Heart & Vascular Institute

Open Heart Surgery

Visit our Consumer Care Series health information web page for a comprehensive description of the Open Heart Surgery procedure. Use the keywords "open heart surgery" in the search field for direct access.

Angioplasty is the dilation or widening of arteries narrowed by plaque accumulation. In a coronary artery angioplasty, a special catheter incorporating a balloon is threaded to the heart via a major peripheral artery. Using special imaging technology in the cardiac cath lab, the physician places the balloon at the site of blockage within the artery and inflates the balloon. This inflation disrupts the plaque and reopens the artery increasing blood flow and oxygen nourishment to this region of the heart muscle. A variety of other devices are available for use alone or in combination with angioplasty to open up the blockage. These include “cutting” balloons, laser, and the rotoblator or atherectomy
technique (also known as the Rotorooter procedure).

Stent technology was developed to prevent the possibility of the tendency for plaque to redevelop at a previous angioplasty site and reblockage of the artery to occur. This created the need for multiple repeat angioplasties for some patients. A stent is usually a stainless steel mesh wire tube that is placed at the blockage site after angioplasty has been successfully accomplished. The wire mesh eventually becomes incorporated into the arterial walls as the natural cell regeneration process of healing occurs at the angioplasty site. Stents are available in various diameters and lengths. Multiple stents may be placed during one procedure if multiple blockages are present.

Drug-Eluting Stents

Recently approved by the Food and Drug Administration, drug-eluting stents are an option for treatment of your heart disease. These stents have a drug delivery system incorporated into the wire mesh structure of the stent. The purpose of the drug is to prevent cell regrowth from blocking the artery again at the angioplasty site. This will reduce the likelihood of requiring a repeat angioplasty at the very same site as a previous procedure. However, the decision to utilize a drug-eluting stent rather than the bare metal stent will be based on the location of the lesion within the coronary anatomy, the diameter of the vessel, and how aggressively the patient is developing heart disease. Each patient situation will be assessed on an individual basis.

Brachytherapy

This technique uses a special catheter or wire that is placed at the site of a previous
artery blockage and controlled radiation is released in an attempt to prevent another restenosis or renarrowing from occurring once again. It has been found to be particularly effective in vein bypass grafts that have become narrowed by plaque development.

Balloon Valvuloplasty

Performed in the cardiac catheterization laboratory, balloon valvuloplasty is a procedure used to address valvular disease. As in coronary artery angioplasty, a balloon catheter is placed within the valve and inflated to widen the valvular area. The catheter is then removed, and the stenosis (narrowing) of the valve has been alleviated with improvement of blood flow across the valve. This technique is used most often for narrowing of the tricuspid, pulmonic, and mitral valves and rarely for aortic stenosis.

Placement of a pacemaker is indicated when there is a need to regulate the heartbeat. When the electrical conduction system of the heart is impaired, a pacemaker may be
necessary. The procedure is considered minor surgery and is done utilizing sedation and a local anesthetic.

Pacemakers consist of a pulse generator and its leads or wires. Think of the pulse generator as providing electronic surveillance of the heart’s electrical activity. The battery unit is incorporated within the pulse generator and the leads are attached to one or more of the heart’s chambers. During the placement procedure, a small incision is made underneath the collarbone and leads are introduced by way of a vein in this region to the heart. A pocket underlying the chest wall will be created for the location of the pulse generator. The leads transmit the heart’s electrical impulses back to the pulse generator which is programmed to monitor this activity and provide additional electrical stimulation if the heart rate falls below a certain desirable rate. This is the most commonly implanted type of pacemaker and is known as a demand pacemaker.

A maintenance schedule for monitoring your pacemaker will be developed in order to interrogate the pacemaker. This is an evaluation of the pacemaker’s programmed messages according to your individual situation as well as an assessment of the pulse generator’s battery life. Batteries generally last from six to ten years and lose their energy at a slow rate allowing ample opportunity to identify a convenient time for replacement.

It is also possible to assess pacemaker function utilizing the telephone. The electronic impulses from the pulse generator can be transmitted over the telephone and a recording of this activity assessed.

Immediately after pacemaker placement, you may have some discomfort in the location of the incision that may require analgesics. You will be advised regarding appropriate care of the incision to prevent the possibility of infection.

Keep in mind that the following can adversely affect the safe programmed function of your pacemaker:

- MRI or Magnetic Resonance Imaging equipment
- Welding machines
- Certain dental equipment
- Radiation-producing machines such as those used in cancer treatment
- Power-generating equipment
- Heavy equipment or motors that include powerful magnets

Patients are often concerned that cell phones may interfere with their pacemaker. Because the cell phones used in the USA generally produce less than 3 watts of energy, they usually do not affect pacer function, but the general rule is to keep your cell phone 6 inches away from your pacemaker and use it on the opposite side of the body from the pacer location.

Commonly referred to as an ICD, automatic implantable cardioverter defibrillator devices can be permanently implanted in much the same fashion as a pacemaker. However, these
devices address a different type of malfunction within the heart’s electrical system. They can be utilized to treat abnormally fast and irregular heart rhythms that have life-threatening potential.

