Different types of heart surgery are used to fix different heart problems. : -

Coronary Artery Bypass Grafting : >>

Coronary artery bypass grafting (CABG) is the most common type of heart surgery. More than 500,000 of these surgeries are done each year in India. CABG improves blood flow to the heart. It's used for people with severe coronary artery disease (CAD).



In CAD, a fatty material called plaque builds up inside your coronary (heart) arteries. It narrows the arteries and limits blood flow to your heart muscle. CAD can cause angina , shortness of breath, and can even lead to a heart attack.



During CABG, a surgeon takes a vein or an artery from your chest, your leg, or another part of your body and connects, or grafts, it to the blocked artery. The grafted artery bypasses (that is, goes around) the blockage. This allows oxygen-rich blood to reach the heart muscle. Surgeons can bypass as many as four blocked coronary arteries during one surgery.



Sometimes you can choose between CABG and angioplasty to treat CAD. Talk to your doctor about these different treatments.

Arrhythmia Treatment : >>



An arrhythmia is a problem with the speed or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm.



Most arrhythmias are harmless, but some can be serious or even life threatening. When the heart rate is abnormal, the heart may not be able to pump enough blood to the body. Lack of blood flow can damage the brain, heart, and other organs. Arrhythmias are usually treated with medicine first. If medicines don't work well enough, you may need surgery. For example, your doctor may use surgery to give you a pacemaker or an implantable cardioverter defibrillator (ICD).



A pacemaker is a small device that's placed under the skin of your chest or abdomen. Wires lead from the pacemaker to the heart's chambers. The pacemaker sends electrical signals through the wires to control the speed of the heartbeat. Most pacemakers have a sensor that activates the device only when the heartbeat is abnormal.



An ICD is another small device that's placed in your chest or abdomen. This device also is connected to the heart with wires. It checks your heartbeat for dangerous arrhythmias. If it senses one, it sends an electric shock to the heart to restore a normal heartbeat.



Another type of surgery for arrhythmia is called Maze surgery. In this operation, the surgeon makes new paths (a maze) for the heart's electrical signals to travel through. This type of surgery is used to treat atrial fibrillation, the most common type of serious arrhythmia.

Heart Transplant : >>

A heart transplant is surgery in which a diseased heart is replaced with a healthy heart from a deceased donor. Heart transplants are done on patients whose hearts are so damaged or weak that they can't pump enough blood to meet the body's needs.



This type of surgery is a life-saving measure that's used when medical treatment and less drastic surgery have failed.



Because donor hearts are in short supply, patients who need a heart transplant go through a careful selection process. They need to be sick enough to need a new heart, yet healthy enough to receive it. Patients on the waiting list for a donor heart receive ongoing treatment for heart failure and other medical conditions. VADs may be used to treat these patients. Surgical Approaches



In recent years, new ways of doing heart surgery have been developed. Depending on a patient's heart problem, general health, and other factors, he or she can now have open-heart surgery or minimally invasive heart surgery.

Who Needs Heart Surgery ?

Heart surgery is used to treat people who have severe heart diseases and conditions. If other treatments, such as lifestyle changes, medicines, and medical procedures, haven't worked or can't be used, heart surgery may be an option.Heart surgery is used to treat heart failure and coronary artery disease. It's also used to fix heart valves that don't work right, to regulate heart rhythms, and to replace a damaged heart with a healthy one. Specialists InvolvedYour primary care doctor, a cardiologist, and a cardiothoracic surgeon will decide whether you need heart surgery. A cardiologist specializes in treating heart problems. A cardiothoracic surgeon specializes in surgery on the heart and lungs.These doctors will talk with you and do tests to learn about your general health and your heart problem. They'll discuss test results with you, and you will help make decisions about the surgery

Medical Evaluation

The kind of heart problem you have, the symptoms it's causing, and how long you have had symptoms

Your history and past treatment for heart problems, including surgeries, procedures, and medicines

Your family's history of heart problems

Your history of other health problems and conditions, such as diabetes or high blood pressure

Your age and general health



The doctors also may do blood tests, such as a complete blood count, a cholesterol test, and other tests as needed.

EKG (Electrocardiogram) : -

An EKG is a simple and painless test that records the electrical activity of your heart. This test is used to help detect and locate the source of heart problems. A technician attaches sticky patches, called electrodes, to the skin of your chest, arms, and legs. The electrodes are attached with wires to a machine that records your heart's electrical signals.An EKG shows how fast your heart is beating and whether its rhythm is steady or irregular. It also shows where in your heart the electrical activity starts, and whether it's traveling through your heart in a normal way

Echocardiography: -



Echocardiography is a painless, noninvasive test. "Noninvasive" means that no surgery is done and no instruments are inserted into your body.



