Who is eligible for heart surgery?
Heart surgery may be required for many heart diseases, but it is most commonly performed for the following problems:
- Narrowing or blockage in the vessels supplying the heart: Bypass surgery (CABG)
- Narrowing or leakage in the heart valves: Heart valve surgery (Valve replacement or repair)
- Congenital heart problems: Congenital heart surgery
Video 1: Bypass Surgery
Video 2: Mitral Valve Surgery
Video 3: Aortic valve surgery
What are the different types of heart surgery?
Surgeons can use different methods for heart surgery. These are; open-heart surgery, off-pump bypass surgery, and minimally invasive surgery. The surgical team explains the pros and cons of these methods to the patient in detail. Thus, the most suitable method for that specific patient is decided.
- Open-heart surgery: For many people, what comes to mind when heart surgery is mentioned is actually open-heart surgery. In this classic method, the surgeon makes a vertical incision 15-20 cm long in the breastbone, called the sternum, and pulls the ribs sideways to reach the heart. The heart is stopped for the intervention. During this time, the patient is connected to a device called a heart-lung machine. The duration of the surgery varies depending on the type of operation. For example, bypass surgery, the most common operation, takes an average of 3-4 hours.
- Off-pump bypass surgery: This surgery is similar to classic heart surgery, but the patient is not connected to a heart-lung machine. The entire surgery is performed while the heart continues to beat. Therefore, its other name is “off-pump” surgery. Only bypass surgery can be performed with this method. It can be applied for one or two vessels.
- Minimally invasive surgery: Although it is popularly known as “closed” heart surgery, it is actually a type of “open” surgery. Unlike the classic method, a much smaller incision is made in the chest. This small incision can be in the breastbone (mini-sternotomy) or between the ribs (mini-thoracotomy). One type of minimally invasive surgery is robotic surgery. Here, several small holes are opened in the chest, and the robot’s arms are inserted into the chest through them. The surgeon does not touch the patient directly; the surgery is performed by remotely controlling the robot’s arms from a corner of the operating room. With minimally invasive surgery, there are fewer scars aesthetically and the recovery time is shortened.
A Comparison of Scarring from Large and Small Incisions in Bypass Surgery
What is the main benefit of heart surgery?
The goal is to help the patient live a longer life by resolving the heart condition. By the end of the recovery process, the patient feels more energetic and healthy.
Artificial blood vessels (grafts) implanted during bypass surgery
What are the risks (complications) of heart surgery?
In general, risks are not seen in most patients, but nevertheless, as with any surgery, the following problems may be encountered:
- Bleeding during or after surgery
- Heart rhythm disturbance (arrhythmia)
- Infection at the chest incision site (skin or bone)
- Intrathoracic (chest cavity) infection
- Pneumonia
- Kidney failure
- Heart attack
- Blood clot in the lung (pulmonary embolism)
- Inflammation of the heart lining (acute pericarditis; early or late-onset types)
- Permanent loss of heart lining flexibility (constrictive pericarditis)
- Heart failure
- Significant edema in the leg if a vessel was harvested from that leg
- Narrowing of the prosthetic heart valve (valve degeneration)
- Infection of the prosthetic heart valve (infective endocarditis)
- Dehiscence of prosthetic valve sutures and development of blood leakage (paravalvular leak)
- Post-operative depression or anxiety disorder
- Forgetfulness or difficulty thinking clearly
- Stroke
- Death
How long does it take to recover from heart surgery?
This timeframe varies depending on the type of surgery performed and the patient’s overall health. Many patients recover within 1.5 to 2 months.
How long do people who have had heart surgery live?
This question is often answered as “many years.” However, how long a patient will live depends on their overall health, whether they have any other serious illnesses, the type of surgery performed, and the patient’s age.
What are the situations that require notifying the doctor after heart surgery?
It is normal to feel a bit restless and unhappy after surgery. During the recovery process, it can be difficult for the patient to distinguish between what is normal and what is abnormal. In case of doubt, it is best to call the doctor for confirmation. However, the following are not normal:
- Worsening chest pain
- Fever
- Nausea or vomiting
- Shortness of breath
- Bleeding
- Purulent (infected) discharge or increasing redness at the incision site
- Speech impairment or similar signs of stroke
Is there an alternative to heart surgery?
The vast majority of heart conditions for which surgery is recommended can also be treated using non-surgical methods. These methods are referred to as “non-surgical” because, unlike surgery, they do not require an incision in the chest or stopping the heart. In other words, all procedures are performed while the heart continues to beat. Since the heart does not need to be stopped and, consequently, there is no need to connect to a heart-lung machine, the risks associated with these procedures are generally lower compared to surgery. Because no incision is made in the chest, the recovery process involves less pain and stress. Since there is no scar on the chest, there are no aesthetic concerns. These procedures are typically performed using long, flexible tubes (catheters) inserted through a small, pencil-thin vascular access point in the groin and guided to the heart. The most common example is the use of stents to open blocked arteries using complex techniques and materials, rather than performing bypass surgery. Additionally, the non-surgical replacement of the aortic valve (TAVI); balloon dilation of mitral valve stenosis (mitral balloon); and treatment of mitral valve regurgitation with a clip (MitraClip) are other commonly used non-surgical methods. All of these non-surgical procedures are performed by interventional cardiologists; surgeries, on the other hand, are performed by surgeons.
Thanks to advancing technology, an experienced interventional cardiologist whose professional interest is complex procedures can now open complex arterial blockages with stents. In most patients for whom bypass surgery is recommended, stenting provides the same benefit as bypass surgery. In other words, for these patients, both bypass surgery and stenting are equally effective; neither is the wrong choice. However, for some patients, bypass surgery remains a necessity (See References).
We recommend seeking a second opinion from a different physician for serious decisions such as treatment choice. It is important to request that the latest scientific evidence for the recommended treatment be presented in an understandable language, along with its references.
Prof. Dr. Şükrü Akyüz is an interventional cardiologist. His professional interest is the treatment of heart diseases using non-surgical methods. These treatments include opening complex arterial blockages through specialized stenting methods, TAVI, and the clip (mandal) method.