Cardiac Surgery

Surgical Procedures

Individuals who are waiting at home for surgery, may be referred to Cardiac Pre-Hab by their cardiologist or by their cardiac surgeon. This program provides rehabilitation before surgery and is designed to help individuals maintain their current level of activity as they wait to have their operation.

Surgical procedures performed at Southlake include:

• Coronary Bypass Surgery (CABG)
  Coronary artery bypass grafting (CABG) surgery is necessary when medication and/or other procedures are not able to improve the blood flow to the heart. This is the most common type of heart surgery. Bypass surgery improves the blood flow of oxygen and nutrients to the heart muscle, which provides relief of angina symptoms and may increase life expectancy.
  
  During surgery, the patient is connected to the heart-lung bypass machine, which takes over the function of the heart and lungs during surgery. The cardiac surgeon makes an incision down the center of the patient’s sternum (breastbone) in order to acquire direct access to the heart. The heart is stopped and the surgeon then performs the bypass procedure. A portion of a blood vessel from the patient’s leg (saphenous vein), arm (radial artery) or inner chest wall (internal thoracic artery) is used to bridge the blocked or diseased area and to improve blood flow to the heart muscle. The vein or artery will be attached to the aorta (large vessel that supplies blood to the heart) at one end and the other end will attach to the coronary artery below the area of blockage or disease. The diseased area is essentially “bypassed” and the coronary artery beyond the blockage receives the oxygen and nutrient-rich blood that is delivered to the heart muscle.
  
  After surgery, the surgeon will close the breastbone with stainless steel wires. Dissolvable sutures (stitches) or staples are then used to close the outer portion of the incision. The steel wires will remain in place and the sutures will dissolve over time.  

• Beating Heart Surgery
  Beating heart surgery is a relatively new technique available for patients undergoing coronary bypass. Instead of using the heart-lung machine to support the patient's circulation during surgery, the surgeons can use a different stabilizer that will enable them to perform the procedure without stopping the heart. Southlake’s cardiac surgeons are fully trained to perform beating heart surgery. There are several types of coronary bypass procedures than can be done using the beating heart technique. Patients are encouraged to discuss with their cardiac surgeon as to whether or not they are a good candidate for this technique.
   
• Heart Valve Surgery
  Heart valves can be abnormally formed as birth defects or damaged by rheumatic fever, bacterial infection, and calcific degeneration. Valves can also degenerate with the normal aging process. Two common types of valve disease are:
  
  • Stenosis
    This occurs when a valve opening becomes smaller or narrower and is unable to open wide enough to allow the blood to easily flow through.
     
  • Regurgitation or Insufficiency
    This occurs when a valve does not close completely and results in back flow of blood causing increased strain on the heart. To compensate for these disorders, the heart is forced to pump harder. This excess work can weaken the heart, causing it to enlarge and produce the following symptoms of heart failure:
    
    • Increased shortness of breath
    • Chest pain
    • Swelling of the ankles and legs
    • Increased fatigue
    • Dizziness
    • Fainting
      
  If medications are no longer able to control the symptoms, heart valve surgery may be recommended. The aortic and mitral valves are the most commonly affected.
  

  Some valves can be surgically repaired to help them open or close more efficiently. Two common surgical repair procedures are:

  • Ring Annuloplasty
    The procedure involves the tightening of the annulus (the ring-like part of the valve) by placing a ring of metal, cloth or tissue around the valve.
    
    
  • Valve Repair
    This procedure reconstructs the leaflets, chordae, and/or papillary muscles of the valve. A reinforcing ring is placed around the edge of the valve to help it maintain proper size and shape while correcting the flow of blood.
    

    Heart valves can also be replaced using two main classifications of artificial valves:

• Tissue/Biological Valves
  These valves are made from animals or humans (for example, the Hancock and Carpentier-Edwards valves) and are specially treated with chemicals to avoid rejection. Blood thinner (anticoagulation) medication is not usually necessary after the first three months following mitral valve surgery, and is not usually required after aortic valve surgery.
   
• Mechanical Valves
  Mechanical valves are made of metal, carbon and/or synthetics (for example, the St. Jude valve). Lifelong blood thinner (anticoagulation) medication is required to prevent blood clots.
  
  
• Atrial or Ventricular Septal Defect Surgery
  The ‘septum’ is the wall of the heart that divides the left and right chambers. Occasionally, areas in this wall fail to close during development before birth, leaving an opening called a septal defect. This defect can be found in the heart’s upper chambers, called an atrial septal defect (ASD), or in the lower chamber of the heart, called a ventricular septal defect (VSD). Sometimes, part of the ventricular septum may be damaged during a heart attack, causing a VSD. This opening may increase the workload on the heart; however, this can be surgically repaired. During surgery, the opening is sewn together or patched with synthetic material or tissue from around the heart.

• Aneurysm Repair
  After a heart attack, part of the heart muscle may become weakened or scarred. When this happens, a part of the heart muscle may bulge (or balloon out) causing the heart to pump inefficiently. This may lead to such symptoms as shortness of breath, pain or irregular heartbeats, as well as possibly aggravating already existing angina symptoms. At the time of surgery, the aneurysm may be removed or patched in conjunction with coronary artery bypass surgery.

The next step in a patient’s recovery following their surgery is participation in the Cardiac Rehabilitation Program. The majority of patients are referred to this program when they are discharged from the hospital.

For more information on how to prepare for cardiac surgery, please click here.

Southlake Regional Health Centre performs first open-heart surgery - December 10, 2003

Cardiovascular Intensive Care Unit (CVICU)

Following cardiac surgery, patients will be transferred to the cardiovascular intensive care unit (CVICU), where highly trained staff and specialized equipment will be used to closely monitor them for approximately 12 to 48 hours. Once the patient no longer requires this level of critical care, they will be transferred to the CV Surgery Inpatient Unit where they will stay until they are ready to be discharged home.

Cardiovascular Surgery Inpatient Unit

The cardiovascular surgery inpatient unit is a 25-bed unit that includes a four-bed intermediate care unit for patients who require a higher level of nursing care during their hospital stay. Representing a wide variety of health disciplines, the unit’s health care team assists each patient to prepare for or recover from heart surgery.

Pre-Operative Clinic

Patients scheduled for cardiac surgery are required to visit the pre-op clinic and participate in an educational class approximately two to three weeks before their surgery. Family members are also encouraged to attend, as they play a key role in their loved one’s recovery.

The educational class provides an excellent opportunity for individuals to meet members of the cardiac team and to ask any questions or express any concerns that they may have about their upcoming surgery.

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For information on resources available to you during your hospital visit or stay (for example: parking, what to bring, discharge times and other helpful information) please click on Patients and Visitors.