This test uses sound waves to create a moving picture of your heart. Echocardiography provides information about the size and shape of your heart and how well your heart chambers and valves are working. The test also can show areas of poor blood flow to your heart, areas of heart muscle that aren't contracting normally, and previous injury to your heart muscle caused by poor blood flow.

Cardiac Magnetic Resonance Imaging : -

Cardiac magnetic resonance imaging (MRI) is a safe and noninvasive test that uses magnets and radio waves to create images of the inside of your body. Cardiac MRI uses a computer to create images of your heart as it's beating. The computer makes both still and moving pictures of your heart and major blood vessels.



Cardiac MRI shows the structure and function of your heart. This test is very accurate at finding aneurysms and determining their size and exact location.

What To Expect During Heart Surgery

Heart surgery is done in a hospital. A team of experts is involved. Cardiothoracic surgeons perform the surgery with a team of other doctors and nurses who assist. The length of time for the surgery depends on the type of surgery. CABG, the most common type of heart surgery, usually takes 3 to 5 hours.

Off-Pump Heart Surgery

Advantages of off-pump heart surgery are : -

No complications related to using a heart-lung bypass machine

Faster recovery from the surgery

Traditional Open-Heart Surgery

This type of surgery is the same as traditional open-heart surgery, except you aren't connected to a heart-lung bypass machine. Instead, your heart is steadied with a mechanical device while the surgeon works on it. Your heart continues to pump blood to your body.For this type of surgery, you're given medicine to make you fall asleep. A doctor checks your heartbeat, blood pressure, oxygen levels, and breathing during the surgery. A breathing tube is placed in your lungs through your throat and connected to a ventilator (breathing machine).A surgeon makes a 6- to 8-inch incision (cut) down the center of your chest wall. Your chest bone is cut and your rib cage is opened so that the surgeon can get to your heart. You're given medicine to thin your blood and keep it from clotting. A heart-lung bypass machine is connected to your heart. This machine takes over for your heart by replacing the heart's pumping action. A specialist oversees the machine. The bypass machine allows the surgeon to operate on a heart that isn't moving and full of blood.

The illustration shows a heart-lung bypass machine attached to a heart during surgery.



You're given medicines to stop your heartbeat once you're connected to the heart-lung bypass machine. A pipe is placed in your heart to drain blood to the machine. The machine removes carbon dioxide (a waste product) from your blood, adds oxygen, and then pumps the blood back into your body. Tubes are inserted into your chest to drain fluid.



Once the bypass machine begins to work, the surgeon performs the surgery to repair your heart problem. At the end of the surgery, your heart is restarted using mild electric shocks. The pipes and tubes are removed from your heart, and the heart-lung bypass machine is stopped. You're given medicine to allow your blood to clot again. Your chest bone is closed with wires. Stitches or staples are used to close the incision. The breathing tube is removed.



An advantage of traditional open-heart surgery is that it's easier for the surgeon to operate. This is very important for long and complex surgeries.

Recovery in the Hospital

Depending on the type of heart surgery, you may spend 1 day or more in the hospital's intensive care unit. Then you will be moved to another part of hospital for several days before you go home.While you're in the hospital, doctors and nurses will closely watch your heart rate, blood pressure, breathing, vital signs, and incision site(s). You may have an intravenous (IV) needle inserted in your arm to give you fluids until you're ready to drink on your own.You also may be given extra oxygen through a face mask or nasal prongs that fit just inside your nose. These pieces of equipment are removed when you don't need them any more

Ongoing Care

Care after your surgery may include periodic checkups with your doctor. During these visits, you may have blood tests, an EKG (electrocardiogram), an echocardiography, or a stress test. These tests will show how your heart is working after the surgery.Your doctor also may talk to you about lifestyle changes and medicines to help you stay healthy. Lifestyle changes may include quitting smoking, making changes in your diet, getting regular physical activity, and lowering and managing stress.You doctor may refer you to a cardiac rehabilitation (rehab) program. Cardiac rehab includes counseling, education, and exercise training to help you recover. The program also will help you learn how to make choices that can lower your risk for future heart problems.

What Are the Risks of Heart Surgery ?

Heart surgery has risks, even though its results often are excellent. Risks can be from the surgery itself or from the heart-lung bypass machine.

They include : -

Bleeding.

Infection, fever, swelling, and other signs of inflammation.

Reaction to the medicine used to make you sleep.

Arrhythmias (irregular heartbeats).

Memory loss and difficulty concentrating or thinking clearly.

Damage to tissues in the heart, kidneys, and lungs.

Death. (People who are very sick before the surgery are at higher risk.)

- : Key Points : -