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What is heart surgery?

Heart surgery is also known as cardiac or cardiovascular surgery referring to any operation that involves the heart, or blood vessels that carry blood away from the heart such as coronary arteries, heart valves, and the aorta. It is performed by Cardiothoracic Surgeons, also known as Cardiac or Cardiovascular Surgeons. Not every heart-related problem requires heart surgery, but surgery is important in some heart conditions when it is severe to improve quality of life and survival. 

Heart surgery is normally performed through an incision in the middle of the chest. A heart-lung machine is normally used to support the heart and lungs during surgery. In most cases, patients stay for 2-3 nights in the intensive care unit after surgery and another 3-4 days in the ward before discharge home.

Types of heart surgery

Common types of heart surgery include:

  • Coronary artery bypass graft surgery (CABG)
  • Valve repair & replacement
  • Aorta repair & replacement
  • Atrial Fibrillation Ablation Surgery
  • Closure of heart defect

Coronary Artery Bypass Graft Surgery (CABG)

Coronary Artery Bypass Grafting (CABG) is the most common type of heart surgery. It is also known as heart bypass surgery. It is performed by using a blood vessel from under the chest wall (internal mammary artery), the arm (radial artery) or the leg (saphenous vein) to bypass the narrowed or blocked coronary artery so that normal amounts of blood is able to reach the heart muscle. This surgery is suitable in cases where several of the coronary arteries are severely narrowed or blocked to give the best improvement in symptoms and long-term survival. In most cases, the surgery can be performed with a 99% success rate. 

 

Coronary artery bypass graft (CABG) surgery

Valve Repair & Replacement

Valves between each of the heart’s pumping chambers keep blood flowing forward through the heart. 

  • Aortic valve. Located between the left ventricle and the aorta
  • Mitral valve. Located between the left atrium and the left ventricle
  • Pulmonary valve. Located between the right ventricle and the pulmonary artery
  • Tricuspid valve. Located between the right atrium and the right ventricle

Heart valves can become diseased and fail to open normally (valve stenosis) or become leaky (valve regurgitation). The common causes for this include normal wear and tear (degenerative valve disease), inflammation (rheumatic valve disease), infection (endocarditis) or a weak and swollen heart (functional valve regurgitation), amongst others. When the valve disease is severe or is causing symptoms such as breathlessness or chest discomfort, surgery to repair or replace the faulty valve is advised to improve symptoms and restore life expectancy back to normal. 

Most cases of degenerative and functional mitral and tricuspid valve regurgitation can be repaired without the need for valve replacement. This would be the best option to improve symptoms and restore life expectancy back to normal.

Diseases of the aortic valve would normally require valve replacement using either a tissue valve (made from animal tissue) or a mechanical (metal) valve. When the aortic valve stenosis (narrowing) is severe, urgent surgery is generally advised to prevent sudden death particularly when it is causing symptoms of breathlessness, chest discomfort or dizziness. The choice of valve replacement type can be tailored to each individual patient depending on age, lifestyle and other factors.

Mechanical Valve
Tissue Valve

Aorta Repair & Replacement

The aorta is the main blood vessel that carries blood away from the heart to the rest of the body. The aortic root is the section of the aorta closest to and attached to the heart. An aortic aneurysm is an abnormal enlargement in the wall of the aorta.

If an aneurysm develops in the aortic root, the aorta can dilate and the aortic valve can leak. If the aneurysm continues to expand, it can tear (aortic dissection) and even rupture. This is life-threatening and often fatal.  It causes symptoms of severe chest or back pain.

In the early stages when the aneurysm is not too big, the aorta can be strengthened to prevent it from getting any bigger using a personalised external aortic root support (PEARS). In more advanced stages when the aneurysm is already large, the dilated part of the aorta will need to be replaced to prevent it from tearing and rupturing. If the aorta is already torn (aortic dissection), urgent surgery is needed to replace it. It is best to perform the surgery electively in dilated aortas before they have torn as the risk of surgery is much lower.

Aorta Graft with valve attached for aortic root replacement
Aortic Root Replacement

In this surgery, the origins of the coronary arteries are detached from the aortic root, and the aortic root and the aortic valve are removed. A new aorta graft which also contains the aortic valve is then sewn onto the heart, and the origins of the coronary arteries are re-attached to the new aorta graft. This procedure is also known as a Bentall’s operation.

Aortic Root Replacement
Valve Sparing Aortic Root Replacement

In this surgery, the origins of the coronary arteries are detached from the aortic root, and the aortic root is removed while preserving the aortic valve. A new aorta graft is then sewn onto the heart, and the origins of the coronary arteries are re-attached to the new aorta graft. This procedure is also known as a valve-sparing aortic root replacement.

