Heart Surgery Through Groin

How Do I Prepare For The Test

Youll need to make your provider aware of any medicines youre taking and any allergies you have. Your provider will let you know how long before your procedure you should stop eating and drinking. Usually, youll need to stop eating and drinking six to eight hours before your heart catheterization.

Allergies

Discuss all of your allergies with your provider, especially these:

• IVP dye/contrast agent allergy.
• Latex/rubber products allergy.

Medications

Discuss your medications with your provider, who may want to stop or adjust the doses several days before or on the day of the procedure, especially these:

Wear comfortable, easy-to-fold clothing on the day of your procedure and bring:

• A family member with you to wait with you before the procedure.
• A robe to wear as you wait for the procedure.
• Toiletries and any other items you would like to make your stay more comfortable if you stay in the hospital after your procedure. Your family member can retrieve these items from your car when you need them. Leave all valuables at home or with a family member.
• A list of your medications and dosages. When you arrive for your appointment, tell your provider if youre taking warfarin , clopidogrel, diuretics or insulin. Also remind the staff if youre allergic to anything, especially iodine, X-ray dye, penicillin-type medications, latex or rubber products .

Heart Valve Surgery Without Cracking Open The Chest

May 2, 2022

The man sitting across from me had traveled a long way from Saudi Arabia. He needed heart valve surgery. He could have had traditional surgery at home, but he wanted to know if we could fix his valve without the pain of breaking his breastbone. I told him we could with minimally invasive heart valve surgery.

Unfortunately, way too many people dont know about minimally invasive heart valve surgery. This is, in part, for two reasons: these procedures are fairly uncommon in most centers, so only a few doctors perform them, and they are highly complex surgeries that are only performed at a handful of centers across the country. This approach is so rare that fewer than 1% of aortic valve surgeries worldwide are performed this way, as well as fewer than 20% of mitral valve surgeries.

What Happens During An Ablation Procedure

During a heart ablation procedure, a cardiologist will perform the following steps depending on if you are undergoing a catheter or surgical ablation:

Catheter ablation

If you are having a catheter ablation, youll have an intravenous line inserted into your arm to deliver anesthesia. You will typically be under general anesthesia due to the length of the procedure.

The cardiologist inserts a small tube through your skin and into a vein usually in your groin. They then insert the electrode catheters into the sheath and thread them to your heart, using X-rays as a guide. The catheter delivers hot or cold energy to eliminate the irregular or abnormal rhythms.

Surgical ablation

If you have surgical ablation, youll receive general anesthesia.

The cardiac surgeon can do the ablation during open-heart surgery. Or your doctor will do a less-invasive hybrid surgery, making small incisions in your chest to access your heart.

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What To Expect After The Procedure

After a TAVR procedure, your hospital stay may be just a few days depending on the approach used. You may be able to return to daily activities, such as exercising and driving, in just a few weeks.

However, as with any procedure involving the heart and blood vessels, TAVR carries some risks both during and after surgery, including:

• Damage and bleeding where the catheters were inserted
• Injury to the kidneys or the heart
• Leaking in the new valve because it does not fit well
• Need for a permanent pacemaker due to damage to the hearts electrical signaling during the procedure

What Happens Before Heart Ablation

All cardiac ablation procedures are performed in the hospital by a cardiologist or cardiac surgeon. Your provider will thoroughly evaluate your heart condition and overall health before deciding which type of cardiac ablation procedure is best.

In preparation for the procedure, your provider will give you specific instructions. You may be asked to:

• Stop taking medications that thin your blood or treat arrhythmia. Follow your providers guidance and stop these medications only as directed.
• Not eat or drink anything the night before your procedure. Your provider will give you exact instructions.
• Arrange for someone to drive you home from the hospital if you are having an outpatient procedure.

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Who Should Not Have Tavr

Contraindications : The Edwards SAPIEN 3 and Edwards SAPIEN 3 Ultra Transcatheter Heart Valve System should not be used in patients who: Cannot tolerate medications that thin the blood or prevent blood clots from forming. Have an active infection in the heart or elsewhere.

https://www.youtube.com/watch?v=bVuOMua60NU

What Are The Risks Of Heart Ablation

Side effects of heart ablation are more common after surgical ablation than after catheter ablation. Possible risks of heart ablation include:

• Arrhythmias.
• Damage to the vein from the sheath and catheter.
• Damage to your heart, like a puncture or damaged valves or conduction.
• Narrowing of the veins that carry blood between your lungs and heart .
• Exposure to radiation during catheter ablation.
• Infection or bleeding.

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When To Call The Doctor

• There is bleeding at the catheter insertion site that does not stop when you apply pressure.
• Your arm or leg below where the catheter was inserted changes color, is cool to the touch, or is numb.
• The small incision for your catheter becomes red or painful, or yellow or green discharge is draining from it.
• You have chest pain or shortness of breath that does not go away with rest.
• Your pulse feels irregular — it is very slow or very fast .
• You have dizziness, fainting, or you are very tired.
• You are coughing up blood or yellow or green mucus.
• You have problems taking any of your heart medicines.
• You have chills or a fever over 101°F .

