Coronary artery bypass surgery and other valve surgery
After you and your doctor have decided that surgery is the appropriate treatment for your heart valve problem, you may need to consider having other surgeries, such as a coronary artery bypass graft (CABG, pronounced "cabbage") or other valve procedures, at the same time.
Why would I need a coronary artery bypass graft?
CABG surgery is a serious treatment for coronary artery disease (CAD). It requires removing a vein or artery from either the leg or chest and grafting it onto the coronary artery. Blood flow is then redirected through the healthy, grafted blood vessel so that the heart can continue receiving fresh, oxygenated blood in the necessary amounts. CABG surgery is usually the preferred treatment when many coronary arteries are severely blocked.
CAD can sometimes be diagnosed with a noninvasive stress test. Either stress electrocardiography or stress echocardiography can be used. (These are the same as electrocardiography or echocardiography, except that you are asked to exercise first.) But invasive tests are often required. Specifically, CAD is diagnosed using cardiac catheterization (angiogram), in which a catheter is inserted into an artery in the groin or arm. The catheter is then threaded into the arteries of the heart. Dye is then injected into the artery while X-ray images are taken. These films show the inside of the blood vessels and reveal any blockages, as well as their location and the degree of blockage.
Cardiologists often use cardiac catheterization and angiography before valve surgery to gain a clearer understanding of the anatomy of your heart, especially since an echocardiogram does not confirm whether you have multiple valve problems. In these cases, your doctor will check for CAD as long as you are already having the angiogram. Even if you do not need angiography before valve surgery to identify valve problems, if your doctor feels that the risk of CAD is high enough that angiography should be considered (so that a CABG can be performed if necessary), he or she will discuss it with you. In other words, missing CAD and the opportunity to treat it through CABG while the chest is already open for valve surgery is a greater risk to your health than that posed by having a diagnostic angiogram.
Why would I want to have CABG and valve surgery at the same time?
There is always risk associated with placing someone under anesthesia, opening the chest, and operating on the heart. But having two surgeries at the same time may minimize the number of times you have to endure this physical stress. Although having a CABG along with mitral valve surgery will increase the amount of time that blood flow to the heart is stopped, this risk is far lower than that of being anesthetized and having the chest opened more than once.
Why other valve surgery?
Most valve surgeries involve stopping the heart and directing blood through a heart-lung machine to circulate and oxygenate the blood the body needs. But, as with CABG, the risk of having additional surgeries to replace another valve is greater than having several surgeries performed at the same time.
More importantly, if all malfunctioning valves are not fixed, you are not fixing the problem in your heart. Blood will still not be passing through your heart efficiently, and this inefficiency will continue to place stress on your heart. When only one valve problem is corrected, the adaptations the heart has made to accommodate both valve problems may no longer help the heart cope with just one problem valve. By fixing one valve, the dynamics of the blood flow have been changed but not corrected—blood is still not flowing normally through your heart. This could create problems where there were none before. The heart may suddenly have to deal with a large volume of blood flowing in a manner for which it is not able to compensate. The death rate is higher for individuals who do not have all valve problems fixed at the same time.
While having only one valve replacement surgery may seem overwhelming, it is important for your long-term health to consider having multiple valves replaced and CABG surgery if necessary. Having these operations at the same time increases your chance of survival and leads to better health.
| Author: | Robin Parks, MS | Last Updated: March 18, 2008 |
| Medical Review: | Caroline S. Rhoads, MD - Internal Medicine E. Gregory Thompson, MD - Internal Medicine Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology | |
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