CARDIAC SURGERY : TAKE A TOUR OF INFORMATION ABOUT IT

OVERVIEW

Life style of today’s world has become hectic as well as sophisticated, and due to this heart related diseases are very common now a days amongst individuals and it is increasing with a very noticeable speed day by day.

Not every heart disease requires a cardiac surgery, some heart diseases can be solved just by making very small changes in your lifestyle.

Usually Cardiac surgery is often needed to address problems such as heart failure, faulty heart valves, dilated or diseased major blood vessels such as aorta and abnormal heart rhythms and these are the indications for cardiac surgery.

 

TYPES OF CARDIAC SURGERY

1. OPEN HEART SURGERY

It is a type of cardiac surgery which includes the surgical opening of the chest and exposure of the heart outside the chest wall. This surgery is performed on the muscles, valves or arteries of the heart. The most common is coronary artery bypass surgery

This surgery is most common among patients having multivessel atherosclerotic disease who are suffering from angina or heart attack.

2. MODERN BEATING HEART SURGERY

This cardiac surgery in simple terms means – bypass surgery of the heart while it is still beating. Your heart will not be stopped while performing this surgery. You will not require a heart- lung machine during this.

The patients who require coronary artery bypass graft surgery can undergo beating heart surgery approach as well.

 

3. HEART TRANSPLANT

Heart transplant surgery is basically the replacement of a healthy working heart (that is received by the donor) by the removal of the diseased heart (that is removed from the receiver).

This includes three steps:

• Harvesting heart from the donor – A new heart from a brain dead donor is removed in the first operation.
• Removal of the diseased heart – The diseased heart is removed from the receiver in the second operation.
• Implantation of the new healthy heart obtained from the donor into the receiver is the third and the last operation

Heart transplant is done in patients suffering from heart failure.

 

4. CORONARY ARTERY BYPASS GRAFTING

This is a type of cardiac surgery that improves blood flow to the heart. The procedure for this can be invasive or non-invasive.

It is done for patients having severe coronary heart disease such as arteriosclerosis and atherosclerosis which blocks the blood flow to the heart and it is the most common method used for adults.

There are three types of CABG:

• TRADITIONAL CORONARY ARTERY BYPASS GRAFTING

Traditional coronary artery bypass grafting is one of the most common method of coronary artery bypass grafting and is done when at least one major artery needs to be bypassed.

• OFF-PUMP CORONARY ARTERY BYPASS GRAFTING

This type of coronary artery bypass grafting is similar to the traditional CABG as in this as well the chest bone is opened to access the heart. However, the heart does not stop.

• MINIMALLY INVASIVE DIRECT CORONARY ARTERY BYPASS GRAFTING

This type of coronary artery bypass grafting is similar to the off-pump CABG just the difference is that, in this instead of large incision several small incisions are made to open up the chest wall.

5. HEART VALVE REPAIR OR REPLACEMENT SURGERY

In this cardiac surgery, the damaged heart valve is repaired or completely replaced. This is an open heart surgery because the heart or aorta must be opened and in this the breast bone is divided and the heart is stopped therefore an heart-lung machine is required.

For example, Valvuloplasty is a heart valve repair surgery that repairs the narrowed valves.

The moat common types of replacement valves are mechanical (artificial) valves or tissue (animal) valves.

6. INSERTION OF A PACEMAKER OR AN IMPLANTABLE CARDIOVERTER DEFIBRILLATOR (ICD)

Insertion of a pacemaker is basically inserting a new artificial pacemaker when the natural pacemaker at the SA node stops working.

Thin wires are used to carry the signals to the heart muscle which starts the contraction and starts functioning at a normal pace. The pacemaker Is usually placed below the collarbone.

An implantable cardioverter defibrillator is basically a device that detects any abnormal heart beat in simpler terms or any rapid heartbeat. This abnormal heartbeat is termed as arrhythmia. If ICD detects any arrhythmia it immediately sends a shock to the heart and this shock changes the abnormal heartbeat back to the normal one and this process is termed as defibrillation.

7. MAZE SURGERY

It is also known as the “Cox” maze procedure or simply maze surgery in which a series of  incisions are made in the atria in a “Maze” like pattern. This is basically a type of cardiac surgery for atrial fibrillation in which the heart rhythm is irregular.

8. TRANSCATHETER STRUCTURAL HEART SURGERY

Basically, transcatheter structural heart surgery is a minimally invasive alternative to open-heart surgery and it involves guiding a long, thin, flexible tube called catheter to the heart through blood vessels that can be accessed through various parts of the body such as from the groin, thigh, chest, neck or collar bone.

 

MANAGING PAIN POST CARDIAC SURGERY

Cardiac surgery is a major surgery as it includes the surgery of the most important organ – HEART. So having pain after the surgery is very natural. For managing this pain a cardiac anesthesiologist who is basically a trained physician anesthesiologist and is also a pain management specialist is required.

In the pre-operative phase your anesthesiologist may ask you some common questions about your pain tolerance which will help him out to manage your post- operative pain.

Inspite of being major surgeries heart surgeries are not related to long term pain. There are several pain management options to overcome the post-operative short term pain.

• Nerve blocks
• Ketamine
• Non-steroidal anti-inflammatory drugs
• Acetaminophen
• Lidocaine infusion

 

RISKS RELATED TO CARDIAC SURGERY

Most of the cardiac surgeries are successful surgeries, still they do entail risk. Some of the risk factors are:

• Infection
• Bleeding
• Reactions to anesthesia
• Stroke
• Damage to tissue of heart, kidney, liver and lungs
• Death, this is very rare and happens especially for someone who is already very sick before surgery

 

RISK REDUCTION

There are basically two ways of risk reduction after cardiac surgery

• NON-PHARMACOLOGIC APPROACHES

Includes preoperative physical therapy that may reduce postoperative pulmonary complications such as pneumonia and atelectasis

• PHARMACOLOGICAL APPROACHES

Beta-blocking medication is sometimes prescribed during cardiac surgery which may reduce the incidence of atrial fibrillation and ventricular arrhythmias in patients undergoing cardiac surgery.

 

RECOVERY TIME

Recovery time after cardiac surgery totally depends on the type of surgery you have undergone. On an average it usually takes 6-8 weeks on an average to recovery.