Cardiac Surgical Procedures

Coronary Artery Bypass Grafting - CABG

More than 300,000 people have successful bypass surgery in the United States each year. It is sometimes also called coronary artery bypass graft surgery (CABG), coronary artery bypass, coronary bypass or bypass surgery.

In this procedure, a section of vein from your leg, chest or another part of your body is used to bypass the blocked or diseased portion of a coronary artery, which brings blood to the muscle of your heart. This creates a new, clear way for the blood to flow to get oxygen to your heart muscle so it can work properly. This type of surgery is done to the outer walls of the heart; it doesn't require opening up the chambers of the heart.

Sometimes people talk about single, double, triple or quadruple bypass surgery. This refers to the number of blocked arteries that had to be bypassed. However, the need for more bypasses doesn't necessarily mean the heart condition is worse.

During bypass surgery, the breastbone (sternum) is divided. The heart itself is stopped and cooled. The blood that normally would be pumped by the heart is sent through a heart-lung machine.  A long piece of vein may be removed. In some cases, a small vein from the lower arm, the radial artery, may be used for the bypass.  This is called a graft. One end will be attached to the ascending aorta, the large artery that carries oxygen-rich blood from the heart to the rest of the body. The other end of the graft will be attached to a coronary artery below the blocked area. The surgery takes two to six hours, depending on the number of bypasses needed.

Heart Valve Repair or Replacement Surgery

Surgery is required for severe mitral valve regurgitation (MR). Surgery for MR is recommended when the symptoms of heart failure are present and when your ejection fraction drops below 60 percent and your left ventricle is larger than 45 mm at rest.
 
Generally, surgery for mitral valve prolapse (MVP) is only done when mitral valve regurgitation is present. Valve repair or replacement are the two types of surgeries available to treat these conditions. Valve repair or replacement is an open-heart surgery. You are given general anesthesia and placed on a heart-lung machine during the surgery, which usually lasts about 3 to 5 hours.
 
The decision between repairing or replacing the valve depends on the type of damage to the mitral valve. For instance, repair is more successful if there is limited damage to certain areas of the mitral valve flaps (leaflets) or to the tough fibers that control movement of the mitral valve leaflets (chordae tendineae). Replacement, however, is usually preferred for people who have a hard, calcified mitral valve ring (annulus) or widespread damage to the valve and surrounding tissue. For heart valve repair, one of the following procedures is done: - Reshaping of the valve by removing excess valve tissue - Adding support to the valve ring by adding tissue or a collarlike structure around the base of the valve - Attaching the valve to nearby heart cordlike tissues (chordal transposition) Heart valve replacement surgery involves the removal of the badly damaged valve. The valve is replaced with a plastic or metal mechanical valve, or a bioprosthetic valve.
 
Recovery from heart valve surgery usually involves a few days in our cardiac intensive care unit (CICU). Full recovery from heart valve surgery can take several months. Recovery includes healing of the surgical incision, gradual building of physical endurance, and exercise. An exercise program under the direction of a physical therapist or outpatient cardiac rehabilitation specialist is usually recommended.
 
Once you have an artificial valve, your heart function and your life will largely return to normal. You should feel better than before you had the surgery if your condition was symptomatic; for example, you should no longer experience shortness of breath and fatigue. However, if your heart was already severely affected before your surgery, you may continue to experience complications of heart disease. You should be able to resume most of your normal activities, although you will have to continue to monitor your condition. You need to watch out for blood clots and infections so it is important that you see your doctor regularly.

Transmyocardial Revascularization

Transmyocardial Revascularization (TMR) is a laser surgery that facilitates the growth of blood vessels, resulting in decreased chest pain due to inadequate oxygen supply reaching the heart muscle. TMR is usually performed in conjunction with bypass surgery (CABG) on individuals with blood deprived heart muscle. The surgeon may create 20-40 new channels, each 1 millimeter wide, in the muscular wall of the left ventricle using a laser. These new channels stimulate angiogenesis, which is the natural growth of new blood vessels within the heart muscle.
 
The surgery is performed in the cardiac surgery suite under general anesthesia and usually takes one to two hours to perform if this is the sole procedure being done. It may only take minutes if being performed as part of a Coronary Artery Bypass Graft (CABG) procedure.

Robotic-assisted Minimally Invasive Cardiac Surgery

Pomona Valley Hospital continues to bring advanced technology to the cardiovascular program. The Stead Heart and Vascular Center has begun to utilize robotic surgery for cardiac care, the first in the Inland Empire, and one of only a handful in all of Southern California.
 
Robotic-assisted minimally invasive cardiac procedures avoid the drawbacks of traditional heart surgery, including blood loss, pain and scarring associated with sternotomy.
 
The da Vinci® System offers breakthrough capabilities that enable surgeons to operate through smaller incisions made between the ribs. These procedures avoid some of the the drawbacks of traditional heart surgery, including blood loss, pain and scarring associated with sternotomy. As a result, the da Vinci Surgical System is changing the practice of cardiac surgery as it's known today. Data suggests that recovery time, pain and trauma are reduced significantly through this less invasive approach.
 
By providing superior visualization and exposure of the valve annulus, leaflets and subvalvular structures, da Vinci MVR can enable more complex mitral valve repair with the most minimally invasive approach possible.
 
For most patients, minimally invasive cardiac procedures performed with the da Vinci Surgical System can offer numerous potential benefits over open-chest surgery, including:
  • Shorter hospital stay
  • Less pain and scarring
  • Less risk of infection
  • Less blood loss and fewer transfusions
  • Faster recovery
  • Quicker return to normal activities
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