Open Heart Surgery Patient Risk
The risk of open heart surgery to any patient is very dependent on the patient themselves and how sick they are. Of course a healthy 45 year old is going to have a lower risk than an 85 year old. Several risk factors have been found to be important when determining the risk for any given patient.
Age Older patients are in general at higher risk than younger patients.
Sex In general female patients have higher risk than make patients.
Obesity Obese patients are at higher risk.
Heart Function Pumping function of the heart is important those with impaired heart pumping function are at higher risk.
Kidney Function Patients with impaired kidney function have higher risk the worse the kidney function the higher the risk.
Heart Attack Those that have had a heart attack are at higher risk, particularly if the heart attack is around the time of surgery or if there are active symptoms of chest pain at the time of surgery.
Lung Disease Those with known lung disease, such as COPD, are at higher risk the worse the lung disease the higher the risk.
Emergency Surgery Surgery that needs to be performed emergently due to active symptoms, or instability carries a much higher risk than elective planned surgery.
Presence of Multiple Problems The more issues that need fixing, the higher the risk for example someone needing a simple bypass operation is lower risk than someone needing a bypass and 2 valves fixed at the same time.
Procedure Completion Both Methods
Your doctor will sew the sternum together with small wires .
He or she will insert tubes into your chest to drain blood and other fluids from around the heart.
Your doctor will sew the skin over the sternum back together.
Your doctor will put a tube through your mouth or nose into your stomach to drain stomach fluids.
He or she will then apply a sterile bandage or dressing.
Ct For The Assessment Of Graft Patency After Cabg Surgery
Thousands of CABG surgeries are performed annually in the US and minimally invasive robotic CABG surgery has been performed in select institutions over the past 15 years . Unfortunately, coronary bypass graft occlusions are frequent and increase with time . A study of 1,074 recipients of saphenous vein grafts found that the 10-year patency of grafts was 61% . As such, patients need to be monitored post-surgery. Currently, the reference standard in the assessment of graft patency following CAGB is invasive coronary angiography . ICA began with the work of F. Mason Sones, who pioneered cine coronary arteriography and noted a correlation between symptomatic coronary disease and major coronary artery stenosis . ICA involves the catherization of a patient and subsequent injection of radio opaque contrast while using X-rays to image the vasculature. Although minimally invasive, ICA comes with risks of myocardial infarction and death .
Another study compared 64-slice CTA with ICA results in 131 patients with CABG and similar statistical parameters as the meta-analysis were obtained . Here, only 2% of the grafts were of non-assessable quality. The study also demonstrated that while the evaluability of bypass grafts in arrhythmic patients was significantly lower than in non-arrhythmic patients, it was still high .
Read Also: How Many Heart Attacks Can You Have
Utilization Of Ct In Pacemaker Lead Evaluation
Biventricular pacemakers can be used to treat heart failure and conduction delay, and epicardial lead placement is a procedure that can be safely performed via minimally invasive means . Rarely, the leads migrate, penetrate the ventricle and have to be corrected. The method most commonly used to detect location of the leads is echocardiography however, there are reported cases of echocardiographic findings being ambiguous. CT was used in its place, with excellent results .
Preoperative Imaging In Other Robotic Cardiac Surgery Procedures
Vascular ring division procedures further highlight the preoperative benefit of CT. Robotically assisted totally endoscopic vascular ring division was shown to be a feasible and safe procedure and CT and MRI are used preoperatively to detect vascular aberrations, airway compression, or esophageal impingement .
Patent ductus arteriosus repair is another procedure that can be done totally endoscopically with a robotic surgical system . It was established that ECG gated CT is able to clearly demonstrate a patent ductus arteriosus in adults, its size, and calcification level. Furthermore, virtual angioscopy allows visualization of calcification within the duct. As such, it can be utilized as a noninvasive preoperational screening method, since patients whose ducts are heavily calcified, distorted, or contain aneurysms are poor candidates for surgery .
CT virtual cardioscopy is an effective tool in visualizing intracardiac tumors. A case report demonstrated that a left atrial myxoma was visualized using CT virtual cardioscopy, and its anatomy was confirmed via angiocardiography and surgery . Since robotic atrial myxoma resections seems to be safe , virtual cardioscopy may become a standard for these procedures since it is superior to echocardiography and catheterization in examining the intracardiac anatomy and pathology in multiple planes .
Don’t Miss: What Is Normal Blood Pressure And Heart Rate
Open Heart Surgery What To Expect As A Patient
Diagnosis Most patients will see a cardiologist first who will diagnose their problem based on their story, physical exam, and tests. Multiple tests may be required including echocardiograms, CT scans, and a heart catheterization. Once the diagnosis and the need for open heart surgery have been determined then the patient is referred to a cardiac surgeon for an evaluation.