The ICD monitors the heart’s electrical activity, and when it detects a dangerous heart rate or rhythm, the device is programmed to provide a sudden electrical shock to convert the heart rhythm back to a more normal state. This electrical shock is equivalent to that delivered via the external chest using pads and electrodes when patients experience life-threatening arrhythmias or sudden cardiac death.

Smaller than a cigarette pack, ICDs are implanted either in the upper chest or the abdominal region. The procedure is done under minor sedation and a local anesthetic. The ICD consists of a pulse generator and its wires or leads. A pocket will be created surgically for the pulse generator while a vein in the upper chest will be used to place the lead or leads in the chambers of the heart.

Sometimes, the ICD implanted will combine the capabilities of a pacemaker unit and can
detect heart rates that are too slow and are programmed to respond accordingly. Patients who have had ICDs implanted report differing levels of awareness and sensation with the
electrical shock provided by the ICD. Some note it as a minor fluttering sensation while others experience it as a major blow to the chest.

The usual function of an ICD may be compromised when exposed to major electrical or
magnetic fields. Be sure to seek specific counsel as to what machines or devices to avoid. You will be given instructions about follow-up care and what to do when the device is activated by an arrhythmia. The battery life of the pulse generator will also be monitored and replacement planned when indicated.

This pacemaker is a relatively new treatment option for moderate to severe congestive heart failure. For patients on maximum medical therapy who find their heart failure symptoms still remain self-limiting, biventricular pacemakers send impulses to both lower chambers of the heart (the ventricles) to provide synchronized pumping action. By increasing the efficiency and effectiveness of the heart as a pump, many patients receiving the biventricular pacer experience a lessening of symptoms with an increase in energy and decreased difficulties with shortness of breath. This device is technically challenging to place and not all patients show a benefit from its use. Usual pacemaker precautions and ongoing follow-up will be specified. Dietary measures and drug therapy for congestive heart failure will remain components of your treatment plan.

This procedure is helpful in the treatment of persistent cardiac arrhythmias and is performed by a specially trained cardiologist in the electrophysiology lab. When an abnormality of the heart’s electrical system occurs producing an abnormal heartbeat, the purpose of the ablation procedure is to disrupt the electrical conduction pathway creating the arrhythmia. This is accomplished by introducing electrode catheters via peripheral vessels and applying radiofrequency waves to the abnormal pathway. This stops the abnormal conduction in this particular region of the heart. To assess the procedure success, attempts will be made to reproduce the abnormal heartbeat under the controlled conditions of the electrophysiology lab. If the electrical challenge does not reproduce the arrhythmia, the radiofrequency waves have successfully eliminated this area of electrical conduction.

Peripheral Vascular Bypass

Used to address blockages in the peripheral vascular system, the bypass surgical technique reroutes blood flow around an obstruction utilizing the patient’s own veins or an artificial graft as an alternative. An example of this would be a femoral-popliteal bypass. The femoral arteries carry blood supply from the aorta to the lower extremities. Beginning in the groin area, the femoral arteries traverse the thighs and pass behind the knees where they are known as the popliteal arteries.

The femoral and popliteal arteries are common sites of plaque accumulation. This obstruction will often result in claudication or a cramping discomfort in the legs experienced during activity. This is due to a decreased amount of oxygen-enriched blood reaching the leg muscles. When medical management does not result in successful improvement of this condition, then a femoral-popliteal bypass may be a treatment approach. In this technique, a bypass is created by utilizing the patient’s own veins to reroute the circulatory flow around blockages in the femoral artery directly to the popliteal artery located behind the knee. If necessary, a plastic tube may be used instead to create a route for alternative blood flow.

This procedure is a major surgery and will require a three-to-five day hospital stay and approximately four to six weeks as a recovery period. A lifestyle management plan to minimize the reoccurrence and further development of peripheral vascular disease will be of primary importance.

Carotid endarterectomy is the most common surgical procedure performed for the prevention of stroke. The carotid arteries located on either side of the neck are the principal supplier of blood flow to the brain. Plaque accumulation in the carotid arteries can significantly increase the risk for stroke occurrence.

Carotid endarterectomy is the general surgical procedure performed to remove the plaque obstructing blood circulation in the carotid arteries. The surgeon will perform an open incision in the neck area at the site of the plaque. A shunt may be used temporarily to reestablish blood flow through the vessel. The plaque is then removed from the site of the blockage.

Not all carotid artery blockages are candidates for carotid endarterectomy. Each patient’s presentation is considered on an individualized basis including the estimated percentage of the existing blockage, the symptoms experienced by the patient, and the health status of the patient. Carotid endarterectomy is considered a major surgical procedure. Patients are observed closely in the immediate postoperative period.

A surgical treatment approach for abdominal aortic aneurysm will be decided based on the size of the aneurysm and the patient’s overall health condition. Generally, an abdominal aneurysm greater than 5 cm in diameter is recommended for surgical intervention. A long incision allows access and resection of the aneurysm. A synthetic graft is then placed at the site of the removal.

Open surgical removal of AAA is a major surgery and can result in significant complications related to the organ systems. Uncomplicated postoperative recovery generally involves a hospital stay of from five-to-seven days and six-to-eight week recuperative period.