Medical Procedures for Heart Disease
Depending on severity, heart patients may need a surgical procedure to treat coronary conditions effectively.
When is heart surgery performed?
Heart surgery may be performed for a number of reasons including:
To implant a medical device
To treat heart failure
To treat coronary heart disease
To repair heart valves
To treat arrhythmia
To replace the heart altogether
Types of Heart Surgery
Many types of surgical procedures are performed including:
Coronary Artery Bypass Grafting
The most common surgical procedure performed on heart patients is coronary artery bypass grafting (CABG). This effectively treats coronary heart disease in many cases.
How is coronary artery bypass grafting performed?
In CABG a healthy artery or vein essentially bypasses the blocked artery and is grafted to either heart tissue or a coronary artery. This allows blood to flow to the heart muscle freely. In the course of one surgery, surgeons can bypass several coronary artery blockages.
Other Types of Heart surgery
About two-thirds of all angioplasties are performed during a serious cardiac event such as a heart attack, or escalating angina pain. The procedure takes about 20 minutes and can restore blood flow and reduce pain almost immediately. Angioplasty can lower the risk of having a second heart attack.
One-third of angioplasty patients undergo the procedure to reduce risk of heart attack. This is only performed, however if the individual has serious symptoms and standard therapies such as medications are not successful.
Complications and Risks of Angioplasty Procedure
- Bleeding from the catheter insertion site
- Blood clots that can induce a minor heart attack or stroke during the procedure
What is coronary angioplasty?
A coronary angioplasty procedure is sometimes performed in order to open an artery to improve blood flow to the heart. Coronary arteries may become blocked due to a medical condition known as atherosclerosis. Atherosclerosis is caused by plaque build up in the artery walls.
While plaque can build up in any artery of the body, when it occurs in coronary arteries it is referred to as coronary artery disease (CAD).
How does coronary angioplasty help?
Coronary angioplasty allows increased blood flow to the heart, which may help:
- Angina symptoms
- Shortness of breath
- Limit damage to the heart during a heart attack
- Save a life by opening blocked artery (arteries)
How common is the coronary angioplasty procedure?
Over 1 million Americans get coronary angioplasty each year.
Who gets coronary angioplasty?
While lifestyle changes such as eating a healthy diet, getting plenty of exercise, and quitting smoking are the first line of defense against heart disease, sometimes other treatment options must be considered.
When medication is unsuccessful in treating coronary artery disease, a coronary angioplasty procedure may be needed.
A coronary angioplasty can be performed in an emergency setting or as a preventive measure to reduce risk of heart attack.
What is the medical term for an angioplasty procedure?
An angioplasty procedure with stent may also be referred to as percutaneous coronary intervention (PCI).
How does angioplasty work?
A thin tube known as a catheter is threaded through an artery in the femur or wrist until it reaches the blocked coronary artery. A small balloon attached to the end of the catheter is inflated to expand the artery and allow for blood flow. The surgeon will place a stent, or small metal mesh coil in the artery to keep the artery open. Tissue will begin to grow around the stent and medications including antiplatelets may be given to reduce the stickiness of blood platelets that could cause blood clots in the stent.
Transmyocardial Laser Revascularization—TMR
This type of heart surgery relieves angina symptoms when other treatments for the condition have failed. TMR may be combined with CABG or offered if CABG has already been performed. In TMR a surgeon makes small laser cuts into the lower left chamber of the heart, which may help new blood vessels to grow. This allows additional blood flow through the heart and angina pain relief.
Repair or Replacement of Heart Valves
Heart valves ensure that blood flows in only one direction through the muscle. Sometimes flaps on heart valves don’t open as widely as necessary, however or don’t completely close. They may also become thick, stiff or fused together which inhibits proper blood flow. Valves may be replaced with animal tissue (valves) combined with man-made materials.
Surgically Treating Arrhythmia
If the rhythm of the heartbeat is not normal, the heart may sometimes fail to pump the right amount of blood. This could result in brain, heart, or other organ damage. If other non-surgical treatments have been ineffective, a pacemaker or implantable cardioverter defibrillator (ICD) may be placed under the skin of the abdomen or chest to regulate the heart.
Repair of an Aneurysm
Sometimes an artery wall (or the heart muscle itself) becomes weak in certain areas and bulge with the flow of blood. The artery can also split causing bleeding into the artery walls. This type of heart surgery requires a procedure to patch or graft the weak section of the artery or heart wall.
In the end stages of heart failure a heart transplant may be the only option left to save the life of the patient. In this case, the heart is too diseased or too weak to pump enough blood to support the body and brain and all other treatment methods have been unsuccessful. While waiting for a suitable heart, a ventricular assist device (VAD) or total artificial heart (TAH) may be implanted to assist heart pump function or to replace lower ventricles. Both procedures require open-heart surgery.
Approaches to Surgery
There are several approaches to heart surgery depending on the severity of the heart problem and the age and health of the patient.
Open-Heart Surgery—In this case, the surgeon cuts into the chest to expose and open the ribcage. This allows complete access to the heart. A heart-lung bypass machine is connected to the patient to allow blood to flow away from the heart, so it can be stopped.
Off-Pump Heart Surgery—The chest cavity is opened to allow access to the heart, though the heart is still beating and no heart-lung bypass machine is used. This surgical approach may be used to perform a CABG procedure.
Minimally Invasive Heart Surgery—Small incisions are made between the ribs, in the side of the chest and a heart-lung bypass machine may or may not be used. Some bypass surgeries, valve replacements and device placements may allow for this minimally invasive approach. Robotic-assisted surgery is sometimes performed in these cases.