What Are The Risks Of Cardiac Catheterization

Possible risks associated with cardiac cath include:

• Bleeding or bruising where the catheter is put into the body
• Pain where the catheter is put into the body
• Blood clot or damage to the blood vessel that the catheter is put into
• Infection where the catheter is put into the body
• Problems with heart rhythm

More serious, but rare complications include:

• Ischemia , chest pain, or heart attack
• Sudden blockage of a coronary artery
• A tear in the lining of an artery
• Kidney damage from the dye used
• Stroke

If you are pregnant or think you could be, tell your doctor due to risk of injury to the fetus from a cardiac cath. Radiation exposure during pregnancy may lead to birth defects. Also be sure to tell your doctor if you are lactating, or breastfeeding.

There is a risk for allergic reaction to the dye used during the cardiac cath. If you are allergic to or sensitive to medicines, contrast dye, iodine, or latex, tell your doctor. Also, tell your doctor if you have kidney failure or other kidney problems.

For some people, having to lie still on the cardiac cath table for the length of the procedure may cause some discomfort or pain.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor before the procedure.

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When You’re In The Hospital

A catheter was inserted into an artery in your groin or arm. Then it was carefully guided up to your heart. Once it reached your heart, the catheter was placed into the arteries that deliver blood to your heart. Then contrast dye was injected. The dye allowed your doctor to see any areas in your coronary arteries that were blocked or narrowed.

If you had a blockage, you may have had angioplasty and a stent placed in your heart during the procedure.

What Happens During Coronary Angiography

During the procedure a long, thin, flexible tube called a catheter is inserted into a blood vessel in your groin or arm.

Using X-ray images as a guide, the tip of the catheter is passed up to the heart and coronary arteries.

A special type of dye called contrast medium is injected through the catheter and X-ray images are taken.

The contrast medium is visible on the angiograms, showing the blood vessels the fluid travels through. This clearly highlights any blood vessels that are narrowed or blocked.

The procedure is usually carried out under local anaesthetic, so you’ll be awake while the procedure is carried out, but the area where the catheter is inserted will be numbed.

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Researchers Urge New Guidelines For Common Procedure To Assess Blockage In Arteries

Contact: Beth Casteel, [email protected], 202-375-6275

SAN DIEGO –

Patients with acute coronary syndrome undergoing coronary angiogram, a procedure used to assess blockages in the hearts arteries, had a significantly lower risk of major bleeding and death if their interventional cardiologist accessed the heart through an artery in the arm rather than the groin, according to research presented at the American College of Cardiologys 64th Annual Scientific Session. Study authors said the results should prompt a re-evaluation of clinical guidelines and that the arm, currently used in a minority of cases in the United States, should be the preferred approach for most catheter-based heart procedures.

The study did not show a significant reduction in one of its two primary endpoints, a composite rate of death, heart attack or stroke 30 days after a catheterization procedure. However, the second primary endpoint, which included those events plus major bleeding, showed a significant reduced risk in patients randomized to receive a catheter via the arm, known as the radial approach, rather than the groin, known as the femoral approach. In addition, patients receiving a catheter via the groin faced a significantly higher risk of death, which was driven by increased bleeding complications in these patients, the study authors said.

This study was simultaneously published online in The Lancet at the time of presentation.

What Happens After Cardiac Catheterization

In the hospital

After the cardiac cath, you may be taken to a recovery room or returned to your hospital room. You will stay flat in bed for several hours. A nurse will monitor your vital signs, the insertion site, and circulation/sensation in the affected leg or arm.

Let your nurse know right away if you feel any chest pain or tightness, or any other pain, as well as any feelings of warmth, bleeding, or pain at the insertion site.

Bedrest may vary from 4 to 12 hours. If your doctor placed a closure device, your bedrest may be shorter.

In some cases, the sheath or introducer may be left in the insertion site. If so, you will be on bedrest until your doctor removes the sheath. After the sheath is removed, you may be given a light meal.

You may feel the urge to urinate often because of the effects of the contrast dye and increased fluids. You will need to use a bedpan or urinal while on bedrest so you don’t bend the affected leg or arm.

After the period of bed rest, you may get out of bed. The nurse will help you the first time you get up, and may check your blood pressure while you are lying in bed, sitting, and standing. You should move slowly when getting up from the bed to avoid any dizziness from the long period of bedrest.

You may be given pain medicine for pain or discomfort related to the insertion site or having to lie flat and still for a prolonged period.

Drink plenty of water and other fluids to help flush the contrast dye from your body.

