Reasons To Call Your Doctor
If you feel any of these symptoms, report them to your doctor or nurse:
- Palpitations or a heart rate greater than 120 beats per minute when you are at rest, or a change from a regular to an irregular pulse.
- Increased fatigue or shortness of breath at rest.
- Temperature greater than 101 degrees more than one time, or chills for 24 hours.
- Excessive redness, swelling, soreness or drainage from any wound site.
- Swelling in your ankles and hands with a weight gain of two or more pounds in one day or five pounds in one week.
- Abnormal pain or other symptoms that do not go away with your medication.
- Pain in the calf of your leg.
What Makes A Reoperation Surgery More Challenging
1. Age, complications
First of all, youre older than you were when you had your initial heart surgery, and you are possibly dealing with additional medical problems. Depending on how serious your other medical issues may be, a reoperation can be more difficult to recover from.
Second, you probably have adhesions which are similar to scar tissue.
These web-like connections between the structures in your chest can develop as a result of the first operation. This may present technical difficulties for your surgeon, especially if they are not experienced in performing reoperations. A preoperative CT scan can be helpful to determine the safety of and strategy for reentering your chest.
3. Progression of your disease
If you had coronary bypass grafting before, your surgeon likely used your best arteries for the first surgery, and now he or she must rely on a segment of artery that is further along the vascular tree.
If you had a valve operation, you may now have disease involving multiple valves. If you have aortic disease, you may have an aneurysm involving an additional segment of your aorta. Or you may now have disease involving one of these structures that did not need attention during the previous operation.
These multi-component operations are best handled by a team with experience preparing for and performing these complex operations.
How Is Open Heart Surgery Performed
Your open heart surgery will be performed in a hospital. It requires a large incision in your chest and through your breastbone . Open surgery allows your surgeon to directly view and access the surgical area.
If you are having on-pump surgery, your surgical team will stop your heart with medicine and the heart-lung machine will pump blood to the body. Your surgeon will take your heart off the machine when the surgery is complete.
Some heart surgeries can now be performed at certain medical centers using minimally invasive techniques. These surgeries include and heart valve repair and replacement.
Minimally invasive procedures use smaller incisions instead of the larger incision made in open surgery. The surgeon uses special instruments with an attached camera to see the surgical area on a video screen. Minimally invasive surgery, as compared to an open procedure, generally has a faster recovery time, less pain, and a lower risk of some complications, such as infection.
Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different procedures and ask why your surgeon will use a particular type for you.
Types of anesthesia that may be used
Your surgeon will perform open heart surgery using either general anesthesia or regional anesthesia.
What to expect the day of your open heart surgery
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Who Performs Open Heart Surgery
The following specialists perform open heart surgery:
Cardiac surgeons specialize in the surgical treatment of conditions of the heart and its blood vessels. Cardiac surgeons may also be known as cardiothoracic surgeons.
Congenital cardiac surgeons specialize in the surgical treatment of heart defects present at birth.
Thoracic surgeons specialize in the surgical treatment of diseases of the chest, including the blood vessels, heart, lungs and esophagus. Thoracic surgeons may also be known as cardiothoracic surgeons.
How Successful Is Heart Surgery And What Are The Risks
Risks associated with heart surgery include infection, irregular heartbeat, and bleedingas well as such serious problems as heart attack and stroke. Older people, women, and those with serious diseases, such as diabetes or lung disease, are at higher risk for complications.
But surgeons using the latest techniques, technologies and approaches often have excellent results, even for many high-risk patients.
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Heart Bypass Surgery Procedure
Youâll be asleep the whole time. Most operations take between 3 and 6 hours. A breathing tube goes in your mouth. It’s attached to a ventilator, which will breathe for you during the procedure and right afterward.
A surgeon makes a long cut down the middle of your chest. Then they’ll spread your rib cage open so that they can reach your heart.
Then the surgeon will remove a blood vessel, called a graft, from another part of your body, like your chest, leg, or arm. They’ll attach one end of it to your aorta, a large artery that comes out of your heart. Then, they’ll the other end to an artery below the blockage.
The graft creates a new route for blood to travel to your heart. If you have multiple blockages, your surgeon may do more bypass procedures during the same surgery .
In some cases, the surgeon may not need to stop your heart. These are called âoff-pumpâ procedures. Others need only tiny cuts. These are called âkeyholeâ procedures.
Some surgeries rely on the help of robotic devices. Your surgeon will recommend the best operation for you.
Are There Alternatives To Standard Open
Thanks to medical advancements, many procedures that once required opening the chest can now take place using minimally invasive heart surgery or with small incisions. The surgeon sometimes still needs to cut through part of the breastbone .
