Congenital Heart Defects Surgery
It’s important for you to be as healthy as possible for the operation. During the two weeks before the day of surgery it’s a good idea to keep away from people who have a cold or fever. If you develop a fever, cough or cold during that time, talk to someone on the cardiology or surgical team to decide if the operation should be delayed.
You will be seen for preoperative counseling and testing the week before the scheduled surgery. At that visit it may be possible to arrange a tour of the hospital. Common pre-operative tests include an electrocardiogram, echocardiogram, chest X-ray and blood testing.
Patients are usually admitted to the hospital the morning of the operation or the day before. How long your operation will take and how long you will need to be in the hospital depend on your heart condition and the operation that’s being done.
Sometimes the operating schedule has to be changed unexpectedly because of an emergency. Try to be prepared for possible delays.
Endoscopic Saphenous Vein Harvesting
Endoscopic saphenous vein harvesting is a less invasive method of removing the veins from your legs.
Rather than making a large cut in your leg, the surgeon makes a number of small ones near your knee. This is known as keyhole surgery.
A special device called an endoscope will be inserted into the cut.
An endoscope is a thin, long flexible tube with a light source and video camera at one end, so that images of the inside of your body can be relayed to an external television monitor.
The endoscope allows the surgeon to locate your saphenous vein. Surgical instruments can also be passed along the endoscope to remove a section of the vein. Nearby tissue is then sterilised with antibiotic fluid and the cut is healed.
The main advantages of this technique are that there’s likely to be a:
- shorter hospital stay
- lower risk of leg wound infections
- quicker recovery from CABG
Totally Endoscopic Robotically Assisted Coronary Artery Bypass Grafting
Totally endoscopic robotically assisted coronary artery bypass grafting is a newer technique in heart surgery.
It’s a minimally invasive method of performing a heart bypass.
During a TECAB grafting procedure, the surgeon deflates your lungs and makes a number of small cuts between your ribs.
Robotic arms, controlled by the surgeon, are used to carry out the surgery.
An endoscope is attached to the robotic arms so the surgeon can see inside your body and view the results of the surgery on a screen.
TECAB grafting can be carried out using a heart-lung bypass machine, or it can be done off-pump.
There are lower rates of wound infection with this type of surgery, plus minimal scarring and a faster recovery time.
But as this is a newer technique that’s only been carried out on a small number of people, it’s difficult to assess how effective and safe it is in the short and long term, and how the outcomes compare with other types of surgery.
If you’re considering having TECAB, it’s important you understand there are still uncertainties about how safe the procedure is and how well it works.
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Creating The Gastric Pouch
In the next step, the stomach is divided about 1-2 inches below the area where the esophagus connects to the stomach by creating a window in the clear space of the gastrohepatic ligament . Once the lesser curvature of stomach is reached, a space behind the stomach is created that provides access into the lesser sac. The stomach is further divided with stapling to create a completely divided separate section. This smaller upper section of your stomach that remains connected to the esophagus is your new stomach, also known as the gastric pouch. This new gastric pouch has the capacity to hold approximately 1 to 2 ounces of food.
The Heart Bypass Vessel
The most well known bypass is called the LIMA to LAD. LIMA stands for left internal mammary artery and is an artery that runs from the left collarbone area down the chest wall. LAD stands for left anterior descending artery which is the artery commonly responsible for the Widowmaker Blockage. In a bypass it is carefully taken down from the chest wall and attached beyond a blockage acting as a bypass. The LIMA to LAD is very successful as a bypass and has good long-term results. In other types of bypasses, arteries can be taken from the forearm, or veins can be taken from the legs. Read this article on heart blockages and this article on the Widowmaker for more information. This article titled how long does a bypass last is useful and goes in to a little more depth about the different bypasses.
The Left Internal Mammary Artery is depicted here and is labelled #8.
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Minimally Invasive Direct Coronary Artery Bypass
This procedure uses two small incisions between the ribs on the left side of the chest to access the heart. We’ll harvest an artery from the chest, either directly or via a surgical robot, and will stitch the harvested artery to the coronary arteries.
The small incisions allow for a quicker recovery and a shorter hospital stay. This surgery is performed without a heart-lung bypass machine, making it a consideration for patients with chronic pulmonary disease, peripheral vascular disease and kidney failure.
What Is The Fastest Way To Recover From Bypass Surgery
The fastest way to recover is to be patient with yourself. Take time to return to a normal routine dont try to rush it. Know that your cardiac care team cares about your recovery and is available to help you through this process.
Perhaps one of the most important steps to recovery is your outpatient cardiac rehabilitation program. This usually starts a few weeks after surgery. It includes guidance on exercise, nutrition, and lifestyle all the keys to heart health after CABG. The program is supervised by therapists who are specially trained to care for people with heart conditions.
