Garfield Medical Center, Heart Surgery - What to expect, CABG & Valve Package
Coronary Artery Bypass Grafting (CABG) and Valve Surgery
What to expect before, during and after your surgery?
What is wrong with my heart? How a healthy heart should be?
The heart is a muscular organ about the size of your fist. It is a strong muscle and it works continuously to pump blood that carries oxygen and nutrients throughout the body. Just like other muscles in the body, the heart needs blood to do its work. Although the heart is full of blood, it cannot receive oxygen and nutrients from the blood inside it. Instead, it relies on the blood brought in by the arteries on its surface to nourish it and keep it working properly. These surface arteries are known as the coronary arteries. They branch into thousands of smaller arteries –like a tree trunk branches into limbs– bringing oxygen and nutrients to the heart muscle.
The heart is composed of four chambers; two upper chambers called atria and two lower chambers called ventricles. There are four valves in the heart: Tricuspid valve, Pulmonary valve, Mitral valve and Aortic valve. Blood is pumped through your heart in only one direction. Heart valves open and close their flap-like "doors" (called cusps or leaflets) with each heartbeat at just the right time to prevent a backflow of blood.
What causes heart disease?
Occasionally, these coronary arteries become narrowed due to a build-up of fat, cholesterol and calcium inside their walls, making it difficult for the blood to flow through them. This is similar to what happens to the plumbing in our homes as the pipes become rusty with a build-up of mineral deposits –not as much water can flow.
When the heart muscle does not get all the oxygenated blood it needs, it does not function properly. This is felt by the patient as tightening, pressure or fullness in the chest.
If your doctor has told you that you have coronary artery disease this means that your coronary arteries have an abnormal condition which is keeping them from delivering enough blood to your heart muscle.
When a valve does not work properly?
If your doctor has told you that one or more of your heart valves are not working properly, you could have one of these two problems:
Regurgitation is also called insufficiency or incompetence. It happens when a valve doesn't close properly and blood leaks backward instead of moving in the proper one-way flow. If too much blood flows backward, only a small amount can travel forward to your body's organs. The heart tries to make up for this by working harder, but with time it becomes enlarged (dilated) and less able to pump blood through the body.
Stenosis happens when the leaflets do not open wide enough and only a small amount of blood can flow through the valve. This occurs when the leaflets thicken, stiffen or fuse together. Because of the narrowed valve, your heart must work harder to move blood through your body.
What is Coronary Artery Bypass Grafting (CABG)?
Coronary Artery Bypass Grafting, known as CABG for its initials, can also be called Myocardial Revascularization. This is a surgical procedure that improves the blood flow to the heart by creating a new route, "bypassing" around a section of clogged or diseased artery. Bypass grafts tend to stay open for an average of about 10 years. Despite an initially successful surgery, some patients will develop symptoms again. Most often, this is caused by the progression of disease in the coronary arteries. Less often, new fatty deposits build up inside the bypass grafts.
During this procedure, your cardiovascular surgeon removes a healthy section of vein from your leg, or artery from the chest or another part of the body. This section is then sewn to form a "bridge" from one artery to another, around the diseased coronary artery, so that the heart muscle gets the oxygen-rich blood it needs to work properly. During bypass surgery, the breastbone (sternum) is divided, the heart is stopped, and blood is sent through a heart-lung machine, where it gets oxygenated before being pumped back into the body.
When you hear the words single bypass, double bypass, triple bypass, or quadruple bypass, this refers to the number of arteries that are bypassed. The number of bypasses does not necessarily indicate how severe the heart condition is.
Potential benefits of having CABG surgery
The two main goals of bypass surgery are to relieve symptoms of angina and to prolong life.
1) The effect of surgery on relieving symptoms is often significant. About 90% of bypass patients either become free of angina symptoms or have fewer symptoms. Many patients remain totally free of angina symptoms for years.
2) The effect of surgery on prolonging life, on the other hand, is not as clear-cut. Most experts agree that surgery usually prolongs life in people who have disease of the left main artery or severe blockages in all three major coronary arteries.
What are Valve Repair and Replacement?
Here are some procedures surgeons may use to repair a valve:
Valvuloplasty strengthens the leaflets to provide more support and to let the valve close tightly. This support comes from a ring-like device that surgeons attach around the outside of the valve opening.
Repair of structural support replaces or shortens the cords that give the valves support. When the cords are the right length, the valve can close properly.
When there is severe valve damage, the valve needs to be replaced. Valve replacement is most often used to treat aortic valves and severely damaged Mitral valves. It is also used to treat any valve disease that is life-threatening. Sometimes, more than one valve may be damaged in the heart, so patients may need more than one repair or replacement.
There are 2 kinds of valves used for valve replacement:
Mechanical valves are usually made from materials such as plastic, carbon, or metal. Mechanical valves are strong, and they last a long time. Because blood tends to stick to mechanical valves and create blood clots, patients with these valves need to take a blood thinning medicine (called coumadin) for the rest of their lives. Periodic blood draws are then needed to ensure that the blood is "thinned" enough to help prevent clots, but not so much as to cause bleeding. Your coumadin dose is adjusted based on your test results, shown as a number called either protime or INR.
Biological valves are made from animal tissue or taken from the human tissue of a donated heart. Patients with biological valves usually do not need to take blood-thinning medicines. These valves are not as strong as mechanical valves, though, and they may need to be replaced every 10 years or so. Biological valves break down even faster in children and young adults, so these valves are used most often in elderly patients.
You and your doctor will decide which type of valve is best for you. During valve repair or replacement surgery, the breastbone is divided, the heart is stopped, and blood is sent through a heart-lung machine. Because the heart or the aorta must be opened, heart valve surgery is called open heart surgery.
Preparing for cardiac surgery
You may need the following tests done before your surgery:
• Blood and urine tests
• Chest X-ray
• Electrocardiogram (ECG)
This provides the surgical team with baseline information on the current state of your health.