At home

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What Are The Risks

Most heart surgeries are major surgeries. Although often successful, they do entail risks. The National Heart, Lung, and Blood Institute identifies some of these risks as:

• Bleeding
• Damage to tissues in the heart, kidneys, liver, and lungs
• Stroke
• Death, especially for someone who is already very sick before surgery

The risk is higher if you have other diseases or conditions, such as diabetes, peripheral artery disease, or kidney or lung disease.

What Are The Types Of Heart Ablation Procedures

Healthcare providers perform heart ablation using a minimally invasive catheter procedure, surgery or combination treatment.

• Catheter ablation:Catheter ablation is the most common type of heart ablation. Its a minimally invasive procedure. A cardiologist threads a catheter through a vein, typically through your groin and guides it into your heart. The catheter delivers hot or cold energy to your heart tissue, creating scars that block irregular or abnormal heart rhythms.
• Surgical ablation:Cardiac surgeons often perform an open-heart ablation called a maze procedure while doing other heart surgery. If youre having or a valve replacement and also need ablation your doctor may suggest a maze procedure. This is now also performed using hot or cold energy to create scar lines in your heart, which blocks the electrical signals causing the arrhythmia.
• Hybrid surgical/catheter ablation: If you don’t need open-heart surgery, your cardiac surgeon can perform a hybrid procedure, sometimes called a mini maze. The surgeon makes small incisions in your chest. Surgeons can then insert a catheter to treat the arrhythmia-causing signals.

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What Are Some Types Of Heart Surgery

There are many types of heart surgery. The National Heart, Lung, and Blood Institute, which is part of the National Institutes of Health, lists the following as among the most common coronary surgical procedures.

In addition to these surgeries, a minimally invasive alternative to open-heart surgery that is becoming more common is transcatheter structural heart surgery. This involves guiding a long, thin, flexible tube called a catheter to your heart through blood vessels that can be accessed from the groin, thigh, abdomen, chest, neck, or collarbone. A small incision is necessary. This type of surgery includes transcatheter aortic valve implantation to replace a faulty aortic valve with a valve made from animal tissue, MitraClip® placement for mitral valve abnormalities, and WATCHMAN® placement for nonvalvular atrial fibrillation patients.

How Long Does It Take To Recover From A Heart Catheterization

You can usually drive 24 hours after leaving the hospital. Depending on where the catheter was put into your body, youll need to avoid strenuous activities for two to five days. Your healthcare provider can tell you when you can return to work. You should not submerge the puncture site in water for a week. In other words, you shouldnt sit in a bathtub or pool or go swimming for one week. You may shower 24 hours after the procedure.

A note from Cleveland Clinic

Cardiac catheterization provides valuable information your healthcare provider can use to decide what treatment would be best for you. If your provider found coronary artery disease, you have the power to improve your health by eating healthier foods and exercising. Keep all of your follow-up appointments with your provider and make sure you keep taking your medicines.

Last reviewed by a Cleveland Clinic medical professional on 04/29/2022.

References

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Do You See Patients From Other States

Actually, we see patients from all over the world! Dallas has two major airports and our hospital is located only two miles from Dallas Love Field Airport. Steva and Nelly our intake coordinators work with out-of-town patients all the time. They take care of coordinating benefits, making sure we have the required tests sent over from your providers, and even offer sound technical support because our first appointment is always conducted via telemedicine.

This makes getting a second opinion for out-of-state patients incredibly easy. Since our patients spend an average of only three days after surgery in the hospital, and because pain management is considerably less challenging due to our small incision, our patients are cleared to travel shortly after leaving the hospital.

Research Is Still Pushing Tavr Forward

Heart surgeons and cardiologists have been using transcatheter therapies for several years to care for patients with valvular heart disease who would not have been able to tolerate traditional open heart surgery, says cardiac surgeon Abeel A. Mangi, MD, MBA, surgical director of the Structural Heart and Valve Program. These include very elderly patients, those who have had many prior heart operations, and those with certain conditions, he says. TAVR has been proven to help patients like these live longer, Dr. Mangi says. Now we are entering an era where transcatheter valve technologies may become available to most patients with heart valve disease. This is an exciting time to be a heart valve surgeon because we have so many more tools at our disposalbe it open heart surgery, or TAVRand we can tailor the treatments we offer patients to their medical conditions.

Its been a steady push forward, Dr. Forrest says. With each new finding, we continue to see that TAVR may be a better option than surgery for patients. If you analyze the lower risk patients in these two new studies, you would see that they do even better than older patients.

For more information or to schedule an appointment to consult with a Yale Medicine cardiologist, call 203-785-7990.

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What Is Transcatheter Aortic Valve Replacement

TAVR is a procedure to replace the aortic valve in the heart using a small catheter or tube about the diameter of a pencil. This eliminates the need for traditional open-heart surgery. The catheter is commonly inserted through an artery in the groin. In most cases, the procedure usually takes about two hours.

The new valve, which is made of natural material, is stitched inside a metal stent that is placed inside the patient’s own aortic valve through the catheter. The procedure is done while the heart is still beating, eliminating the need for a heart lung bypass machine.