In general, cardiac rehab programs last at least six weeks. But the length can vary depending on your needs. Its common to think its unnecessary or even too time-consuming. But we cant stress enough how important it is. Please speak with your care team if you have financial or other concerns.
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What Happens During Heart Bypass Surgery
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.
Your surgical team will use medication to temporarily stop your heart. A machine called a heart-lung machine will keep blood and oxygen flowing through your body while your heart isn’t beating.
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.
Taking Care Of Your Child At Home
The surgical team will give you instructions about wound care and activity levels for your child after your child is discharged. In general, the chest incision should be kept clean and dry. Most children will be allowed to take a quick shower or sponge bath followed by gentle towel drying of the incision. Swimming or soaking in a bathtub is usually not permitted for at least a few weeks after surgery. Usually children can participate in regular household activities, but they should avoid any rough, vigorous play or sports until your doctor permits.
School-age children usually are kept home from school for several weeks after the operation. Your doctor will tell you when your child can return to school and to gym class and sport activities.
You should call your surgeon or cardiologist if your child develops fever, chest pain, trouble breathing or redness, swelling or pus at the incision site.
Written by American Heart Association editorial staff and reviewed by science and medicine advisers. See our editorial policies and staff.
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Why Choose Ohio State For Robotic And Minimally Invasive Heart Surgery
The Center for Minimally Invasive Surgery at The Ohio State University Wexner Medical Center was created in 1995 as part of the universitys mission to provide patients with the highest level of care. Utilizing state-of-the-art equipment and technologies, our surgeons, nurses and support staff are committed to providing you with all the benefits of minimally invasive surgery.
At Ohio State, we offer the following minimally invasive heart surgeries:
- Minimally invasive direct coronary artery bypass surgery
- Removal of cardiac tumors
Why The Procedure Is Performed
Your doctor may recommend a minimally invasive coronary artery bypass if you have a blockage in one or two coronary arteries, most often in the front of the heart.
When one or more of the coronary arteries become partly or totally blocked, your heart does not get enough blood. This is called ischemic heart disease or coronary artery disease. It can cause chest pain .
Your doctor may have first tried to treat you with medicines. You may have also tried cardiac rehabilitation or other treatments, such as angioplasty with stenting.
Coronary artery disease varies from person to person. Heart bypass surgery is just one type of treatment. It is not right for everyone.
Surgeries or procedures that may be done instead of minimally invasive heart bypass are:
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Who Will Help Perform The Bypass Surgery
Throughout the surgery, several types of specialists ensure the procedure is performed properly. A perfusion technologist works with the cardiopulmonary bypass machine.
A cardiovascular surgeon performs the procedure and an anesthesiologist ensures anesthesia is delivered to your body properly to keep you unconscious during the procedure.
Imaging specialists may also be present to take X-rays or help ensure that the team can view the site of the surgery and the tissues around it.
When you wake up from heart bypass surgery, youll have a tube in your mouth. You may also feel pain or have side effects from the procedure, including:
- pain at the incision site
- pain with deep breaths
- pain with coughing
Youll likely be in the ICU for one to two days so your vital signs can be monitored. Once youre stable, youll be moved to another room. Be prepared to stay in the hospital for several days.
Before you leave the hospital, your medical team will give you instructions on how to care for yourself, including:
- caring for your incision wounds
- getting plenty of rest
- refraining from heavy lifting
Even without complications, recovery from heart bypass surgery can take 6 to 12 weeks. Thats the least amount of time it takes for your breastbone to heal.
During this time, you should avoid heavy exertion. Follow your doctors orders regarding physical activity. Also, you shouldnt drive until you get approval from your doctor.
- fever over 100.4°F
- increasing pain in your chest
- rapid heart rate
Surgical Steps Of The Procedure
Small incisions are made on the abdominal wall to get into the abdominal cavity. Trocars, medical devices that allow easy exchange of surgical tools, are then passed through the incisions to optimally access the abdominal cavity. The abdomen is then blown up like a balloon with carbon dioxide gas which causes abdomen to swell and lifts your stomach wall away from the small intestine and other organs. This also helps the surgeon to view the abdominal structures and organs clearly using the laparoscope or video camera.
The first part of the operation involves mobilizing the omentum and the transverse colon and creates a window. This lets the undersurface of your stomach be visualized.
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Who Is A Candidate For Minimally Invasive Or Robotic Surgery
There are many ways to reach the heart for surgery. Surgeons at Cleveland Clinic always try to use the smallest incision to provide the safest and most successful surgery. Your surgical team will carefully compare the advantages and disadvantages of minimally invasive techniques with those of traditional surgery techniques. Your surgeon will decide the best approach for you based on several factors, including the type or heart disease you have and how severe it is your age, medical history and lifestyle and results of tests done before surgery.