Meeting the Surgeon Surgeons will often be suggested by the cardiologist depending on their referral patterns however often patients will select their own surgeons based on other recommendations or their own research. Once this is decided the patient will go and meet the surgeon in clinic. Here the surgeon will talk with the patient and review the testing. Based on this meeting a surgical recommendation can be made and operative risk and suitability can be determined. In many cases the surgeon may ask for further testing to be performed.
Details of the Operation
Making the Incision In the case of classic open heart surgery, the breast bone will be split open using a saw. Alternative approaches may use incisions to the side of the bone between the ribs or through some of the ribs on the side. In robotic heart approaches, no large incisions are made, and small tubes are inserted through which the operation is performed, sometimes called keyhole surgery.
The heart lung bypass machine.
The Operation Itself
open heart surgery beating heart with a bypass
open heart surgery sternal wiring
Coronary Artery Bypass Graft Surgery
To sew the grafts onto the very small coronary arteries, your doctor will need to stop your heart temporarily. Tubes will be put into the heart so that your blood can be pumped through your body by a heart-lung bypass machine.
Once the blood has been diverted into the bypass machine for pumping, your doctor will stop the heart by injecting it with a cold solution.
When the heart has been stopped, the doctor will do the bypass graft procedure by sewing one end of a section of vein over a tiny opening made in the aorta, and the other end over a tiny opening made in the coronary artery just below the blockage. If your doctor uses the internal mammary artery inside your chest as a bypass graft, the lower end of the artery will be cut from inside the chest and sewn over an opening made in the coronary artery below the blockage.
You may need more than one bypass graft done, depending on how many blockages you have and where they are located. After all the grafts have been completed, the doctor will closely check them as blood runs through them to make sure they are working.
Once the bypass grafts have been checked, the doctor will let the blood circulating through the bypass machine back into your heart and he or she will remove the tubes to the machine. Your heart may restart on its own, or a mild electric shock may be used to restart it.
You May Like: What Does A Slow Heart Rate Mean
Imaging In Valve Procedures
Robotic mitral valve surgeries have been done in the US since 2000 they can be performed safely by highly trained surgeons and reduce hospitalization time . Pre-operative analysis of patients computed tomography scans has proven to be an invaluable tool to prepare for surgeries and screen for patients for whom minimally invasive surgery is contraindicated.
CT can aid in determining the risk of morbidity and mortality associated with cardiac surgery. The presence of coronary artery disease in patients undergoing valve surgery worsens prognosis, and 64-slice CTA has been demonstrated to be a good tool to pre-operatively screen patients for CAD . In fact, the American College of Cardiology/American Heart Association recommends that candidates for major surgery should be preoperatively evaluated for ischemic heart disease . CT can be used for this purpose, and Russo et al proposed that CT could be the method of choice for assessing cardiac risk in patients who are candidates for major non-coronary cardiac surgery and do not present with symptoms of ischemic heart disease .
Three-dimensional volume rendered image obtained from a computed tomography scan showing a tortuous right external iliac artery with a narrowing . In contrast, the left external iliac artery is normal.
Coronary Artery Bypass Surgery
Once your doctor has opened the chest, he or she will stabilize the area around the artery to be bypassed with a special instrument.
The rest of the heart will continue to function and pump blood through the body.
The heart-lung bypass machine and the person who runs it may be kept on stand-by just in case the procedure need to be completed on bypass.
The doctor will do the bypass graft procedure by sewing one end of a section of vein over a tiny opening made in the aorta, and the other end over a tiny opening made in the coronary artery just below the blockage.
You may have more than one bypass graft done, depending on how many blockages you have and where they are located.
Before the chest is closed, the doctor will closely examine the grafts to make sure they are working.
Recommended Reading: Treatments Congestive Heart Failure
Kanye West Apologizes To Kim Kardashian For Social Media Antics
Amy Grant has shared gripping she underwent open heart surgery, noting something supernatural pulled her through the experience. The singer-songwriter took to Instagram on Sunday to update fans on how she is doing following the for a condition called partial pulmonary venous return, which affects blood flow to the heart.
A slideshow of images showed the 59-year-old musician smiling despite a long, vertical scar running from her neck down to her chest.
The only way I can explain my experience would be to ask you to imagine a non-runner who was signed up for a marathon, she captioned the images. I didnt want it, but I had to have it anyway and it was a week ago Wednesday.
Grant said that since the surgery, she has been inundated by messages from family, friends, fans and acquaintances, with many saying that they are praying for her.
