Among the pioneers in open-heart surgery, cardiac surgeons at O’Connor Hospital continue to employ their skills and expertise in traditional open-heart procedures as well as in newer, minimally invasive surgeries for coronary artery bypass and valve replacement or valve repair.
During open-heart surgery, the surgeon stops your heart in order to repair it and uses a heart-lung machine to pump and oxygenate your blood, just as the heart would do. The surgeon gains access to the heart through a long incision in the chest called a sternotomy. In addition, this surgery can be offered off pump for minimally invasive procedures.
Coronary Artery Bypass
Coronary artery bypass surgery is performed to restore adequate blood flow through the coronary arteries. Instead of trying to open a narrowed artery, vein grafts surgically constructed out of vein segments taken from the leg or from arteries near the collarbone are used to bypass blocked areas.
Multiple vein and artery segments can be used to bypass different narrow areas. In the case of “quadruple bypass,” four bypasses are created. An estimated 85 percent of patients see complete or dramatic relief of symptoms following bypass surgery.
Patients should expect to stay in the hospital for five to seven days following bypass surgery. Coronary artery bypass is usually an open-heart procedure, but patients may be a candidates for “beating heart” bypass procedure in which the heart is not stopped. .
Minimally Invasive Procedures
Minimally invasive heart surgery differs from conventional open-heart surgery in two major respects. Instead of making one long incision down the center of the chest and splitting open the sternum, the surgeon makes one or more smaller incisions that provide access to the heart. The surgeon may repair coronary artery disease while it is beating, which eliminates use of the heart-lung machine and risks associated with the heart-lung machine (for example, stroke).
Both patients and surgeons report favorable results with minimally invasive heart surgery due to:
- Shorter hospital stays
- Faster recovery time
- Smaller scars
- Lower risk of certain complications associated with conventional heart surgery
The doctor determines whether these surgical procedures are right for the patient. And, in the case of any complications, the surgical team may revert to a conventional, open-heart procedure during surgery.
Minimally Invasive Coronary Artery Bypass Procedures
There are three widely used minimally invasive coronary bypass surgical procedures available. Both beating heart surgery techniques described below do not give the surgeon complete access to the heart and are typically used in patients that require only one or two coronary artery bypasses:
- Beating heart surgery with conventional sternotomy: This is the same as conventional bypass surgery, except the heart is not stopped, thus eliminating the need for the heart-lung machine.
- Small-incision beating heart surgery: This technique uses small incisions to access the heart rather than splitting the patient’s sternum and is performed on a beating heart.
- Port-access coronary artery bypass: With this procedure, the surgeon uses small incisions called ports to access the heart. Like conventional coronary bypass surgery, the patient’s heart is stopped temporarily and the patient is placed on the heart-lung machine, which gives the surgeon access to the entire heart so that multiple bypass procedures can be performed.
Minimally Invasive Valve Repair and Replacement Procedures
Any problem with a heart valve increases the work that the heart must do to compensate for a weaker-than-normal valve, which can enlarge the heart over time. Those with more severe heart valve damage may require medication to relieve the symptoms or surgery to repair or replace the valve.
With heart-valve surgery, the heart is not beating; therefore, the heart-lung machine is used for each of the minimally invasive surgical procedures described below for the repair or replacement of heart valves:
- Conventional sternotomy: Conventional heart-valve surgery is similar to open-heart coronary artery bypass surgery.
- Keyhole surgery: In keyhole surgery, small incisions are made along the sternum or between the ribs allowing access to the heart. With the heart stopped, the cardiac surgeon can move the heart as required to make the needed valve repairs.
- Tissue valves can be either an animal tissue valve or the aortic valve from a deceased human donor. Because they are so similar to the heart valve being replaced, these valves are well tolerated by the body without special medications. Unfortunately, they usually are not as long lasting as mechanical valves.
- Mechanical valves are artificial medical devices that are made from hard and durable metals or synthetic materials. Although they are durable, blood has a natural tendency to clot. To prevent clots, people with mechanical valves must take medicine every day for the rest of their lives. For this reason, mechanical valves are usually recommended for younger people with the expectation of a long lifespan and who can take anticoagulant medication daily.
More than one valve can be replaced during heart-valve surgery. Patients without complications should expect to say in the hospital for five to seven days.
Valve Repair (Valvuloplasty)
With many cases of heart-valve disease, the aortic valve can be repaired. Depending on the particular problem, the cardiac surgeon may alter the valve leaflets or tighten the surrounding ring of heart tissue for a “better fit.” Surgeons cannot repair valves that are heavily calcified or those that have been heavily damaged by disease.
One potential complication of valve replacement surgery is the need to also repair the valve root, which may be weak due to a failing valve or the disease process. This complication is not uncommon and may require an additional surgery.
During valve repair and valve-replacement surgery, a coronary stent is sometimes used to help hold an artery open. After the narrowing is reduced or removed, a tiny, slotted, stainless steel tube (the stent) can be implanted at the site by the cardiologist. The stent is a permanent implant that helps keep the artery open, improves blood flow, and may relive the symptoms of coronary artery disease.