Open Heart Surgery
During heart surgery, the beating of the heart is temporarily stopped and life is maintained through a cardiopulmonary bypass (also called CPB or the heart-lung machine). The heart is stopped either through decreasing its temperature and through the injection of a preservative. The heart-lung machine then keeps the blood pumping through the body, adding the necessary oxygen and nutrients. There are risks associated with the use of the heart-lung machine, such as organ damage and blood clots, so every effort is made to keep each patient's time on this machine to a minimum.
Types of Heart Surgery
The most common types of heart surgery we perform are:
Coronary artery bypass graft (CABG): Treatment for coronary artery disease and atherosclerosis. Here, we take a portion of a healthy blood vessel from somewhere else in the body and use it to create a new route around the blocked part of a blood vessel and into the heart. This process is also called revascularization, because it brings blood back to the heart.
Heart valve procedures: Correct defective heart valves from stenosis (narrowing/blockage) or regurgitation (leaking). This type of surgery repairs defective heart valves. If we can’t repair the valve, we replace it with a donor, either a biological (human or animal) or mechanical (man-made) valve.
Heart transplant: Replaces a severely damaged heart with a healthy heart from a human donor. Someday we will transplant man-made hearts and eliminate the long waiting lists for donor hearts.
Thoracic aortic aorta procedures: Surgical treatment for all types of thoracic aortic aorta conditions, including ascending aortic pathology in Marfan's Disease, dissection of the aorta and thoracic and arch aneurysms using circulatory arrest techniques.
Coronary Artery Bypass Grafting (CABG)
We perform coronary artery bypass grafting (CABG or “cabbage”) to bypass blockages or obstructions in the coronary arteries, thereby restoring the flow of oxygen and nutrients to the heart. This process is also known as revascularization.
CABG, requires a median sternotomy, or incision down the front of the chest through the breastbone. This incision gives the surgeon a good view of the heart.
Traditionally, the heart is stopped during the CABG process. The patient is kept alive by a heart-lung machine during the operation. This is known as cardiopulmonary bypass.
To perform a CABG, arteries from the chest and arm and veins from the leg are used to create a detour around the obstruction in the coronary artery. The artery and/or vein are connected to both the aorta and coronary artery, thereby creating a bypass around the blockage.
New CABG Techniques
As part of our mission, we’re always researching new ways to perform surgery with less patient discomfort, better heart function, and faster recovery. The procedures are called minimally invasive because they minimize the trauma of surgery. Statistics are showing that these new techniques also reduce the need for repeat operations in the future.
Endoscopic vein harvesting: A minimally-invasive procedure where we create a small incision to remove veins from the leg.
Multiple arterial grafts: Techniques to increase the utilization of arterial grafts continue to evolve. The use of both internal thoracic arteries and artery from the forearm (radial artery) is frequently used for long-term revascularization in appropriate patients.
Off pump surgery: We’re also excited about the ability to perform bypass surgery without using the heart-lung machine. This is known as off pump coronary revascularization. In this surgery, we operate on the beating heart without relying on cardiopulmonary bypass (stopping the heart and using the heart lung machine to pump blood to the organs). As a result, we greatly reduce the risks associated with the heart lung machine, such as blood clots.
Smaller incisions: By using smaller incisions, we decrease the chances of infection, lessen pain, speed healing, and minimize scarring. For example, in Port Access Coronary Artery Bypass Surgery, we create small incisions, known as “ports,” in the chest. Then the surgical team uses special instruments to reach through the ports to perform the surgery. The surgery involves taking chest arteries or veins from the leg (femoral vessels) to create a detour, or bypass, around the clogged artery(ies). The surgeon views the operation through video monitors, rather then directly, giving him/her a much improved view of this intricate work.
Who Should Have a CABG?
Every patient and situation is unique, so please discuss your health and heart care with your doctor. In general, CABG is recommended for patients with:
Disease of the left main coronary artery or all three major coronary arteries
Defective left ventricles
Severe angina (not helped by medication)
Patients unable to be helped by aggressive medications and balloon angioplasty
Risks of CABG
As with any surgical procedure, there are risks involved. The specific risks of CABG include:
Needing repeat surgery (usually after 10 years)
The potential for complications varies, depending upon the patient's overall health, age, smoking history, medical conditions, and heart function. If you are facing cardiac surgery of any type, discuss these risk factors with your doctor to determine the best treatment for you.
Long-term Success of CABG
The majority of our CABG surgery patients experience long-term success. They no longer have symptoms of angina and most even feel more energetic. For most people, the procedure extends the length of their life—in addition to the quality of their life.
For more information, or to schedule a consultation, please call us at (585) 275-5384.