And now, ten days later, I just want to say, from the moment I went to the hospital, if it really were a marathon race, I felt like I got into that runners block and as soon as it was time for the race to start there was this massive West Texas wind at my back.. just pushing me through, she wrote. Even stuff I was really scared about felt like nothing more than just a deep breath and something supernatural pushed me through it.
A post on her Facebook account on June 4 then asked for prayers as Grant went under the knife.
See more on the musician below.
What Are The Risks Of Coronary Artery Bypass Surgery
Possible risks of coronary artery bypass graft surgery include:
-
Bleeding during or after the surgery
-
Blood clots that can cause heart attack, stroke, or lung problems
-
Infection at the incision site
-
Failure of the graft
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor before the procedure.
Also Check: Bypass Heart Surgery Recovery
Port Location Determination For Robotic Cardiac Procedures
Robotic cardiac surgery involves placing instruments inside of patients via small ports, and as such, port placement is an important issue in surgery planning. 3D volume rendered images obtained from CT scans allow the surgeon to analyze the patients anatomy and determine optimal locations for port placement. For instance, since pericardial calcification can be visualized on these images , this provides crucial information regarding port placement, or can rule out robotic surgery altogether if the pericardial calcifications are too widespread.
Three-dimensional volume rendered images obtained from a computed tomography scan with ribs present and digitally removed . Areas of pericardial calcifications can be easily seen and are indicated by asterisks.
What Happens During Coronary Artery Bypass
Coronary artery bypass graft surgery requires a stay in a hospital. Procedure may vary depending on your condition and your doctor’s practices.
Generally, CABG follows this process:
You will be asked to remove any jewelry or other objects that may interfere with the procedure.
You will change into a hospital gown and empty your bladder.
You will lie on your back on an operating table.
The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery. Once you are sedated , a breathing tube will be put into your throat and you will be connected to a ventilator, which will breathe for you during the surgery.
A healthcare professional will insert an intravenous line in your arm or hand. Other catheters will be put in your neck and wrist to monitor your heart and blood pressure, as well as to take blood samples.
A catheter will be put into your bladder to drain urine.
The skin over the surgical site will be cleaned with an antiseptic solution.
Once all the tubes and monitors are in place, your doctor will make incisions in one or both of your legs or one of your wrists to access the blood vessel to be used for the grafts. He or she will remove the vessel and close those incision.
The doctor will make an incision below the Adam’s apple to just above the navel.
The doctor will cut the sternum in half lengthwise. He or she will separate the halves of the breastbone and spread them apart to expose your heart.
Recommended Reading: How To Differentiate Between Anxiety And Heart Attack
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.
What Is Coronary Bypass Graft Surgery
Coronary artery bypass graft surgery is a procedure used to treat coronary artery disease. Coronary artery disease is the narrowing of the coronary arteries the blood vessels that supply oxygen and nutrients to the heart muscle. CAD is caused by a build-up of fatty material within the walls of the arteries. This build-up narrows the inside of the arteries, limiting the supply of oxygen-rich blood to the heart muscle.
One way to treat the blocked or narrowed arteries is to bypass the blocked portion of the coronary artery with a piece of a healthy blood vessel from elsewhere in your body. Blood vessels, or grafts, used for the bypass procedure may be pieces of a vein from your leg or an artery in your chest. An artery from your wrist may also be used. Your doctor attaches one end of the graft above the blockage and the other end below the blockage. Blood bypasses the blockage by going through the new graft to reach the heart muscle. This is called coronary artery bypass surgery.
Traditionally, to bypass the blocked coronary artery, your doctor makes a large incision in the chest and temporarily stops the heart. To open the chest, your doctor cuts the breastbone in half lengthwise and spreads it apart. Once the heart is exposed, your doctor inserts tubes into the heart so that the blood can be pumped through the body by a heart-lung bypass machine. The bypass machine is necessary to pump blood while the heart is stopped.
Also Check: What Should Your Heart Rate Be When Sleeping
Why Might I Need Coronary Artery Bypass Surgery
Your doctor uses coronary artery bypass graft surgery to treat a blockage or narrowing of one or more of the coronary arteries to restore the blood supply to your heart muscle.
Symptoms of coronary artery disease may include:
-
Swelling in the hands and feet
Unfortunately, you may not have any symptoms in early coronary artery disease, yet the disease will continue to progress until theres enough artery blockage to cause symptoms and problems. If the blood supply to your heart muscle continues to decrease as a result of increasing blockage of a coronary artery, you may have a heart attack. If the blood flow cant be restored to the particular area of the heart muscle affected, the tissue dies.
There may be other reasons for your doctor to recommend CABG surgery.