Cardiac Surgeries

AFIQ JOHARI
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 Cardiovascular Surgeries
• Cardiovascular surgery is surgery on
the heart or great vessels performed by cardiac
surgeons.
• Frequently, it is done to treat complications
of ischemic heart disease, correct congenital heart
disease, or treat valvular heart disease from
various causes including endocarditis, rheumatic
heart disease and atherosclerosis.
• It also includes heart transplantation.

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 World's First Successful Heart Surgery 

• In 1893, Dr. Daniel Hale Williams performed

the first successful open heart surgery at
Provident Hospital on the South Side. The
patient was James Cornish, who had stabbed
in the chest.

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 Heart Surgery
• Indication
 Treat heart failure and coronary heart
disease (CHD)
 Fix heart valves that don't work well
 Control abnormal heart rhythms
 Place medical devices
 Replace a damaged heart with a healthy one

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• If other treatments—such as lifestyle changes,
medicines, and medical procedures—haven't
worked or can't be used, heart surgery might
be an option.

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 Types of Heart Surgeries
• Coronary Artery Bypass Grafting
• Transmyocardial Laser Revascularization
• Heart Valve Repair or Replacement
• Arrhythmia Treatment
• Aneurysm Repair
• Heart Transplant
• Surgery To Place Ventricular Assist Devices or
Total Artificial Hearts
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 Risks of Heart Surgery
Heart surgery has risks, even though its results often are
excellent. Risks include:

• Bleeding.
• Infection, fever, swelling, and other signs of inflammation.
• A reaction to the medicine used to make sleep during the
surgery.
• Arrhythmias (irregular heartbeats).
• Damage to tissues in the heart, kidneys, liver, and lungs.
• Stroke, which may cause short-term or permanent damage.
• Death. (Heart surgery is more likely to be life threatening in
people who are very sick before the surgery.)
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 Surgery Team
During heart surgery, a highly trained group works as a team. Here is a list of
people who will be in the operating room during surgery.

• The cardiovascular surgeon, who heads up the surgery team and performs
the key parts of the surgery.
• The assisting surgeons, who follow the direction of the cardiovascular
surgeon.
• The cardiovascular anesthesiologist, who gives you the medicines that
make you sleep during the surgery (called anesthesia). The anesthesiologist
makes sure that you get the right amount of medicines throughout the
surgery and monitors the ventilator, which breathes for you during surgery.
• The perfusion technologist, who runs the heart-lung machine.
• The cardiovascular nurses, who are specially trained to assist in heart
surgery.

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 Medical Evaluation
• Kind of heart problem and the symptoms it's causing.
• Past treatment of heart problems, including surgeries,
procedures, and medicines.
• Family's history of heart problems.
• History of other health problems, such as diabetes
or high blood pressure.
• Age and general health.
• Blood tests such as a complete blood count, a
lipoprotein panel (cholesterol test), and other tests as
needed.
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 Diagnostic Tests

• Tests are done to find out more about heart

problem and general health. This helps
doctors decide whether patient need heart
surgery, what type of surgery they need, and
when to do it.

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 Diagnostic Test
• ECG (Electrocardiogram)
• Stress Test
• Echocardiography
• Coronary Angiography
• Chest X Ray
• Cardiac Computed Tomography Scan
• Cardiac Magnetic Resonance Imaging

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What To Expect by Patient Before Heart Surgery

• Doctors and others in health care team will

meet with patient to explain what will happen.
• When and how their surgeries will happen
• How to prepare for the surgery
• Patients may have some tests before the
surgery, such as
an EKG (electrocardiogram),chest x ray,
or blood tests.

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 Before Surgery
• An intravenous (IV) line will be placed into a
blood vessel in your arm or chest to give patient
fluids and medicines.
• A member of health care team may shave the
area where surgeon will make the incision (cut).
Also, skin might be washed with special soap to
reduce the risk of infection.
• Medicine will be given to fall asleep and don't
feel pain during the surgery.
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 Surgical Approaches
• Surgeons can use different approaches to
operate on the heart
• The surgical approach will depend on the
patient's heart problem, general health, and
other factors.
 Open-Heart Surgery
 Off-Pump Heart Surgery
 Minimally Invasive Heart Surgery

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 Open-Heart Surgery
•  is any kind of surgery in which a surgeon
makes a large incision (cut) in the chest to
open the rib cage and operate on the heart.
"Open" refers to the chest, not the heart.
Depending on the type of surgery, the surgeon
also may open the heart.
• is used to do CABG, repair or replace heart
valves, treat atrial fibrillation, do heart
transplants, and place VADs and TAHs.
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 Off-Pump Heart Surgery

• This approach is like traditional open-heart

surgery because the chest bone is opened to
access the heart. However, the heart isn't
stopped, and a heart-lung bypass machine
isn't used.
• Off-pump heart surgery isn't right for all
patients. heart problem, age, overall health,
and other factors that may affect the surgery
is carefully consider.

