Your Heart and Your Heart Surgery

The heart is a muscular organ that sits in the center of your chest and is protected by the sternum or “breastbone.”  Its job is to pump blood rich with oxygen and other nutrients to all parts of the body.

The heart is divided into four chambers.  The two upper chambers receive blood from the veins – called atria.  The two lower chambers pump blood out of the heart – called ventricles.

There are four valves in the heart that act as one-way doors to direct the blood flow through the heart and blood vessels.  Healthy valve leaflets are perfectly formed thin tissue that open and close as your heart relaxes and contracts. 

A wall called the septum divides the heart into the right and left sides.

Blood from the right side of the heart is pumped to the lungs to get fresh oxygen.  The blood is then pumped to the left side of the heart where the main pumping chamber (the left ventricle) pumps the oxygenated blood to all parts of the body.

The heart muscle itself must have a blood supply of its own.  The heart receives its blood supply with oxygen and nutrients from the coronary arteries.

Three main arteries lie on the surface of the heart and divide into smaller branches.  Each branch nourishes a different part of the heart muscle.

Ablation or “Cox-Maze” Procedure for Atrial Fibrillation

Atrial fibrillation is the most common type of irregular heart rhythm, affecting more than two million Americans.

The condition may account for roughly 15 percent of all strokes in the United States.  All patients must be on an anticoagulant and various other medicines to try to regulate the heart rate or rhythm.

In a person with a normal heart rhythm, electrical signals trigger the contraction of muscles in the heart’s two upper chambers, the atria. During atrial fibrillation, a chaotic web of electric impulses spreads throughout the atria, causing the chambers to quiver rather than contract together.

For the Cox-Maze procedure, or ablation, your surgeon performs surgical ablation using one of several energy sources to scar the tissue in the atria.  The scar tissue serves as a barrier and traps abnormal electric impulses in a “maze” of barricades. Only one path remains intact, guiding impulses to their correct destination.

The Cox-Maze procedure has a high success rate of converting the heart to a normal rhythm.

This procedure can be done during valve or coronary artery bypass surgery or as an isolated surgery to correct the rhythm.  If performed during heart surgery, you will not have any different incisions or tubes after surgery.

If you are just having the ablation done you will have 3-4 small incisions on your sides and chest tubes on each side.

Anticoagulation

When you go home your surgeon will prescribe an anticoagulant (blood thinner) if you have an abnormal heart rhythm or a mechanical valve replacement.  Routine blood tests will be needed to monitor the effects of this drug.  Your surgeon will give you very specific instructions about the dosage and when to have your blood tested. Your dietitian, pharmacist, and nurse will also educate you on a specific diet, side effects and monitoring.

Coronary Artery Disease

Coronary arteries can become narrowed by a build-up of fat and cholesterol in the walls of the arteries.  As a result, less blood flows through the arteries, therefore decreasing the blood supply and oxygen going to the heart muscle.  This results in “angina” or chest pain and possibly a heart attack.

Coronary Artery Bypass Surgery

If surgery is indicated, your cardiologist and cardiovascular surgeon will work together to make a recommendation about what will work best for you.

The procedure begins by your surgeon making an incision or cut in the middle of your chest and separating the sternum or breastbone.

While the surgeon is working on your heart, your blood will be sent through a machine called the cardiopulmonary bypass machine (or heart-lung machine) to be supplied with oxygen and then circulated to the rest of your body. 

Your surgeon and his assistant will choose and remove a vein or artery or both from your chest, arm or leg and use it to bypass the blocked arteries.  One end of the graft is sewn to the coronary artery just below the blockage and the other end is sewn to the large artery in your chest called the “aorta”.

Toward the end of the surgery, your heart will resume pumping and circulating your blood as you come off the cardiopulmonary bypass machine.

Wires will be used to close the sternum and stitches, staples, or surgical glue will close the skin.

Heart Valve Surgery

Valve repair or replacement is done at the recommendation of your cardiologist and surgeon.  In some cases, it is possible to repair the damaged valve, but some are so seriously damaged or diseased that they must be removed and replaced with a new valve.

There are two types of replacement valves: biological or mechanical. Biological choices are bovine (cow), porcine (pig), and, rarely, human valves. Mechanical valves are made up of metal, carbon or synthetic materials.

Together, you and your surgeon will determine which type of valve is best for you, based on your age, lifestyle and the nature of your heart disease.

Your surgeon will make an incision or cut in the middle of your chest and separate the sternum or breastbone.

Your blood will be sent through a machine called the cardiopulmonary bypass machine (or heart-lung machine) to be supplied with oxygen and then circulated to the rest of your body while the surgeon is working on your heart.

Your surgeon then replaces or repairs your heart valve.

Toward the end of the surgery, your heart will resume pumping and circulating your blood as you come off the cardiopulmonary bypass machine.

Wires will be used to close the sternum and sutures will close the skin. Then staples or surgical glue will be applied to secure the incision.

Off-Pump Coronary Artery Bypass Surgery (OPCAB)

A select number of patients are candidates for this procedure.  This surgery is done without the assistance of the cardiopulmonary bypass machine.  The heart continues to beat and circulate blood during the surgery.  This surgery is commonly performed for patients with one coronary artery blockage or for those who would not be considered candidates for the cardiopulmonary bypass machine due to other health problems.

Valvular Heart Disease

Heart valves can be abnormally formed, as with birth defects, or they can be damaged as a result of rheumatic fever, infection, inherited conditions, aging or heart attack.

There are four valves in your heart: Tricuspid, Pulmonic, Mitral, and Aortic

The aortic and mitral valves are the most commonly affected by disease.  The valve(s) may become narrowed (stenotic) or unable to close completely, resulting in backflow of blood (insufficiency or regurgitation). 

Both conditions require the heart to work harder to pump blood past the narrowed valve or to compensate for the insufficiency caused by the backflow of blood.  This excess work weakens the heart muscle and causes it to enlarge and produce a variety of symptoms.  These may include chest pain, shortness of breath, dizziness, fainting, tiredness and swelling.