphenous vein is used, its other end is stitched to an opening made in the aorta. If the mammary artery is used, its other end is already connected to the aorta. When the graft is completed, the surgeon takes you off the heart-lung machine, rejoins the breastbone with wire, and closes the incision. The entire operation takes 4 to 6 hours. Another common surgical technique is called off-pump coronary artery bypass. This procedure is the same as the standard procedure, except you are not connected to the heart-lung machine. The heart continues to beat. The surgeon uses stabilizers to keep only part of the heart motionless while working on a specific artery. What are the risks? General risks of heart surgery include heart attack, stroke, kidney failure, and The site of the incisions can be bruised and sore or itchy. The heart-lung machine can cause some short-term memory loss and mental confusion. Chest pain and fever can occur up to 6 months after surgery but are easily treated with medication. How do I prepare for heart bypass surgery? What can I expect after the surgery? You then move to the Cardiac Surgery Unit to continue recovery. For several days, you may have tubes in your chest to drain fluid from around the heart. You may also be connected to intravenous lines that supply fluids and mediations. If a graft was taken from your saphenous vein, your leg may be swollen and sore. This is only temporary and is treated by elevating the leg. If there are no complications, you are discharged sometime between the 5th and 7th day after surgery. Once you return home, you will need someone to help you for at least a week. That person should be with you most of the time. You should avoid strenuous activity, including lifting and driving, for 4 to 6 weeks, or until you no longer feel pain. You can take a normal shower, but avoid baths until the surgical wound heals. Some people experience a loss of appetite, mental confusion, mood swings, and insomnia. These symptoms are normal and gradually disappear as you recover. Your doctor will tell you when you can resume your normal activities. Transmyocardial Revascularization What is transmyocardial revascularization? The procedure is performed while the heart is beating and full of blood. During TMR, the surgeon does not cut open the chest or heart as in open-heart surgery. Also, you are not connected to a heart-lung machine. In some cases, heart bypass surgery and TMR are done at the same time. Who performs the surgery? How is transmyocardial revascularization done? The surgeon first makes an incision on the left side of the chest to reach the left ventricle (the lower chamber of the heart and the main pumping chamber). Using a laser, the surgeon makes 20 to 40 tiny channels through the heart muscle and into the left ventricle. The tops of the channels on the heart muscle naturally clot and close. The channels inside the heart stay open and carry oxygen-rich blood from the left ventricle to the heart muscle. The surgeon closes the incision. The operation usually takes about 2 hours. What are the risks? General risks of heart surgery include heart attack, stroke, kidney failure, and The site of the incision can be bruised and sore or itchy. Because TMR is still a relatively new type of surgery, and because doctors still do not fully understand why it reduces angina, the long-term effects are not yet known. How do I prepare for TMR? What can I expect after the surgery? You then move to the Cardiac Surgery Unit to continue recovery. For several days, you may have tubes in your chest to drain fluid from around the heart. You may also be connected to intravenous lines that supply fluids and mediations. If there are no complications, you are discharged sometime between the 5th and 7th day after surgery. Once you return home, you will need someone to help you for at least a week. That person should be with you most of the time. You should avoid strenuous activity, including lifting and driving, for 4 to 6 weeks, or until you no longer feel pain. You can take a normal shower, but avoid baths until the surgical wound heals. Your doctor will tell you when you can resume your normal activities. Heart-Valve Surgery What is heart-valve surgery? There are two types of replacement heart valves: biological (natural) and mechanical (artificial). Biological valves come from human, cow, or pig donors. Mechanical valves are made of metal. Mechanical valves last longer than biological valves. Your doctor will decide which type of valve is best for you. Who performs the surgery? How is heart-valve surgery done? The surgeon first makes an incision in the middle of the chest and separates the breastbone to reach the heart. The surgeon then makes an incision in the heart or aorta to reach the valve. Once the valve is exposed, the surgeon decides to repair or replace it. If the damaged valve can be fixed, the surgeon completes the repairs. If the valve must be replaced, the surgeon first removes part or all of the damaged valve. The surgeon then chooses the type and size of the replacement valve, inserts it into the valve