Understanding Heart Surgery

It’s great if you can keep your heart healthy—by not smoking, eating a healthy diet, and getting regular physical activity. But what if you end up needing heart surgery? What should you know about the procedure?

For one thing, trust you’ll be in good hands.

“We reassure patients they’re being treated by highly trained, caring individuals who are absolutely devoted to getting them to full recovery with the least amount of risk to their well-being and independence,” says Joseph S. Coselli, M.D., a cardiothoracic surgeon in Houston.

Further, Dr. Coselli adds, the prospect for recovery is probably better than you think. “For a coronary artery bypass operation, if you’re otherwise in reasonably good condition, the risk for mortality is only about 1 to 2 percent,” he says. “A few decades ago, the risk would have been in the 5 to 10 percent range.”

Coronary artery bypass is just one form of heart surgery. Others include heart valve repair or replacement; arrhythmia surgery, which helps restore regularity of the heart’s natural rhythm; and aneurysm repair to replace weakened sections of a blood vessel or the heart with a graft.

Coronary bypass surgery

Bypass surgery is the most common. Coronary arteries, which supply the heart muscle with oxygen, can become clogged as a result of a buildup of fats, cholesterol, or other substances. A surgeon can attach a new section of blood vessel that goes around, or bypasses, the clogged arteries to restore a healthy flow of blood to the heart muscle.

Patients are under general anesthesia during bypass surgery, which in standard surgery may take from three to six hours. During the surgery, the patient's breastbone is separated to reach the heart; the heart is stopped, and blood is circulated through the body via a heart-lung machine, Dr. Coselli says. Patients awaken afterward in the hospital’s intensive care unit (ICU). After the ICU, patients are transferred to hospital rooms. 

Valve repair or replacement

Your heart valves allow blood to flow in only one direction. They open and close with each heart beat. Problems with blood flow occur when the valves don't work as they should. These are the two most common valve problems requiring surgery:

• Stenosis: The valve doesn't open wide enough to allow the proper amount of blood through. Surgery can make a wider opening or replace the valve.

• Regurgitation: The valve doesn't close tightly, and blood leaks backward instead of being pumped forward. Surgery can improve how the valve closes or replace the valve.

Today’s artificial valves are far superior to the ones used a few decades ago, both in terms of durability and how well they work inside the heart, says Dr. Coselli.

Arrhythmia surgery

An arrhythmia means an irregular heartbeat. Cardiologists usually treat arrhythmias with medication that restores normal heartbeat. A cardiologist may also try "shocking" the heart into a normal rhythm, or destroying the specific heart nerve cells that are causing the arrhythmia. Another treatment involves implanting a pacemaker or small defibrillator.

The most common type of arrhythmia is atrial fibrillation. It is often treated with a procedure called maze surgery. The cardiologist creates a new electrical pathway or maze for electrical impulses to travel to the heart.

Aneurysm surgery

An aneurysm is a bulge that occurs in a blood vessel or in the wall of the heart. This bulge is a weak spot that can burst if not repaired. Surgery can replace the weakened section of blood vessel or heart wall.

Recent advances

New technologies have reduced surgery and recovery times and make heart surgery an option for even some of the sickest patients.

After being in use for nearly 30 years, for example, coronary artery bypass surgery is now the most frequently performed major surgery in the United States, with more than 500,000 procedures done each year. Advances also have reduced recovery time and heart-surgery-related risks for stroke and spinal cord injury.

Reduced recovery time is particularly important to older patients because a few months can take a big chunk out of their remaining years of life. So is the reduced risk for stroke or other major complications.

“People often wonder if this operation will cause them to lose their independence,” says Dr. Coselli. “Most likely the answer is no, due to the progress we’ve made in providing curative therapies, reducing recovery time, and reducing the loss of independence.”

Minimally invasive surgery

With this option, the rib cage doesn’t have to be opened to access the heart area.

“Perhaps 40 to 60 percent of patients may be eligible for minimally invasive surgery, but it’s still a novel technology,” says Dr. Coselli. “It’s mostly done only in larger hospitals.”

Robots are used for performing minimally invasive surgery, which reduces the size of the incision, the recovery time, and risk to the patient.

Traditional surgery for an aortic aneurysm, for example, commonly can take up to six hours and require two to four days in the intensive care unit, a week to 10 days in the hospital, and two to four months of recovery at home.

Minimally invasive surgery takes about an hour. It’s done with a small incision in the groin only a few inches long through which a stented device is placed into the artery. The patient may spend one night in the recovery room, only two to three days in the hospital and be effectively fully recovered.

Reduced post-surgery discomfort

One of the patients’ biggest complaints after surgery traditionally has been the long scar in the leg where a vein is removed for use as a bypass artery. New procedures have reduced both the size of the scar and the discomfort.

Nearly all patients do feel better, not worse, after surgery, Dr. Coselli says. “Many patients going into surgery are short of breath or have chest pain,” he says. “The treatment addresses these issues. People are more vigorous afterward, they have reduced chest pain and they feel relieved. Their quality of life usually improves dramatically.”