About Heart SurgeryThe earliest surgery on the heart took place in the 19th century, and involved surgical repair of the area around the heart. Surgery on the heart itself was limited by the fact that the heart must beat continuously in order to supply blood to the brain and vital organs. Surgeons needed to find a way to keep the heart motionless and emptied of blood before attempting repair, and were unable to perform surgery on the heart until this problem was solved.
Surgeons began to experiment with techniques that allowed the heart to stop beating while an operation was completed. First, heart surgeons had to find a way to provide blood to the rest of the body while the operation was completed. This is known as cardiopulmonary bypass, where an external system does the work of the heart and lungs. The first attempts started int the 1950's, and used a patient's family member to provide blood during the operation. This was soon replaced with the heart-lung machine, which did the work of oxygenating blood and pumping it to the body during surgery.
The second major hurdle was to find a way to slow the heart down while the operation was completed. This was completed with a combination of medications, potassium, and cold temperatures known as cardioplegia. After refinements in cardiopulmonary bypass and cardioplegia, heart surgeons began to develop techniques to surgically correct problems with the heart valves, coronary arteries, and structure of the heart.
Modern heart surgery undergone tremendous advances in the last 25 years, and continues to advance with new techniques. These include minimally invasive heart surgery techniques with the goal of making smaller incisions and providing for a shorter and less painful recovery from heart surgery. These techniques include robotic heart surgery, where the surgeon sits away from the patient and performs an operation with small instruments that are controlled by the hands.
Please see the following sections for information about common heart surgery procedures. The goal of this guide is to provide background information for patients before meeting with a cardiac surgeon. If you require surgery, you will have the opportunity to ask any questions during your consultation with our surgeons.
• Heart Surgery Information from the National Institutes of Health
• What to Expect After Heart Surgery
The aortic valve is located between the powerful left ventricle and the aorta (the body’s largest blood vessel), and ensures that blood is pumped forward from the heart to the rest of the body. The two main types of problems with the aortic valve are aortic stenosis (narrowing of the valve) and aortic regurgitation (leaking of the valve).
If there is a problem with the aortic valve, the surgeon can conduct aortic valve replacement or aortic valve repair surgery. While there are advantages to aortic valve repair, replacement is usually needed (unlike the mitral valve, where mitral valve repair is usually the best option).
Coronary artery bypass grafting (CABG) is an operation that is performed on patients with coronary artery disease. The coronary arteries supply the heart itself with blood. Coronary artery disease occurs when the vessels become narrowed, which is usually due to atherosclerosis.
Minimally invasive surgery refers to a variety of surgical techniques designed to decrease the impact of open heart surgery on a patient. Some techniques are designed to use a smaller operating "window," which is the opening to the heart that the surgeon uses to perform the operation.
Experts now recommend earlier surgery for mitral valve disease to prevent these irreversible changes. Traditionally, surgeons would perform mitral valve replacement, where the diseased valve is removed and replaced with an artificial valve. Now, experts generally agree that whenever possible, a heart valve should be repaired.
The mitral valve ensures that blood returning from the lungs flows forward from the left atrium and into the powerful left ventricle. The left ventricle pumps blood to the rest of the body. There are three major problems that can occur with the mitral valve that require surgical repair.
Robotic heart surgery is a remarkable new technology that allows surgeons to perform heart surgery using robotic technology that accesses the heart through small incisions. Research data suggests this minimally invasive heart surgery technique may result in shorter recovery time, decreased pain and trauma, and a quicker return to normal activities.
The Modified Maze procedure is used in surgery for atrial fibrillation, and generally completed at the same time the patient is having another type of heart surgery, such as a coronary artery bypass or valve replacement. Because this is open-heart surgery, it only takes a few minutes to create the necessary set of lesions to block the irregular electrical impulses that cause AF.
In the Ross procedure, the patient’s diseased aortic valve is removed and replaced with his or her own pulmonic valve. A homograft or porcine valve is then placed in the pulmonic position. The Ross Procedure can be used to treat aortic stenosis or regurgitation.
Transmyocardial laser revascularization is a procedure used to increase blood flow to damaged heart tissue. These channels are believed to stimulate the growth of new blood vessels in the area and provide increased blood flow to the damaged heart muscle.
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