Heart surgery is used to treat complex Coronary Artery Diseases (CAD) when other forms of treatment like lifestyle changes, medical procedures and medicines fail to work or cannot be used. In CAD, a waxy substance known as plaque builds up inside coronary arteries, that supply blood to the heart. These plaques may harden or rupture, reducing the blood flow to the heart, causing chest pain or angina. Complete blockage of blood flow leads to a heart attack.
Typically, heart surgery is used in the any of the following cases:
- Complex coronary artery disease (CAD) and heart attack
- Control abnormal heart rhythms
- Fix the malfunctioning heart valves
- Place medical devices
- Replace a damaged heart with a healthy one
Types of heart surgery options available
#1. Coronary Artery Bypass Grafting (CABG)
Commonly called bypass surgery, CABG is the most common type of heart surgery. During CABG, a cardiac surgeon grafts a healthy artery or vein from another region of the body, to the blocked coronary artery. This grafted artery bypasses the blocked portion and creates a new pathway for supplying oxygen-rich blood to the heart. It helps to improve blood flow to the heart and is carried out in patients who have severe coronary artery disease (CAD).
Read detailed articles on CABG - CABG Recovery Exercises.
#2. Transmyocardial Laser Revascularization (TMR)
This surgery is used to treat angina, often when other procedures and CABG haven't worked, or in combination with CABG. During TMR, a surgeon creates small channels through the heart muscle with laser, into the heart's left ventricle. It is believed that the surgery helps grow new blood vessels, which carry blood and relieve angina.
#3. Heart Valve Repair or Replacement
Blood must flow in a single direction in the heart, and the heart's valves ensure that through precise opening (to allow blood to pass from one chamber to next to an artery) and closing (to prevent blood from flowing backwards) of flaps in each valve. A heart surgery is sometimes needed to fix those flaps or leaflets that don't close tightly, causing blood to leak back into chambers rather than flowing forward into arteries. A cardiac surgeon performing heart valve surgery may either repair a valve or replace it with a biological or man-made valve. Biological valves are made from cow, pig or human heart muscle.
#4. Surgical Treatment of Cardiac Arrhythmia
Arrhythmia or problem with the rate and rhythm of heartbeat can cause the heart to beat too fast, too slow or with an irregular rhythm. This can cause insufficient blood to be pumped to the body and lead to damage to brain, heart and other organs. Surgery is recommended if medication fails to treat the condition. Surgery involves implantation of a pacemaker or an implantable cardioverter defibrillator (ICD).
- Pacemaker implantation - In Pacemaker Surgery, a small device is placed under the skin of patient's chest or abdomen, with wires connecting it to the heart. Low electrical pulses control the heart rhythm.
- ICD - It is also placed under the skin of chest or abdomen and connected to the heart through wires. However, ICD only checks for dangerous arrhythmias and sends an electric impulse if it senses one.
#5. Aortic Aneurysm Repair
Sometimes, a weakened artery wall creates a balloon-like bulge in its wall or the heart muscle. Pressure from flowing blood can cause this weakened area to bulge further and burst, or bleed into and along the layers of an artery wall. This occurs most commonly in the left ventricle. Repair requires surgery to replace the weakened section of heart or artery wall with a graft or patch.
#6. Heart transplant
A heart transplant is a surgical procedure that removes a diseased heart from a patient with a healthy heart from a deceased donor. The surgery is carried out on a patient with a failing heart, which cannot pump enough blood to meet the body's requirements. It is carried out when all other forms of treatments other than the transplant, have failed. Often, patients on the waiting list for receiving a donor's heart are given simultaneous treatment forms or devices (ventricular assist devices (VADs) or total artificial hearts (TAHs)).
What to expect during and after heart surgery?
Depending on a patient's condition, a team of doctors that usually comprises of a cardiologist and a cardiac surgeon will decide if a heart surgery is the best option ahead. The cardiologist diagnoses and treats heart problems while a cardiothoracic surgeon specializes in surgery of the lungs and heart.
Depending upon the type of surgery, a patient may be kept in the intensive care unit (ICU) for a day or more, and then transferred to another part of the hospital for several days, before being allowed to go home. Recovery time varies depending on the type of surgery but requires sufficient rest and care. Lifestyle changes, medicines and a cardiac rehabilitation programme may be recommended to help a patient recover completely.
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Sources:"Cardiac Procedures and Surgeries," The American Heart Association, https://www.heart.org/HEARTORG/Conditions/HeartAttack/PreventionTreatmentofHeartAttack/Cardiac-Procedures-and-Surgeries_UCM_303939_Article.jsp"When You Need Heart Surgery," Doylestown Hospital, https://www.dh.org/when-you-need-heart-surgery"Who Needs Heart Surgery?" National Institutes of Health, NIH, https://www.nhlbi.nih.gov/health/health-topics/topics/hs/whoneeds.htmlimage source: ihm
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