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All you need to know about heart surgery

Tags: angina , blood , heart

heart-surgery-image-mainThe idea of heart surgery may be daunting, but surgical processes have come a long way in recent years. GP Dr Sarah Jarvis reveals all you need to know about having, and recovering from, heart surgery.

The idea of heart surgery may be daunting, but surgical processes have come a long way in recent years. GP Dr Sarah Jarvis reveals all you need to know about having, and recovering from, heart surgery.

Heart surgery is often the recommended course of action for conditions such as coronary heart disease, angina, heart valve disease or abnormal heart rhythms. Surgery can be a scary prospect, but techniques have improved vastly over the years and it’s now a successful way of treating many heart conditions.

In fact, according to figures from the British Heart Foundation (BHF), in 2010 there were over 87,000 percutaneous coronary intervention (or coronary angioplasty) operations performed and over 17,000 incidences of coronary artery bypass surgery carried out by the NHS.

“Only a few decades ago, heart surgery was relatively rarely performed and, if it was, involved open heart surgery. These days, many heart procedures are minimally invasive – the whole procedure is carried out using tubes passed from the skin surface down an artery to the heart,” explains GP Dr Sarah Jarvis.

Types of heart surgery

Some of the common forms of heart surgery include coronary angioplasty, coronary artery bypass graft, valve repair, balloon valvuloplasty and trans-catheter aortic valve implantation (TAVI). Here’s the lowdown from Dr Jarvis on what’s involved and why they’re carried out.

Coronary angioplasty one of the most common procedures, this is used to open up a blockage in a coronary artery. It is often called PCI or percutaneous coronary intervention, because the surgeon reaches the blocked artery from the skin, rather than by opening up the chest.

What’s involved: Under local anaesthetic, a flexible tube is inserted through an artery in your groin or wrist and threaded up to your heart. A hollow mesh tube, called a stent, is passed through into the coronary artery. A balloon inside the tube is inflated to open up the stent and push the walls of the blocked artery open.

Coronary Artery Bypass Graft (CABG) – this is usually done using cardiac bypass, but it’s occasionally carried out with the heart still beating. A blood vessel from your leg is cut and attached at two points on one of your coronary arteries to replace a section which is too blocked for angioplasty to be effective.

What’s involved: In most operations, a 25cm cut is made through the front of the sternum (breastbone) to get direct access to the coronary artery which is to be replaced. In some cases, it can be carried out through two or three small incisions on the chest wall.

Valve repair this is carried out to repair valves in the heart chamber. Valves can become leaky, allowing blood to flow back (known as regurgitation) or become stiff and narrowed (known as stenosis).

What’s involved: Under general anaesthetic, the heart is put onto ‘bypass’ (sending the blood through a heart bypass machine to carry out the job of both the heart and lungs) while the heart is stopped to carry out the repair.

Balloon valvuloplasty – this procedure can be carried out under local anaesthetic to open up a valve affected by narrowing (stenosis).

What’s involved: A catheter is passed along an artery (usually from your groin) to the heart. A guide wire with a deflated balloon on is passed up and the position checked using X-ray video imaging. Once in the correct position, the balloon is inflated to widen the artery and then removed.

Trans-catheter aortic valve implantation (TAVI) – this minimally invasive procedure has become a more frequent procedure in recent years. It’s used to repair the aortic valve in people who are unfit for conventional valve repair.

What’s involved: As with angioplasty, a replacement artificial aortic valve is passed up a tube inserted in your groin and manoeuvred into position.

Preparing for heart surgery

Before you have surgery, it’s important to be in the best physical shape you can.

“Smoking can increase the risk of complications of surgery, including chest infections like pneumonia, plus it can increase the chance of wound infections,” explains Dr Jarvis. So speak to your doctor about getting expert help to stop smoking or lose weight.

“Being informed is key to helping yourself prepare mentally. Most forms of heart surgery are now routine procedures and complication rates are low.

“When you have your pre-surgery outpatient appointment, make a list of questions and take someone with you – you may forget what you’re told if you’re feeling anxious.”

Recovering from surgery and maintaining heart health

Depending on your surgery, you may be allowed home the same or the next day, or spend several days in hospital.

To reduce the risk of a blood clot forming on your leg, which can pass to the lungs, you’ll be given compression stockings to wear in hospital and have injections of blood-thinning medicine. “You’ll also be encouraged to get up and about as soon as possible, as this also reduces the risk of a blood clot,” says Dr Jarvis.

Your specialist will provide information on what you can and can’t do after your surgery and when you can go back to work.

Visit our Heart Centre for more information about different forms of heart disease or read our articles on how to improve your heart health.

References:

British Heart Foundation – www.bhf.org.uk

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