What Is Heart Bypass Surgery
Heart bypass surgery is when a surgeon takes blood vessels from another part of your body to go around, or bypass, a blocked artery. The result is that more blood and oxygen can flow to your heart again.
Imagine youâre on a highway. An accident causes traffic to pile up ahead. Emergency crews redirect cars around the congestion. Finally, youâre able to get back on the highway and the route is clear. Heart bypass surgery is similar.
It can help lower your risk for a heart attack and other problems. Once you recover, youâll feel better and be able to get back to your regular activities.
Youâll still need a healthy diet, exercise, and probably medicine to prevent another blockage. But first, youâll want to know what to expect from the surgery, how to prepare, what complications can happen, and what the recovery is like.
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Minimally Invasive Heart Surgery
At Stanford Health Care, our expert surgeons use a minimally invasive approach whenever possible. Our team has extensive experience and specialization with this advanced technique. If we can perform a heart procedure without open-heart surgery, we will do it.
When you come to Stanford for minimally invasive heart surgery, you benefit from:
- Experience from high volume: Whenever possible, we perform heart surgeries using a minimally invasive approach. That commitment means our surgeons have a superior level of experience and skill in these procedures.
- Advanced technology: Our cardiovascular surgeons use innovative, high-resolution imaging technology in the operating room. This advanced equipment sends incredibly detailed, 3-D images of the beating heart to your surgeon in real time, for the most precise results possible as we operate.
- Reputation: Our heart surgery program at Stanford is world-renowned for its pioneering work in a number of heart procedures: From the first adult heart transplant in the U.S., to the world’s first ventricular assist device. Now, were leading the way with new techniques for minimally invasive heart surgeries and applying this knowledge to some of the most complex cases.
Advisory: This brochure contains graphic images.
How Is Gastric Bypass Surgery Performed
Most Roux-en-Y surgery operations today are performed by laparoscopy, a minimally-invasive surgery technique. The laparoscopic gastric bypass was introduced almost 30 years ago and has since become the standard of care for most people.
Laparoscopic surgery involves three to five small incisions in your abdomen, each about a half an inch. Smaller cuts mean fewer complications, less bleeding, less pain and a faster recovery. Your surgeon will perform the operation through these openings, using long, narrow tools.
Sometimes laparoscopic operations such as Roux-en-Y are done with robotic assistance. Robotic surgery is still controlled by the surgeon. It just means that the surgeon attaches robotic arms to the laparoscopic tools. They control the arms with a computer.
While 90% of Roux-en-Y surgeries are performed laparoscopically, some people may need to have open surgery to manage their specific conditions. Rarely, some laparoscopic Roux-en-Y surgeries may need to convert to open surgeries to be completed safely.
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Benefits Of Mics Cabg/ The Mcginn Technique
Eliminating the need for median sternotomy greatly reduces the trauma and pain associated with open-chest surgery and improves quality of life for patients. In the hospital, reduced post-operative discomfort enables patients to quickly begin a shorter recovery process. Most patients ambulate more easily and participate more actively in their personal care. Additionally, this approach lowers risk of complications such as bleeding, infection and eliminates the risk of sternal non-union.
Minimally invasive heart surgery improves cosmetic results. Rather than a prominent 10-inch scar down the middle of the chest, patients are left with smaller marks to the side of the ribs. For women, in many cases, this scar is completely unnoticeable as it sits below the breast.
Benefits Include:
Totally Endoscopic Coronary Artery Bypass
Totally endoscopic coronary artery bypass is the least invasive coronary artery bypass grafting procedure available.
During TECAB, we do not need to open your chest at all. Instead, we place the bypass graft through tiny holes in your chest, using robotic instruments to ensure the effectiveness of the procedure. This is an even less invasive procedure than the MIDCAB.
This leads to minimal scarring, a shorter, more comfortable recovery, and a return to normal activities more quickly.
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Why Minimally Invasive
I am passionate about these new techniques. Evidence indicating the effectiveness of minimally invasive surgery has been published in many international publications.
Research has shown these procedures are safe, when they are performed regularly by surgeons who are experienced in these techniques. Benefits include a shorter hospital stay and less bleeding, so less likelihood of a transfusion being required. Patients also experience a reduced risk of wound infection, better recovery following their surgery and often less pain. And, of course, they also have much smaller scars too.
Although minimally invasive procedures may not have a huge reduction on how long patients spend recovering in hospital following their surgery, the patients and the cardiologists caring for them certainly notice the difference afterwards.
They are more energetic, able to do more and feel better, faster, compared to those who have undergone conventional surgery. They can walk further, take up their hobbies more quickly, become active and return to work faster. This is far better compared to patients who have had conventional open-heart surgery.
A significant advantage of these new vanguard of minimally invasive treatments, many of which use heart valves made from animal tissue rather than the conventional mechanical valves, is patients do not need to take blood thinning drugs for the rest of their lives.