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Cardiac Surgery

Aortic Valve Surgery

Blood flows out of your heart and into a large blood vessel called the aorta. The aortic valve separates the heart and aorta. The aortic valve opens so blood can flow out. It then closes to keep blood from returning to the heart.

Valve Repair

You may need aortic valve surgery to repair or replace the aortic valve in your heart if:

  • Your aortic valve does not close all the way so blood leaks back into the heart. This is called aortic regurgitation.
  • Your aortic valve does not open fully so blood flow out of the heart is reduced. This is called aortic stenosis.
  • Open aortic valve surgery replaces the valve through a large cut in your chest.

Alternative Names

Aortic valve replacement; Aortic valvuloplasty; Aortic valve repair; Replacement - aortic valve; AVR

Valve Replacement

If your aortic valve is too damaged, you will need a new valve. This is called replacement surgery. Your surgeon will remove your aortic valve and sew a new one into place. There are two main types of new valves:

  • Mechanical, made of man-made materials, such as titanium or carbon. These valves last the longest. You may need to take blood-thinning medicine, such as warfarin (Coumadin) for the rest of your life if you have this type of valve.
  • Biological, made of human or animal tissue. These valves may last 10 to 20 years, but you may not need to take blood thinners for life.

You may need surgery if your aortic valve does not work properly. You may need open-heart valve surgery for these reasons:

  • Changes in your aortic valve are causing major heart symptoms, such as chest pain, shortness of breath, fainting spells, or heart failure.
  • Tests show that changes in your aortic valve are beginning to seriously harm how well your heart works.
  • Your heart valve has been damaged by infection of the heart valve (endocarditis).
  • You have received a new heart valve in the past and it is not working well.
  • You have other problems such as blood clots, infection, or bleeding.
Learn more about Aortic Valve Surgery.

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Automatic Implantable Cardioverter-Defibrillator (ICD)

Internal Cardiac Defibrillators (ICDs) -- An automatic ICD is a device that monitors a person's heart rate. It can be used to monitor and treat tachycardia (when the heart beats too fast), brachycardia (when the heart beats too slowly). They do also act as pacemakers to treat rhythms that are too slow also if needed

The device is programmed to either speed up or slow down the heart, depending on the patient's heart rate. The automatic ICD gives the heart a shock if the patient starts having life-threatening arrhythmias (abnormal heart beat) or an abnormally high heart rate.

There are different kinds of automatic ICD systems, but they all have two parts -- electrodes (thin, flexible wires) and a generator. The electrodes, or leads, monitor or sense the heart's electrical activity. The generator is the battery power source. It is a small metal can about 1/2 the size of a deck of cards.

The generator stores information about any arrhythmias the patient may have, and tracks how often a shock is needed.

About the procedure: Typical surgical implantation of an automatic ICD system is done with moderate to deep sedation. The surgery usually takes between 1 and two hours.

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Cardiac Rhythm Management

Cardiac Rhythm Management describes a procedure where an electrical firing device is installed within the upper chest to control both fast and slow cardiac rhythm. Examples of devices used are:

Implantable Cardioverter Defibrillator

An implanted cardioverter defibrillator (ICD) is a device that is implanted in a patient's body to help control the heart's rhythm. ICDs are extremely effective at stopping dangerous arrhythmias and are the most effective therapy for treating ventricular fibrillation, the major cause of sudden cardiac death. The ICD continuously monitors the heart rhythm and delivers a "pacemaker" shock when the heart rhythm gets too slow. If the heart rhythm gets dangerously fast, the ICD can deliver a life-saving shock that returns the heart to a normal rhythm.

Pacemaker

The heart has a natural "pacemaker" that regulates electrical impulses in the heart. This natural"pacemaker" is called the sinoatrial node. But sometimes the sinoatrial node does not work properly and an artificial pacemaker is needed to regulate the heart's rhythm. An implantable pacemaker device continuously monitors the rhythm of the heart and transmits electrical impulses to stimulate the heart if it is beating too slowly or unevenly.

Bi-Ventricular Pacing

Bi-Ventricular devices stimulate the left and right ventricles simultaneously, the bi-ventricular pacing system resynchronizes the heart and dramatically improves the heart's ability to pump blood through the body.

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Cardiac Surgery

Our cardiac surgery program offers a broad range of cardiac surgical options which may include:

  • Open heart (coronary artery bypass, or CABG) surgery is performed in order to reroute, or "bypass," blood around blocked arteries, thereby improving the supply of oxygen-rich blood to the heart. Surgeons usually use an artery from the chest wall to construct the "detour" around the blocked part of the artery. Veins from the legs are also used.
  • Off-pump bypass surgery is possible for some open heart surgery patients. While standard open heart surgery requires the use of a mechanical heart-lung machine during the procedure, this reduces the risk of some complications and shortens recovery time.
  • Valve repair or replacement is performed when a heart valve is leaking, or when the opening is too small to allow sufficient blood to flow. Surgeons try first to repair a valve. When replacement is necessary, either a mechanical (artificial) or biological (human or animal) valve is used.
  • Repair of structural heart defects are performed to correct defects in the structures of the heart that are the result of a congenital birth defect or acquired as a result of other cardiac diseases.
  • Cardiac trauma surgery is performed when the heart is damaged or involved in a traumatic injury.