Depending on your situation, your surgeon may be able to use these methods:
- Catheter-based: Your surgeon threads a catheter to the heart. The surgeon then inserts surgical instruments, balloons, or stents through the catheter to perform a procedure. Catheter-based procedures include transcatheter aortic valve replacement and coronary angioplasty and stenting.
- Video-assisted thoracic surgery : Your surgeon performs VATS by inserting a tiny video camera and surgical instruments into several small chest incisions. Your surgeon may use VATS to place a pacemaker, repair heart valves or treat an arrhythmia.
- Robotically-assisted: Certain patients with valvular heart disease, cardiac tumors, atrial fibrillation and septal defects may be candidates for this minimally invasive approach.
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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:
- Damage to tissues in the heart, kidneys, liver, and lungs
- 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 Is Heart Ablation Surgery Used For
Cardiac ablation surgery is used to treat:
- Supraventricular tachycardia , an abnormally fast heartbeat that occurs because of abnormal conduction fibers in the heart
- Atrial flutter, in which the hearts upper chambers beat too fast
- Arial fibrillation, which is an irregular and often rapid heartbeat that increases the risk for stroke and heart failure
Medications are often used to treat rapid and irregular heartbeats but when they dont work, doctors may recommend cardiac ablation.
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Coronary Artery Bypass Grafting
Coronary artery bypass grafting, also called revascularization, is a common surgical procedure to create an alternative path to deliver blood supply to the heart and body, with the goal of preventing clot formation. This can be done in many ways, and the arteries used can be taken from several areas of the body. Arteries are typically harvested from the chest, arm, or wrist and then attached to a portion of the coronary artery, relieving pressure and limiting clotting factors in that area of the heart.
The procedure is typically performed because of coronary artery disease , in which a plaque-like substance builds up in the coronary artery, the main pathway carrying oxygen-rich blood to the heart. This can cause a blockage and/or a rupture, which can lead to a heart attack.
Why Might I Need Heart Valve Repair Or Replacement Surgery
Valve repair or replacement surgery is done to correct the problems causedby one or more diseased heart valves.
If your heart valve becomes damaged or diseased, you may have thefollowing symptoms:
The repaired or replaced valve doesn’t work correctly
There may be other risks depending on your specific medical condition. Besure to discuss any concerns with your healthcare provider before theprocedure.
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What Are Your Options If You Don’t Have Surgery
Surgery isn’t right for everyone. Some people can be helped by angioplasty along with medicines and lifestyle changes . Others use medical therapy alone.
- Angioplasty with stents, along with medicines and lifestyle changes. Angioplasty is done through a blood vessel, so it is less invasive than surgery. The procedure has fewer risks for some people. Recovery is quicker than with surgery. After angioplasty with stents, most people take medicine to reduce the risk of blood clots. You may take this medicine for at least 1 year.
- Medical therapy alone. You need to take medicines and make lifestyle changes with any treatment that you choose. But medical therapy alone may be a choice for you if your angina is not affecting your quality of life. The medicines help prevent blood clots, lower cholesterol, and manage blood pressure. Lifestyle changes include eating healthy foods, being physically active, staying at a healthy weight, and not smoking.
One of these treatments may be an option for you. It depends on your age, your other health problems, and how severe your heart disease is. It also depends on what you want. You and your doctor can decide together whether bypass surgery or another treatment is right for you.
Why Would You Need Heart Reoperation Surgery
There are several reasons why you may need a second heart operation.
1. Its been awhile since your first surgery
If you had coronary artery bypass, you may find that you need a second surgery later in life because of new disease in your own vessels or disease that has developed in your bypass grafts. How long a coronary artery bypass lasts depends on a number of things, including:
- Type of bypass used
- Quality of the coronary arteries being bypassed
- Risk factors
- Genetic tendencies
2. A valve repair or replacement fails
If you had a heart valve repair or replacement, the operation sometimes needs to be repeated. Repairs are typically chosen over replacement because of the prospect for longer durability.
Depending on the reason for the first repair, sometimes the valve itself will still degenerate over time. Similarly, tissue replacement valves are known to wear out over time and even mechanical valves can develop later problems that may require a reoperation.
For example, the valve might start to leak or allow blood to flow backwards . This impairs your heart function. We can often repair the valve again to achieve the outcomes that we hoped for in the first surgery, or we can replace the valve.
3. Complications develop
If you develop an infection or other complications from your initial surgery, you may need a second heart surgery. These reoperations are particularly difficult and should be addressed by a team familiar with the safest techniques for successful treatment.
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Heart Valve Repair Or Replacement Surgery
The heart is a pump made of muscle tissue. It has 4 pumping chambers: 2 upper chambers, called atria, and 2 lower chambers, called ventricles. Valves between each of the heart’s pumping chambers keep blood flowing forward through the heart.
