HEART SURGERY

ANGIOPLASTY (PTCA)

Percutaneous Transluminal Coronary Angioplasty (PTCA) is often carried out if narrowing's or blockages are found in the coronary arteries, it may be possible to open the narrowing using a tiny fluid filled balloon which is guided into the narrowed artery using an extremely fine catheter. The catheter is placed in an artery, commonly the femoral artery; this catheter has a small deflated balloon at the tip. Under X-ray guidance, the cardiologist advances this catheter into the narrowed or blocked artery of the heart. When it is in position, the cardiologist inflates the balloon, thereby opening up the blocked artery and blood can then flow through the artery again.

Sometimes the Cardiologist may decide to implant a small reinforced metal spring called a stent to help to keep the artery open after the procedure. The stent is mounted on a PTCA balloon catheter which is then inflated inside the artery. The stent expands and is left in place as the balloon is deflated and the catheter is withdrawn.

During the procedure the ECG and blood pressure are very carefully monitored. Patients usually have some sedative medication to help them relax during the procedure as it may take up to 1 to 2 hours. They may also experience some angina type symptoms as the balloon is inflated but this soon passes. For any coronary invasive intervention, there are associated risks. The artery may become completely blocked and depending on the importance of this artery, it may be necessary to undergo an immediate bypass graft operation. This is a rare event, with approximately one out of every two hundred people undergoing PTCA converting to coronary artery bypass graft surgery (CABG). A detailed discussion of the risks versus benefits with the cardiologist will provide an individual guide prior to the procedure.

Recuperation

A small bruise may develop on the person's groin at the site where the catheter was inserted. That area may feel sore or tender for about a week. Keep an eye on bleeding from the site, unusual pain, swelling, redness, or other signs of infection at or near the insertion site. Certain activities, such as heavy lifting, may need to be avoided for a short time after the procedure.

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CORONARY ARTERY BYPASS GRAFTING

Coronary artery bypass grafting (CABG) is the most common type of heart surgery. CABG improves blood flow to the heart. It is used for people with severe coronary artery disease (CAD). In CAD, a fatty material called plaque builds up inside your coronary (heart) arteries. It narrows the arteries and limits blood flow to your heart muscle. CAD can cause angina (chest pain or discomfort), shortness of breath, and can even lead to a heart attack.

Surgical Procedure

Depending on a patient's heart problem, general health, and other factors, the surgeon will decide whether he or she can have open-heart surgery or minimally invasive heart surgery. During CABG, a surgeon takes a vein or an artery from your chest, your leg, or another part of your body and connects, or grafts, it to the blocked artery. The grafted artery bypasses (that is, goes around) the blockage. This allows oxygen-rich blood to reach the heart muscle. Surgeons can bypass as many as four blocked coronary arteries during one surgery. The length of time for the surgery depends on the type of surgery. CABG, the most common type of heart surgery, usually takes 3 to 5 hours.
How long are you expected to be hospitalized?

Depending on the type of heart surgery, you may spend 1 day or more in the hospital's intensive care unit. Then you will be moved to another part of hospital for several days before you go home. While you're in the hospital, doctors and nurses will closely watch your heart rate, blood pressure, breathing, vital signs, and incision site(s). You may have an intravenous (IV) needle inserted in your arm to give you fluids until you're ready to drink on your own. You also may be given extra oxygen through a face mask or nasal prongs that fit just inside your nose. These pieces of equipment are removed when you don't need them anymore.

Recuperation

Each person responds differently to heart surgery. Your recovery at home also will depend on what kind of heart problem and surgery you had. After effect of surgery are normal. They may include muscle pain, chest pain and swelling (especially if you have an incision in your leg from coronary artery bypass (CABG).
Other after-effects may include loss of appetite, difficulty sleeping, constipation, and mood swings and depression. After-effects gradually go away.
Recovery time varies with type of heart surgery. Full recovery from traditional open-heart CABG may take 6 to 12 weeks or more. Less recovery time is needed for off-pump heart surgery and minimally invasive heart surgery.

Your doctor will let you know when you can go back to your daily activities, such as working, driving, and physical activity.

