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Heart Surgery In Detail

Before, During & After Heart Surgery

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Updated July 08, 2009

human heart, heart surgery, EKG, ECG

Human Heart and EKG

Image: © ADAM

Heart Surgery

Heart surgery is done for a variety of reasons and ranges from minimally invasive procedures to actually removing the heart and replacing it with a donor heart. Most heart surgery is performed under general anesthesia, requiring that the patient be intubated and on a ventilator. Some less invasive procedures, such as placing stents or a pacemaker, may be performed with monitored anesthesia care, known as twilight sleep.

Before Heart Surgery

It is important that you choose your surgeon wisely. In the vast majority of cases, the surgery will be performed by a cardiothoracic surgeon. The right doctor will take the time to discuss the general risks of surgery and the risks of heart surgerywith you and help you determine if surgery is necessary.

The Human Heart

Knowing how the heart works is essential for understanding the procedure you are having. The heart is made up of four valves and four chambers that move blood through the body. If any part of the heart is damaged or malfunctions, the course of blood through the heart may be altered, decreasing its efficiency. Changes in the function of the heart can result in weakness, fatigue, irregular heart rhythms and even blood clots.

Open Heart Surgery

Open heart surgery is a type of heart surgery that require the heart to be exposed in order to perform the procedure. In these cases, the sternum (breast bone) is cut in half vertically so the chest can be opened, making the heart visible. The pericardium is then pulled away from the heart, giving the surgeon direct access.

Less invasive alternatives to open heart procedures are being improved every day, resulting in surgeries that can be performed without opening the chest. One example of a surgery that is now available using a minimally invasive technique is the MAZE procedure, a surgery that helps control atrial fibrillation.

Congenital Heart Defect Repairs

Congenital heart defects are conditions that are present at birth. They range from minor problems to major life-threatening issues that must be repaired in order for the child to survive.

How To Prepare Children For Surgery

Heart Valve Repair and Replacement

The valves of the heart work to keep blood flowing in the right direction through the heart and lungs. If they are damaged or not working properly, the flow may be disrupted, causing minor issues, such as a heart murmur, or more serious diseases of the heart valves such as a mitral valve prolapse or endocarditis.

Depending on the severity of the problem, a valve repair or a valve replacement may be necessary. There are many types of heart valve replacement currently on the market, your surgeon should be able to guide you in your choice. Your surgeon may recommend that you take blood thinners to prevent clots after heart surgery.

Heart Transplant Surgery

Heart transplant surgery is one of the riskiest heart surgeries performed today. Transplantation is done when the heart is so badly damaged, or functioning so poorly, that the patient will not survive without a new heart. If the heart cannot supply the body with enough blood, a device such as an LVAD to control symptoms of congestive heart failure, or ECMO may be used to support the heart function until a donor heart is found.

Heart Bypass Surgery

Heart bypass surgery, also known as coronary artery bypass grafting or CABG, bypasses the clogged arteries that feed the heart muscle. When the vessels are damaged by atherosclerosis and/or arteriosclerosis, less blood reaches the heart. When the blockage is severe, or it does not respond to less invasive treatment such as stents, chest pain or even a heart attack may result.

Bypassing the coronary arteries increases the blood flow to the heart muscle and helps prevent damage from occurring or worsening. The surgery is performed in two ways, one utilizes the heart-lung bypass machine (on pump) and the other is performed without the machine (off pump).

Pacemaker Surgery

A pacemaker is a device that is implanted into the body to help control the rhythm of the heart. Pacemaker surgery is one of the least invasive heart surgeries, and does not require the chest to be completely opened as is done in open heart procedures. There are a variety of types of pacemakers, each designed to suit a different purpose. However, the pacemaker implant procedure is virtually the same, regardless of the type of pacemaker.

Life After Pacemaker Surgery

After Heart Surgery

Once your heart surgery is complete, there are a few things that are essential to a great recovery. Good incision care is important. Keeping the incision clean and dry will help prevent infection during your recovery, and speed healing.

Very simple things become far more important after heart surgery, one great example of this is keeping your bowels moving. Constipation after heart surgery can be dangerous. Straining to have a bowel movement after surgery can place great strain upon the heart, and should be avoided. Even rising from a seated position may require a special technique, bracing your incision with a pillow to provide support.

After your procedure, your surgeon may recommend cardiac rehabilitation to help get you back to your normal activities.

Sources:

Open Heart Surgery. Cincinnati Children’s Hospital. Accessed April, 2009. http://www.cincinnatichildrens.org/health/heart-encyclopedia/treat/surg/open.htm

What Are The Risks of Heart Surgery? National Heart Lung and Blood Institute. Accessed April, 2009. http://www.nhlbi.nih.gov/health/dci/Diseases/hs/hs_risk.html

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