A Guide to Heart Surgery

Cardiologists and thoracic surgeons at South Texas Health System Heart employ advanced technologies in both non-invasive and invasive heart surgery. Some of our common surgical procedures include coronary artery bypass surgery and heart valve surgery. 

Coronary Artery Bypass Surgery

Coronary artery disease, the most common type of heart disease in the United States, occurs when blood flow to the heart is limited due to atherosclerosis or "hardening of the arteries". High blood pressure, smoking, high cholesterol levels, your family’s health history, and diabetes are all major risk factors for coronary artery disease. When atherosclerosis occurs, hard fatty deposits called plaque block normal oxygen-rich blood flow to the heart. Lack of oxygen to the heart muscle can cause chest pain or pressure, also called angina. When complete blockage of blood in one area of the heart occurs, it is called a heart attack.

Coronary bypass surgery is the most common kind of open heart surgery. It is performed in order to restore blood flow to the heart muscle, stop chest pain, and to reduce the risk of a heart attack. First the surgeon must divide the breastbone to expose the heart. Next, a segment of a vein in the leg is used to build a detour around the blockage. One end of the vein is sewn into the aorta, and the other end is sewn into the coronary artery below the blockage.

The vein can be spared from the leg because there are many others in the area that can perform the same function.  In most patients, the surgeon uses the internal mammary artery (IMA) as the bypass graft. There are two IMA's, left and right, that lie close to the heart on the back of the breastbone. They can be used alone or along with a vein bypass procedure.

The heart muscle should be in a resting state while the bypass grafts are sewn into place. For this reason, a device called a heart/lung machine takes over the function of the heart and lungs during surgery. Once the bypass grafts are sewn into place, the heart/lung machine is no longer needed. The heart and lungs resume function, and the chest is closed. The operation takes about three to five hours, including preparation time.

Heart Valve Surgery

Valve problems occur in most cases from birth defects, rheumatic fever, age or infection, and impair the valves's ability to open and close properly. Stenosis is a valve problem that happens when the valves narrow and the flow of blood is decreased. With regurgitation, valves do not close as they should and some blood flows backward instead of forward. When the valves do not open and close as they should, the heart has to work harder to pump blood which can result in trouble breathing, leg swelling and heart failure.

Sometimes heart medications alone can improve the heart's pumping and relieve heart failure. More often, heart surgery is needed to repair or replace a damaged valve. Usually heart valve replacement is an open heart operation, meaning the surgeon must open your chest up to remove the damaged heart valve in order to place a new prosthetic valve. Sometimes, valve replacement surgery can be performed using small incisions near the breastbone (minimally invasive surgery). Your surgeon will talk with you about his or her plans for surgery and any other procedures you may need.

Heart valves may be replaced with either a tissue or mechanical valve. Mechanical valves are very sturdy, so they usually last longer than tissue valves. You may need to take a blood thinner called Coumadin for the rest of your life to prevent clots from sticking to the valve. A tissue valve is made from an animal source and molded into a ring. The use of this type of valve does not always require medication to prevent the blood from clotting on it. There is little risk of rejection, as in transplants, because the valve has been pretreated. In valve repair surgery, the breastbone is divided and the heart/lung machine takes over the work of the heart and lungs until surgery is finished. Your doctor or nurse will be able to describe the kind of valve that will be used for you and answer any questions you have.

Heart Surgery Guide 

The following information will guide you through the heart surgery process and tell you what to expect during your time as a heart surgery patient at South Texas Health System Heart.

If you need to see a physician affiliated with South Texas Health System Heart for a non-urgent medical problem, call the South Texas Health System Reserve and Learn line at 800-879-1033.