Heart conditions are often treated with a combination of medications and lifestyle changes. In more severe cases in which these therapies fail, surgery offers a way to improve your cardiovascular health.
Depending on the condition and severity of your case, there are different surgery options available. In this article, we’ll look at seven common types of heart surgery.
When a heart valve becomes damaged, it is best to either repair or replace it. Doctors generally prefer repairs, because the approach can preserve the heart tissue. Heart valve surgery can either be minimally invasive or open, depending on the procedure. Many valves can now be fixed or even replaced using nonsurgical catheter-based procedures.
One type of repair is balloon valvuloplasty, which helps expand valves that have narrowed. This procedure can be performed through a catheter — a small tube inserted into a blood vessel and directed using an X-ray into the heart or blood vessel. The approach is less intense than open-heart surgery. Candidates for this procedure include those whose valves are healthy enough to be repaired. This procedure is also ideal for people who cannot have open-heart surgery because of underlying health conditions. A balloon valvuloplasty may also be performed to prepare for a valve replacement.
During a balloon valvuloplasty, the surgeon makes a small incision and inserts a catheter with a balloon on the end. The surgeon maneuvers the catheter into the heart and places it in the valve, where the balloon is expanded. This step opens up the valve and allows more blood to flow through. Balloon valvuloplasties are most often used to treat narrowing in the pulmonic valve, mitral valve, and aortic valve.
After surgery, you will stay in the hospital for observation and will be required to remain flat in bed for around two to six hours. You will be asked to drink plenty of fluids to help flush a dye used during the procedure from your body. Depending on your health, you may spend the night in the hospital.
In addition to opening up narrowed valves, other types of repairs can be made to:
These procedures may be performed using minimally invasive surgery or with a catheter, similar to a balloon valvuloplasty.
When the tissue has become too damaged and cannot be repaired or fixed with minimally invasive surgery, a doctor may recommend a valve replacement. This procedure is done to either replace a valve that has become narrowed and damaged or one that is leaky.
A valve replacement is often used to treat narrowing or leakage of the aortic and mitral valves. Blood flow moves in one direction throughout the heart. However, when the aortic valve is leaky, it allows blood to flow back into the heart instead of out into the body. The mitral valve can also be leaky and cause blood to flow back into the lungs instead of to the heart. Narrowed heart valves prevent blood from moving appropriately through the heart. If left untreated, this issue may lead to heart failure. Frequently, people are referred for valve replacement (especially common with mitral valves), and the surgeon can repair the valve without replacing it.
The valves used in replacement surgeries come from one of three places: a donated human or animal valve, a mechanical valve made of long-lasting materials, or your own healthy valve. The American Heart Association states that mechanical valves last the longest but require you to take blood thinners every day to prevent blood clots. On the other hand, tissue valves last between 10 to 20 years, so they will likely need to be replaced. However, they usually do not require recipients to take blood thinners.
Valve replacement surgeries are typically open-heart surgeries. After the procedure, you will stay in the intensive care unit (ICU) for a few days. You will then stay in the hospital for several more days to recover, and the length of your stay will depend on your condition.
Transcatheter aortic valve replacement (TAVR) is a nonsurgical alternative to open heart surgery. This procedure uses a catheter to move a new, expandable valve into the heart. The valve expands once in place and takes over for the old, damaged valve. Candidates for this procedure have a narrowed aortic valve and may not be ideal candidates for standard valve replacement procedures.
Coronary artery bypass grafting (CABG) is a surgery that treats the narrowing of the heart’s arteries, caused by coronary artery disease (CAD). These blood vessels carry oxygen to the heart. They become narrowed when fatty deposits form, which cut off oxygen flow and other nutrients to the heart muscle. CABG is used to treat people who have severe CAD and are at risk of having a heart attack. It is also an option for those who cannot undergo angioplasty or stenting, catheter-based procedures that open blocked arteries caused by CAD.
CABG is bypass surgery, meaning that it creates a new route for blood to flow through. The surgeon takes a healthy blood vessel from one part of your body and uses it to “bypass” the blockage. This blood vessel may be taken from your chest, leg, or forearm.
Both open-heart and minimally invasive procedures are used for this surgery. The open-heart procedure is common and requires a large chest incision to get to the heart. To keep the heart pumping during surgery, it is hooked up to a heart-lung bypass machine. Minimally invasive procedures do not use this machine and instead are performed with robotic assistance or through very small incisions.
After the surgery, you will likely stay in the ICU for a few days to be monitored. You will then move to another room to stay at the hospital for several more days. Your heart surgeon will likely have you start a cardiac rehabilitation program while still in the hospital to help strengthen your heart. Overall, recovery takes between six to 12 weeks.
A heart transplant is a surgery that replaces a diseased heart with a healthy donor heart. Candidates for this procedure are those with end-stage heart failure who have not responded to other treatment options. During end-stage heart failure, the heart muscle cannot pump enough blood to meet the body’s needs
This is an open-heart surgery that requires a heart-lung bypass machine to help circulate your blood while the old heart is taken out and the new one is put in. This is a serious surgery with a long recovery period. After the procedure is complete, you will be monitored in the ICU for several days. After you are moved to another room, you can expect to stay in the hospital for one to two weeks for recovery and rehabilitation.
Pacemakers help treat arrhythmias (abnormal heart rhythms). They use electrical signals to help control the heart’s rhythm, but they cannot correct it. Implantable cardioverter defibrillators (ICDs) work similarly to pacemakers, but they can detect severely abnormal heart rhythms. After detecting a dangerous rhythm, the devices can shock the heart and correct the rhythm back to normal. Candidates for pacemakers and ICDs include those with arrhythmias, a history of heart attacks, or heart failure.
Pacemakers and ICDs can be inserted via minor surgery. The surgeon creates a small incision in the chest, and the wires (known as leads) for the pacemaker or ICD are inserted through the veins in the chest and into the heart. The leads are then connected to the device, which is inserted just under the skin over the chest. Some newer devices do not require leads in the heart. Overall, the surgery can last two to five hours.
If you have atrial fibrillation (AFib), your cardiologist may recommend a maze procedure. This involves creating a maze pattern of scar tissue on the heart that blocks the abnormal heart rhythms caused by AFib, while still allowing normal heart rhythms through. This procedure can often be performed using a minimally invasive small-incision procedure. Candidates for this surgery include those who:
During a maze procedure, the surgeon uses high-energy radio waves or cryoablation (extreme cold) to create the scar tissue maze. They may also remove a part of the left side of the heart known as the left atrial appendage, which is thought to be responsible for 90 percent of blood clots in people with AFib.
After the surgery, you will stay in the ICU for a few days, then move to another hospital room for a few more days. The average time in the hospital is four to seven days. You will likely need to take blood thinners for a few months to help prevent blood clots.
If your heart is not pumping blood properly, medical devices can help. The total artificial heart (TAH) and ventricular assist device (VAD) both help pump blood from the lower chambers of the heart (ventricles) to the rest of the body. These devices keep you healthy enough to wait for a heart transplant. A VAD may also be used in people who are not eligible for a heart transplant or who are experiencing temporary heart failure.
Both the TAH and VAD require open-heart surgery for placement. Surgery for these devices can take between three to nine hours, depending on your case. After surgery, you will be in the ICU for monitoring. You may need a ventilator to help you breathe for a couple of days.
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