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 Minimally Invasive Heart Surgery

• a surgeon makes small incisions (cuts) in the

side of the chest between the ribs. This type of
surgery may or may not use a heart-lung
bypass machine.
• It is used to do some bypass and maze
surgeries. It's also used to repair or replace
heart valves, insert pacemakers or ICDs, or
take a vein or artery from the body to use as a
bypass graft for CABG.
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 Robot-assisted technique
• This type of procedure allows for even smaller,
keyhole-sized incisions. A small video camera
is inserted in one incision to show the heart,
while the surgeon uses remote-controlled
surgical instruments to do the surgery. A
heart-lung bypass machine sometimes is used
during this procedure.

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 What To Expect During Heart Surgery

• How long the surgery takes will depend on the

type of surgery. (CABG, the most common
type of heart surgery, takes about 3–6 hours)

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 Traditional Open-Heart Surgery

• For this type of surgery, the patient will be given

medicine to help them fall asleep.
• Checking heartbeat, blood pressure, oxygen levels,
and breathing during the surgery is important.
• A breathing tube will be placed in lungs through
throat. The tube will connect to a ventilator. 
• Surgeon will make a 6- to 8-inch incision (cut)
down the center of chest wall. Then, he or she will
cut breastbone and open rib cage to reach heart.

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 Traditional Open-Heart Surgery
• During the surgery, the patient will receive
medicine to thin blood and keep it from clotting. A
heart-lung bypass machine will be connected to
heart. The machine will take over patient heart's
pumping action and move blood away from heart.
• A specialist will oversee the heart-lung bypass
machine. The machine will allow the surgeon to
operate on a heart that isn't beating and that
doesn't have blood flowing through it.

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• The patient will be given medicine to stop heartbeat
once connected to the heart-lung bypass machine. A
tube will be placed in heart to drain blood to the
machine.
• The machine will remove carbon dioxide (a waste
product) from blood, add oxygen to blood, and then
pump the blood back into body. Surgeon will insert
tubes into chest to drain fluid.
• Once the bypass machine starts to work, the surgeon
will repair heart problem. After the surgery is done, he
or she will restore blood flow to the heart. Usually, the
heart will start beating again on its own. Sometimes
mild electric shocks are used to restart the heart.
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• Once the heart has started beating again,
surgeon will remove the tubes and stop the
heart-lung bypass machine. Patient will be given
medicine to allow your blood to clot again.
• The surgeon will use wires to close breastbone.
The wires will stay in body permanently. After
breastbone heals, it will be as strong as it was
before the surgery.
• Stitches or staples will be used to close the skin
incision. Breathing tube will be removed when
patient is able to breathe without it.

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 Off-Pump Heart Surgery

• Off-pump heart surgery is like traditional open-

heart surgery because the chest bone is
opened to access the heart. However, the
heart isn't stopped, and a heart-lung bypass
machine isn't used.
• Instead, surgeon will steady heart with a
mechanical device so he or she can work on it.
the heart will continue to pump blood to the
body.
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 Minimally Invasive Heart Surgery

• For this type of heart surgery, surgeon will make

small incisions in the side of chest between the ribs.
These cuts can be as small as 2–3 inches. The
surgeon will insert surgical tools through these small
cuts.
• A tool with a small video camera at the tip also will
be inserted through an incision. This tool will allow
the surgeon to see inside the body.
• Some types of minimally invasive heart surgery use a
heart-lung bypass machine and others don't.
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Coronary Artery Bypass Graft

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 Coronary Artery Bypass Graft
• Coronary artery bypass grafting (CABG) is a
type of surgery that improves blood flow to
the heart. Surgeons use CABG to treat people
who have severe coronary heart
disease (CHD).

