Cardiothoracic – Heart & Lung Surgery
The Oregon Heart & Vascular Institute (OHVI) at PeaceHealth Sacred Heart Medical Center at RiverBend is one of the busiest heart surgery centers in the Northwest.
OHVI incorporates the latest innovations in heart surgery with the expertise of cardiologists, cardiothoracic surgeons, interventional radiologists and vascular surgeons.
Coronary Artery Bypass Grafting (CABG)
CABG is a type of surgery that improves blood flow to the heart. Surgeons use CABG to treat people who have severe coronary heart disease.
During CABG, a healthy artery or vein from the body is connected, or grafted, to the blocked coronary 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.
Surgeons can bypass multiple coronary arteries during one surgery.
Maze Procedure for Atrial Fibrillation
The Maze procedure is a surgical treatment for atrial fibrillation. The surgeon can use small incisions, radio waves, freezing, or microwave or ultrasound energy to create scar tissue. The scar tissue, which does not conduct electrical activity, blocks the abnormal electrical signals causing the arrhythmia. The scar tissue directs electric signals through a controlled path, or maze, to the lower heart chambers (ventricles).
The Maze procedure is usually done during open-heart surgery.
Mini-Maze – Alternative Option for Certain Patients
In the vast majority of patients, atrial fibrillation is caused by an abnormal electrical impulse, which starts in cells in one of the four pulmonary veins. These veins return oxygenated blood from the lungs to the left atrium. Insulating the heart electrically from the four veins prevents the spread of abnormal electrical signals to the atrium and is an effective treatment for atrial fibrillation.
Cardiac surgeons can offer patients a minimally invasive surgical option, called Mini-Maze surgery, which provides safe and easy access to the heart through a two-inch incision between the ribs. The Mini-Maze procedure does not require separation of the breastbone or use of a heart-lung machine. Talk with your doctor about whether this option is appropriate for you.
Mitral Valve Replacement
Mitral valve replacement is a surgical procedure in which the diseased mitral valve of the heart is replaced by a mechanical or biological tissue valve that correctly controls the direction of blood flow.
The mitral valve can become diseased, preventing it from adequately controlling the direction of the flow of blood between the left atrium and left ventricle. It also can become insufficient (regurgitant) and allow blood to flow backwards into the left atrium from the left ventricle during ventricular contraction (systole). In addition, the mitral valve can become stenotic (narrowed), preventing the flow of blood from the left atrium into the left ventricle during ventricular filling (diastole). In mitral valve prolapse, one or more of the mitral valve's cusps protrude back into the left atrium during ventricular contraction.
Transcatheter Aortic Valve Replacement Procedure
Some patients have not been candidates for valve replacement surgery because they are not healthy enough for open-heart surgery. These patients may benefit from a new replacement valve that can be implanted through a small incision in the groin or between the ribs, eliminating the need for a large incision in the chest.
Transcatheter aortic valve replacement (TAVR) is appropriate for patients with aortic valve stenosis who are not candidates for open surgery to replace their natural aortic valve. The procedure resembles a balloon angioplasty, in which a catheter -- a long, flexible tube -- is threaded through an artery, and a balloon device on the end inflates to help open up a narrowing in an artery in the heart. The surgeon positions the replacement valve inside the patient's natural aortic valve and inflates the balloon.
Patients usually enjoy immediate benefit from the procedure due to improved blood circulation. Because the replacement valve is placed using minimally invasive techniques, patients usually experience a much more rapid recovery than they would from a traditional, open-heart valve replacement.
Video-Assisted Thoracic Surgery
Video-assisted thoracic surgery (VATS) was recently developed to enable doctors to view the inside of the chest cavity after making only very small incisions. It allows surgeons to remove masses close to the outside edges of the lung and to test them for cancer using a much smaller surgery than in the past. It is also useful for diagnosing certain pneumonia infections, diagnosing infections or tumors of the chest wall, and treating repeatedly collapsing lungs.
Laser Lead Extraction
A pacemaker or implantable cardioverter defibrillator (ICD) delivers energy to the heart muscle through wires called leads. Lead extraction is the removal of one or more leads from inside the heart.
Leads that are placed outside the heart during open-heart surgery cannot be removed during this type of procedure.
When Is Lead Extraction Needed?
This procedure is needed when your leads are not working properly. This can be caused by:
- Damage to the inside or outside of the lead
- Large amounts of scar tissue forming at the tip of the lead
- Infection at the site of the device and lead implant
A laser or special electrosurgical sheath is used to deliver energy to remove scar tissue from the lead. New leads may be implanted (placed in your heart) during this procedure or at a later date, depending on the reason your current leads are being removed.
Robotic-Assisted Heart Surgery
Surgeons at The Oregon Heart & Vascular Institute are performing an increasing number of cardiovascular surgeries with minimally invasive techniques. The newest of these is robotic-assisted surgery using the da Vinci™ Si Surgical System.
The cutting-edge technology enables surgeons to perform complex surgeries using small incisions to access the heart, instead of the traditional breastbone-splitting incision (sternotomy).
General benefits to the patient are:
- Shorter hospital stay
- Less pain, scarring and risk of infection
- Less blood loss and reduced need for blood transfusions
- Less risk of heart attack and stroke following surgery
- Superior results with less need for repeat surgery
Current robotic-assisted cardiothoracic procedures include:
- Mitral valve repair or replacement
- Removal of cardiac tumors
- Repair of septal defects
- Tricuspid valve repair or replacement
- Epicardial lead placement
- In select cases, coronary artery bypass grafting (CABG)
In the near future we anticipate robotic-assisted surgery will be used for removal of chest tumors, lung cancer surgery and surgery for atrial fibrillation.