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VALVE REPAIR OR REPLACEMENT

For the heart to work right, blood must flow in only one direction. The heart's valves make this possible. Healthy valves open and close in a precise way as the heart pumps blood. Each valve has a set of flaps called leaflets. The leaflets open to allow blood to pass from the heart chambers into the arteries.
Then the leaflets close tightly to stop blood from flowing back into the chambers.

Heart surgery is done to fix leaflets that don't open as wide as they should. This can happen when they become thick or stiff or fuse together. As a result, not enough blood flows through the valve into the artery. Heart surgery also is done to fix leaflets that don't close tightly.
This means blood can leak backward into the chambers, rather than only moving forward into the artery as it should.

Surgical Procedure

Depending on a patient's heart problem, general health, and other factors, the surgeon will decide whether he or she can have open-heart surgery or minimally invasive heart surgery. During the surgical procedure, the surgeons either repair the valve or replace it. Replacement valves are taken from animals, made from human tissue, or made from man-made substances. The length of time for the surgery depends on the type of surgery. Heart surgery usually takes 3 to 5 hours.

How long are you expected to be hospitalized?

Depending on the type of heart surgery, you may spend 1 day or more in the hospital's intensive care unit. Then you will be moved to another part of hospital for several days before you go home.
While you're in the hospital, doctors and nurses will closely watch your heart rate, blood pressure, breathing, vital signs, and incision site(s). You may have an intravenous (IV) needle inserted in your arm to give you fluids until you're ready to drink on your own.
You also may be given extra oxygen through a face mask or nasal prongs that fit just inside your nose. These pieces of equipment are removed when you don't need them anymore.

Recuperation

Each person responds differently to heart surgery. Your recovery at home also will depend on what kind of heart problem and surgery you had. After effect of surgery are normal. They may include muscle pain, chest pain and swelling. Other after-effects may include loss of appetite, difficulty sleeping, constipation, and mood swings and depression. After-effects gradually go away. Recovery time varies with type of heart surgery. Full recovery from traditional open-heart surgery may take 6 to 12 weeks or more. Less recovery time is needed for off-pump heart surgery and minimally invasive heart surgery. Your doctor will let you know when you can go back to your daily activities, such as working, driving, and physical activity.

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UNDERSTANDING HEART SURGERY

In recent years, new ways of doing heart surgery have been developed. Depending on a patient's heart problem, general health, and other factors, he or she can now have open-heart surgery or minimally invasive heart surgery.

Open-Heart Surgery

Open-heart surgery is any kind of surgery where the chest wall is opened and surgeons operate on the heart. "Open" refers to the chest wall, not the heart. Depending on the type of surgery, the heart may be opened too.
Open-heart surgery is used to bypass blocked arteries in the heart, repair or replace heart valves, fix atrial fibrillation, and transplant hearts.
In recent years, more surgeons have started to use off-pump, or beating heart, surgery to do CABG. This approach is like traditional open-heart surgery, but surgeons don't use a heart-lung bypass machine.
Off-pump heart surgery may reduce complications that can occur when a heart-lung bypass machine is used. It also may speed up recovery time.
Off-pump heart surgery isn't right for all patients. Your surgeon will decide whether you should have this type of surgery. He or she will carefully consider your heart problem, age, overall health, and other factors that may affect the surgery.

Minimally Invasive Heart Surgery

For minimally invasive heart surgery, a surgeon doesn't make a large incision down the center of the chest to open the rib cage. Instead, he or she makes small incisions in the side of the chest between the ribs.
A heart-lung bypass machine is used in some types of minimally invasive heart surgery, but not others.
This newer heart surgery is used for some CABG and Maze procedures. It's also used to repair or replace heart valves and insert pacemakers.
One type of minimally invasive heart surgery that's still being developed is robotic-assisted surgery. For this surgery, a surgeon uses a computer to control surgical tools on thin robotic arms. The tools are inserted through small incisions in the chest. This allows surgeons to perform complex and highly precise surgery. The surgeon is always in total control of the robotic arms; they don't move on their own.

Benefits of minimally invasive heart surgery compared to open-heart surgery include smaller incisions and scars, lower risk of infection, less pain, a shorter hospital stay, and a faster recovery.

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