- Tricuspid valve. Located between the right atrium and the right ventricle
- Pulmonary valve. Located between the right ventricle and the pulmonary artery
- Mitral valve. Located between the left atrium and the left ventricle
- Aortic valve. Located between the left ventricle and the aorta
When valves are damaged or diseased and do not work the way they should they may need to be repaired or replaced. Conditions that may cause heart valve dysfunction are valve stenosis and valve regurgitation .
When one valve becomes stenotic , the heart has to work harder to pump the blood through the valve. Valves can become narrow and stiff from infection and aging. If one or more valves become leaky, blood leaks backwards, which means less blood is pumped in the right direction. Based on your symptoms and the overall condition of your heart, your healthcare provider may decide that the diseased valve needs to be surgically repaired or replaced.
Left Ventricular Assist Device
A VAD – also known as an LVAD for Left Ventricular Assist Device – is a circulatory support device. It takes blood from the left ventricle and pumps it into the aorta , helping the heart in pumping blood round the body.
It was originally designed to support the work of the heart while someone was waiting for a heart transplant. However, its now also used as a long-term support therapy for people who are not candidates for transplant and have end-stage heart failure.
Learn more about left ventricular assist devices through the British Heart Foundation.
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Why Do I Need Heart Bypass Surgery
Bypass surgery treats symptoms of coronary artery disease. That happens when a waxy substance called plaque builds up inside the arteries in your heart and blocks blood and oxygen from reaching it.
Your doctor may suggest heart bypass surgery if:
- You have severe chest pain that your doctor thinks happens because several of the arteries that supply blood to your heart are blocked.
- At least one of your coronary arteries has disease that’s causing your left ventricle — the chamber that does most of your heart’s blood pumping — to not work as well as it should.
- There’s a blockage in your left main coronary artery, which gives your left ventricle most of its blood.
- You’ve had other procedures, and either they haven’t worked or your artery is narrow again.
- You have new blockages.
Anemia In The Critically Ill Patient
Anemia in the setting of critical illness is quite prevalent, with 3744% of patients receiving at least one blood transfusion during their intensive care unit stay . In one representative study , 85% of patients with an ICU length of stay greater than 1 week received at least one blood transfusion. In more than two thirds of these cases blood transfusion was not associated with acute blood loss. Concerns over the deleterious effects of anemia are increasingly being balanced by an increased awareness of the serious, well documented consequences of packed red blood cell transfusion .
Current evidence suggests that clinicians are reconsidering more conservative transfusion practices in light of these and similar data. Vincent and coworkers conducted a cross-sectional study intended to evaluate transfusion practices in 146 European ICUs. They reported that pretransfusion hemoglobin concentrations are currently lower than those previously cited . Data from a prospective, multi-center, observational trial suggest a similar trend toward more restrictive transfusion practices in the USA. The mean pretransfusion hemoglobin was 8.6 ± 1.7 g/dl . This shift toward restrictive transfusion policies may in part be related to the work published by the Canadian Critical Care Trials Group.
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What Is Recovery Like After Open
Recovery time varies depending on the surgery type, complications and your overall health before surgery. It can take 6 to 12 weeks to recover from an open-heart procedure.
Your surgeon will let you know when you can return to work and other activities. Typically, you shouldnt drive or lift anything heavy for the first six weeks.
Some people need to take blood thinners after heart surgery to prevent blood clots. Your healthcare provider may also recommend cardiac rehabilitation. This medically supervised program can help you regain strength and stamina and improve overall heart health.
Potential Complications During And After
Some of the more common complications of heart surgery are routinely dealt with during the hours and days of recovery in the hospital. The patient is closely monitored for these complications by staff and through lab tests.
- Bleeding: May occur at the incision site or from the area of the heart where surgery is performed
- Abnormal Heart Rhythm: In rare cases, a temporary external, or permanent internal pacemaker may be necessary to correct this problem.
- Ischemic Heart Damage: Damage to heart tissue caused by a lack of blood flow to the heart
- Death: The risk of death is increased in surgeries where the heart is stopped for the procedure.
- Blood Clots: Clots may form in and around the heart or travel through the bloodstream.
- Stroke: Often caused by clots that form in the blood after surgery
- Blood Loss: In some cases, a transfusion may be necessary.
- Emergency Surgery: If a problem is discovered after surgery, emergency surgery may be necessary to repair any problems.
- Cardiac Tamponade : A life-threatening condition where the pericardium, the sac surrounding the heart, fills with blood. This makes it difficult, or impossible, for the heart to fully function.
- : Separation of the sternum may slow the healing process of the bone. Sternal precautions help prevent this as well as excessive pulling on the surgical incision.
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