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 Coronary Artery Bypass Graft
• is one treatment for CHD. During CABG, a
healthy artery or vein from the body is
connected, or grafted, to the blocked coronary
artery. The grafted artery or vein bypasses
(that is, goes around) the blocked portion of
the coronary artery. This creates a new path
for oxygen-rich blood to flow to the heart
muscle.
 Coronary Artery Bypass Graft
• The goals of CABG may include:
• Improving patient’s quality of life and reducing
angina and other CHD symptoms
• Allowing to resume a more active lifestyle
• Improving the pumping action of heart if it has
been damaged by a heart attack
• Lowering the risk of a heart attack (in some
patients, such as those who have diabetes)
• Improving chance of survival
 Indication
• Coronary artery bypass grafting (CABG) is used to treat
people who have severe coronary heart disease (CHD)
that could lead to a heart attack. CABG also might be used
during or after a heart attack to treat blocked arteries.
• doctor may recommend CABG if other treatments, such
as lifestyle changes or medicines, haven't worked. He or
she also may recommend CABG if you have severe
blockages in your large coronary (heart) arteries,
especially if your heart's pumping action has already
grown weak.
 Indication
A candidate for CABG based on factors such as:
• The presence and severity of CHD symptoms
• The severity and location of blockages in your
coronary arteries
• Your response to other treatments
• Your quality of life
• Any other medical problems you have
 Risks
• As with any type of surgery, coronary artery
bypass grafting (CABG) has risks. The risks of
CABG include:
• Wound infection and bleeding
• Reactions to anesthesia
• Pain
• Stroke, heart attack, or even death
• Fever associated with chest pain, irritability,
and decreased appetite. This is due to
inflammation involving the lung and heart sac.
This complication sometimes occurs after
surgeries that involve cutting through the
pericardium (the outer covering of the heart).
The problem usually is mild, but some patients
may develop fluid buildup around the heart
that requires treatment.
• Memory loss and other issues, such as problems
concentrating or thinking clearly, might occur in
some people. These problems are more likely to
affect older patients and women. These issues
often improve within 6–12 months of surgery.
• In general, the risk of complications is higher if
CABG is done in an emergency situation (for
example, during a heart attack). The risk also is
higher if you have other diseases or conditions,
such as diabetes, kidney disease, lung disease, or
peripheral arterial disease (P.A.D.).
 Before procedure
• tests to prepare patient for coronary artery
bypass grafting (CABG). For example, patient
may have blood tests,
an EKG (electrocardiogram),echocardiography,
a chest x ray, cardiac catheterization,
and coronary angiography.
 Before procedure
• The physician will tell patient how to prepare
for CABG surgery. He or she will advise you
about what can eat or drink, which medicines
to take, and which activities to stop (such as
smoking). Patient will likely be admitted to the
hospital on the same day as the surgery.
During Procedure
 Types of Coronary Artery Bypass Grafting

• Traditional Coronary Artery Bypass Grafting (3-

6hrs)
• Traditional CABG is used when at least one major
artery needs to be bypassed. During the surgery,
the chest bone is opened to access the heart.
• Medicines are given to stop the heart; a heart-
lung bypass machine keeps blood and oxygen
moving throughout the body during surgery. This
allows the surgeon to operate on a still heart.
• The surgeon will take an artery or vein from patient’s body
—for example, from chest or leg—to use as the bypass
graft. For surgeries with several bypasses, both artery and
vein grafts are commonly used.
• Artery grafts. These grafts are much less likely than vein
grafts to become blocked over time. The left internal
mammary artery most often is used for an artery graft.
This artery is located inside the chest, close to the heart.
Arteries from the arm or other places in the body also are
used.
• Vein grafts. Although veins are commonly used as grafts,
they're more likely than artery grafts to become blocked
over time. The saphenous vein—a long vein running along
the inner side of the leg—typically is used.
• After surgery, blood flow to the heart is restored.
Usually, the heart starts beating again on its own.
Sometimes mild electric shocks are used to restart the
heart.
• Patient will be disconnected from the heart-lung bypass
machine. Then, tubes will be inserted into your chest to
drain fluid.
• The surgeon will use wire to close your chest bone
(much like how a broken bone is repaired). The wire will
stay in your body permanently. After your chest bone
heals, it will be as strong as it was before the surgery.
• Stitches or staples will be used to close the skin
incision. The breathing tube will be removed when
you're able to breathe without it.
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