Graft for Ascending Aorta Replacement
Ascending Aorta Replacement 

In this surgery, the dilated portion of the aorta above the aortic root is removed until just before the origins of the blood vessels to the head and neck (aortic arch). A new aorta graft is then sewn onto the aortic root and the aortic arch.

Aorta Arch Replacement with covered stent graft (frozen elephant trunk)
Aorta Arch Replacement 

In this surgery, the dilated portion of the aorta in the area where the blood vessels to the head and neck arise is removed until just before the blood vessels to the lower part of the body (descending thoracic aorta). A new aorta graft is then sewn onto the ascending aorta, the head and neck vessels, and the descending thoracic aorta.

In some cases, a graft which also contains a covered stent is used. This is called a frozen elephant trunk and is useful for aneurysms or dissections involving both the aortic arch and the descending thoracic aorta. 

Personalised External Aortic Root Support (PEARS) operation

In this surgery, a custom-made device is used to wrap around the dilated aortic root to strengthen it and prevent it from getting any bigger or from tearing. A CT scan is performed first to obtain the precise measurements of the aortic root for the device to be manufactured. 

 

Personalised External Aortic Root Support (PEARS)
Aortic Root Support Placement

Atrial Fibrillation Ablation Surgery

Atrial fibrillation (AF) is an irregular heart rhythm condition that affects the upper chambers (atria) of the heart. This arrhythmia inhibits blood from being effectively pumped to the rest of your body. As a result, the patient may have symptoms of breathlessness, palpitations or lethargy. There is also increased risk of blood clots forming in the heart chamber due to the abnormal flow of blood through it, resulting in stroke. This condition is quite common in patients with severe diseases of the mitral valve such as mitral regurgitation or mitral stenosis, occurring in one-third of these patients.

The atrial fibrillation can be treated during  mitral valve surgery by using radiofrequency ablation to re-direct the electrical conduction signals of the heart in an orderly direction. This procedure is known as atrial fibrillation ablation surgery. It adds about 20 minutes to the duration of the surgery.  An area in the heart chamber where blood clots tend to form in patients with atrial fibrillation (the left atrial appendage) is also usually closed during the procedure to further reduce the risk of stroke in the longer term.

In patients where heart surgery is not being performed, atrial fibrillation ablation can also be done by passing a catheter (thin hollow tubes) through a blood vessel in the groin and threading it up to the heart, and then into the heart chamber. Radiofrequency ablation is then done with the catheter to direct the electrical conduction signals of the heart in the right direction through the heart, similar to what is done at surgery.

Closure of heart defect

Surgery to repair or close sizeable heart defects is recommended to prevent heart failure and improve survival. Common heart defects include atrial septal defects and ventricular septal defects. These defects can be closed either through open surgery or by less invasive means.

Catheter-based repair

Using imaging methods, a thin, flexible tube (catheter) is placed into a blood vessel in the groin, and directed to the heart. To seal the hole, a closure device is placed across the defect via the catheter.  Catheter-based closure is commonly used for secundum atrial septal defects. However, this procedure would not be suitable for secundum atrial septal defects which are very big or which have inadequate tissue around it for placement of the closure device. 

Open-heart surgery

A chamber of the heart is opened to access the heart defect. The defect is the closed using a patch of the patient’s own tissue (pericardium) or other material (animal pericadium or synthetic patches). Open-heart surgery is usually required to correct primum, sinus venosus, and coronary sinus atrial abnormalities. 

Risks of heart surgery

In most patients, heart surgery can be performed with a 99% success rate, or a 1% risk of mortality, stroke, bleeding, infection or kidney impairment.. In some patients, the risk may be higher. These are usually patients in whom the heart condition is diagnosed late, and where the heart is already enlarged and weak. Patients with pre-existing lung or kidney disease also have an increased risk of surgery.

What to expect after heart surgery

  • Most patients stay in the hospital for 5-7 days after the surgery.
  • Driving is not advised for 1 month after the surgery.
  • It takes up to 3 months to fully recover from heart surgery and feel better than before the surgery.
Things to know about heart surgery_CVSKL_Blog

Some Precautions

  • Find someone to help take care of you
  • Follow a healthy diet
  • Avoid extreme exercises
  • Avoid carrying heavy things
  • Careful using the arms and upper body
  • Follow up regularly
  • Get back to your routine slowly

For the benefit of your loved ones, family, and friends, do take good care of your heart by going for regular medical check-ups. You may contact CVSKL hospital which has experienced doctors with different expertise all in one place. We do provide health screening packages, with full and detailed checking results of your heart and can also tailor your medical check-up according to your specific condition.

Do contact us at appointment@cvskl.com to have a consultation with our heart specialist now! 

Information Shared By

Dr. John Chan Kok Meng

Consultant Cardiothoracic Surgeon

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