opening, and sews it firmly into place. The surgeon then closes the incision in the heart or aorta, takes you off the heart-lung machine, rejoins the breastbone with wire, and closes the incision. The entire operation takes 4 to 6 hours. What are the risks? General risks of heart surgery include heart attack, stroke, kidney failure, and The site of the incision can be bruised and sore or itchy. The heart-lung machine can cause some short-term memory loss and mental confusion. How do I prepare for heart-valve surgery? If you need dental work, your doctor may tell you to have it done before the surgery. Bacteria often enter the bloodstream during dental work and may cause infection around a new heart valve. What can I expect after the surgery? You then move to the Cardiac Surgery Unit to continue recovery. For several days, you may have tubes in your chest to drain fluid from around the heart. You may also be connected to intravenous lines that supply fluids and mediations. If there are no complications, you are discharged sometime between the 5th and 7th day after surgery. Once you return home, you will need someone to help you for at least a week. That person should be with you most of the time. You should avoid strenuous activity, including lifting and driving, for 4 to 6 weeks, or until you no longer feel pain. You can take a normal shower, but avoid baths until the surgical wound heals. Your doctor will tell you when you can resume your normal activities. If you have a mechanical replacement valve, you will most likely take medication to prevent blood clots for the rest of your life. Atrial Septal Defect Repair What is atrial septal defect repair? Who performs the surgery? How is atrial septal defect repair done? The surgeon first makes an incision in the middle of the chest and separates the breastbone to reach the heart. The surgeon then makes an incision in the heart to reach the septum. Once the septum is exposed, the surgeon decides which of two types of repair to make. The surgeon may stitch up the opening, which is known as primary closure. Or the surgeon may sew a patch made of tissue or a synthetic material over the opening. This is known as secondary closure. The surgeon then closes the incision in the heart, takes you off the heart-lung machine, rejoins the breastbone with wire, and closes the incision. What are the risks? General risks of heart surgery include heart attack, stroke, kidney failure, and The site of the incision can be bruised and sore or itchy. The heart-lung machine can cause some short-term memory loss and mental confusion. How do I prepare for atrial septal defect repair? If you need dental work, your doctor may tell you to have it done before the surgery. Bacteria often enter the bloodstream during dental work and may cause infection around a repaired septum. What can I expect after the surgery? You then move to the Cardiac Surgery Unit to continue recovery. For several days, you may have tubes in your chest to drain fluid from around the heart. You may also be connected to intravenous lines that supply fluids and mediations. If there are no complications, you are discharged sometime between the 5th and 7th day after surgery. Once you return home, you will need someone to help you for at least a week. That person should be with you most of the time. You should avoid strenuous activity, including lifting and driving, for 4 to 6 weeks, or until you no longer feel pain. You can take a normal shower, but avoid baths until the surgical wound heals. Your doctor will tell you when you can resume your normal activities. Your pediatrician will tell you how to care for a child at home. Open Aneurysm Repair
What is open-aneurysm repair? Many patients who have a thoracic aortic aneurysm also have heart disease. Sometimes open-heart surgery is performed at the same time as open-aneurysm repair. Who performs the surgery? How is open-aneurysm repair done? The surgeon makes an incision in your chest, locates the aorta, and places clamps on the aneurysm to stop the flow of blood for a short time. The surgeon repairs the aneurysm by removing the material that is causing the bulge. The surgeon then sews a fabric tube, called a graft, onto the aorta. This graft replaces the aneurysm and carries the blood from the aorta to the rest of the body. The surgeon then removes the clamp and sews up the incision in your chest.
What are the risks? If there is plaque (fatty material) in the blood vessels, there is an increased risk of heart attack or stroke during the operation. If the blood supply is cut off too long, there is a possibility of damage to the kidneys. How do I prepare for open-aneurysm repair? What can I expect after the surgery? Once you return home, you should avoid strenuous activity and driving for 4 to 6 weeks, or until you no longer feel pain. You can take a normal shower, but avoid baths until the surgical wound heals. Your doctor will tell you when to come back for a checkup and when to resume your normal activities. Complete recovery may take up to 3 months. |
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