Heart surgery addresses various conditions affecting the heart and its major blood vessels. It treats issues like blockages, heart valve problems, and congenital defects when medication is insufficient. This specialized field has seen significant advancements, allowing for complex procedures that improve patient outcomes and quality of life.
Foundations of Heart Surgery
Before heart surgery, preparatory steps ensure patient safety and surgical effectiveness. General anesthesia is administered, rendering the patient unconscious and pain-free. An anesthesiologist continuously monitors vital signs, including heart rate, blood pressure, and oxygen levels, making adjustments to medication as needed.
Most open-heart surgeries use a heart-lung bypass (CPB) machine. This machine temporarily takes over heart and lung functions, circulating and oxygenating blood. This allows the surgeon to operate on a still, bloodless heart, which is necessary for intricate repairs or replacements.
Access to the heart is gained through a median sternotomy. This involves a vertical incision along the center of the chest, where the sternum (breastbone) is divided using a specialized saw. The breastbone halves are then spread apart, providing the surgical team with a clear view and direct access to the heart.
Major Heart Surgery Procedures
Coronary Artery Bypass Graft (CABG) Surgery
Coronary Artery Bypass Graft (CABG) surgery addresses blockages in the coronary arteries, which supply blood to the heart muscle. After exposing the heart, a healthy blood vessel, often from the patient’s leg (saphenous vein) or chest (internal mammary artery), is prepared for grafting. The heart-lung bypass machine is typically employed, allowing the heart to be temporarily stopped.
One end of the harvested vessel connects to the aorta, the body’s main artery, and the other to the blocked coronary artery just beyond the narrowed section. This creates a new pathway for blood, bypassing the obstruction and restoring adequate blood supply to the heart muscle. Depending on the number of blockages, a patient may receive multiple grafts. Once the grafts are secured, the heart is restarted, and the bypass machine is gradually disconnected.
Heart Valve Repair or Replacement
Heart valve surgery addresses valves that are too narrow (stenosis) or do not close properly (regurgitation), disrupting blood flow. Traditionally, this involves open-heart surgery with a sternotomy and a heart-lung bypass machine, allowing the surgeon to work on a motionless heart.
For valve repair, the surgeon may separate fused valve leaflets, reshape or patch torn leaflets, or tighten the ring around the valve (annulus) with an artificial band. If repair is not feasible, the damaged valve is removed and replaced with either a mechanical valve, made of durable materials like metal or carbon, or a biological tissue valve, derived from animal or human heart tissue. After the new valve is secured or repaired, the heart is restarted and monitored for proper blood flow and absence of leaks.
Heart Transplant
Heart transplantation is for patients with end-stage heart failure when other treatments have failed. This complex procedure typically involves a median sternotomy and connecting the patient to a heart-lung bypass machine for circulation and oxygenation. The diseased heart is carefully removed, leaving a portion of the left atrium and major blood vessels.
The donor heart, transplanted within approximately four hours of removal, is then meticulously sewn into the recipient’s chest. The donor heart’s major blood vessels connect to the recipient’s remaining structures. Once connections are complete, blood flow is restored to the new heart, which often begins beating on its own, though sometimes an electric shock is used to initiate its rhythm.
Minimally Invasive Heart Surgery
Minimally invasive heart surgery offers an alternative to traditional open-heart surgery for some conditions. Instead of a large sternotomy, surgeons make smaller incisions, typically 2 to 4 inches, often between the ribs. Specialized instruments, cameras, and sometimes robotic arms are inserted through these openings, allowing the surgeon to visualize and operate on the heart with enhanced precision.
This approach is used for various procedures, including some valve repairs or replacements, and coronary artery bypass grafting. Benefits include reduced pain, less blood loss, smaller scars, and potentially faster recovery times and shorter hospital stays compared to traditional open-heart surgery. Patients may also return to normal activities quicker.
The Path to Recovery
After heart surgery, patients are typically transferred to an intensive care unit (ICU) for close monitoring. During this immediate post-operative period, tubes and lines may be present, including a breathing tube connected to a ventilator, intravenous (IV) lines for fluids and medications, and chest drainage tubes. Pain management is a significant focus, with intravenous and oral medications provided to control discomfort.
As recovery progresses, patients are moved from the ICU to a general ward, usually within a few days. Nurses and therapists assist with early mobilization, encouraging patients to sit up, walk short distances, and perform deep breathing exercises to prevent complications like lung infections and blood clots. Wound care involves keeping incisions clean and dry, with gentle washing using soap and water during showering, and avoiding ointments or direct soaking.
The typical hospital stay after open-heart surgery ranges from four to seven days, while minimally invasive procedures may allow for shorter stays of one to three days. Upon discharge, a gradual return to daily activities is advised. Cardiac rehabilitation programs are often recommended, providing supervised exercise, nutritional counseling, and support for lifestyle adjustments. Full recovery, including breastbone healing, can take six to eight weeks, with restrictions on heavy lifting and driving for about one month.