 

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Carotid Endarterectomy

Every year, more than 300,000 people in the United States are diagnosed with blockages, or plaques, in their carotid artery. If left untreated, these blockages can slow or even stop blood flow to the brain, causing a potentially disabling stroke, also known as a "brain attack."

Carotid Endarterectomy(CEA) - a carotid endarterectomy is a surgical procedure to open or clean the carotid artery with the goal of stroke prevention. Endarterectomy involves physically removing plaque from inside the carotid artery. A surgeon makes an incision in the neck to expose the artery, clamps the artery, then opens it lengthwise in the region of the narrowing. After scraping the fatty plaque out of the artery, the surgeon enlarges the artery with a diamond-shaped patch, stitches the artery together, then closes the skin of the neck.

Cardiac Clinical Trials - Some hospitals are participating in cardiac clinical trials of new procedures that also help unblock the carotid artery.

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Coronary Artery Bypass (CABG)

A broad range of cardiac surgical options are available at McLaren Macomb including:

  • Open heart (coronary artery bypass, or CABG) surgery is performed in order to reroute, or "bypass," blood around blocked arteries, thereby improving the supply of oxygen-rich blood to the heart. Surgeons usually use an artery from the chest wall to construct the "detour" around the blocked part of the artery. Veins from the legs are also used.
  • Off-pump bypass surgery (OPCAB) is possible for some open heart surgery patients. While standard open heart surgery requires the use of a mechanical heart-lung machine during the procedure, this reduces the risk of some complications and shortens recovery time.
  • Endoscopic Vein Harvesting is a minimally invasive procedure performed to extract the saphenous vein from the leg. The procedure requires one to three small incisions, each less than 1 inch in length. The procedure is part of coronary artery bypass graft (CABG) surgery, which is performed to bypass one or more blocked coronary arteries and restore oxygen-rich blood flow to the heart.

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Endoscopic Vein Harvesting

Endoscopic Vein Harvesting

This is a minimally invasive procedure performed to extract the saphenous vein from the leg. The procedure requires one to three small incisions, each less than 1 inch in length. The procedure is part of coronary artery bypass graft (CABG) surgery, which is performed to bypass one or more blocked coronary arteries and restore oxygen-rich blood flow to the heart.

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Mitral Valve Procedures

Anatomy of the Mitral Valve: The heart is a biological pump with four chambers and four valves directing the flow of blood. The right side of the heart collects the blood from the body and pumps it into the lungs.

The left side of the heart collects the blood from the lungs and, in turn, pumps it into the body. Between the two chambers on the right side lies the tricuspid valve. The other valve -- the pulmonary valve -- is on the right side is between the bottom chamber and the main feeding artery to the lungs.

On the left side lies the mitral valve between the top chamber and the bottom chamber. The aortic valve lies between the bottom chamber on the left side and the main feeding vessel of the body -- the aorta. The pulmonary valve and the aortic valve have three leaflets and are relatively simple valves. Their function resembles that of valves of an engine, except these valves allow blood to flow in one direction only.

The mitral valve is a complex apparatus whose function is intimately related to the left ventricle -- the bottom chamber on the left side. This valve has four basic components; the annulus, or ring of the valve; two leaflets; the chords that attach to the free edge of the leaflets at one point, and to the papillary muscles at the other end. All are attached to the base of the left ventricle. All these components work in harmony to maintain an effective and efficient function of the left ventricle.

Disorders of the Mitral Valve: Any disruption of the mitral valve components could lead to a leaking of the valve. This is commonly known as mitral regurgitation.

A narrowing of the valve -- mitral stenosis -- could also occur--and is much more common in third-world countries. Typically it is linked to the disease -- rheumatic fever. This condition is rare in the United States.

A much more common condition is mitral valve prolapse, which causes poor operation of the mitral valve leaflets, and may result in leakage or a backward flow of blood into the left atrium from the left ventricle.

However, not all patients with mitral valve prolapse have symptoms or leakage and do not require treatment. They need to be followed carefully to detect progression of this disorder.

As mitral regurgitation progresses, fluid builds up in the lungs and increases the workload of the left ventricle. The body compensates for this by retaining more fluid, and by increasing muscle mass of the left ventricle. At some point, the compensation fails. Patients become progressively more symptomatic, and this can result in congestive heart failure and dilation of the left ventricle.

Symptoms of Mitral Valve Disorders: Not all patients with mitral valve prolapse need surgery, unless there is a significant regurgitation of blood, resulting in symptoms, such as:

  • Shortness of breath with exertion or exercise and/or when lying down flat in bed;
  • Swelling of ankles and feet;
  • Awakening in the middle of the night with shortness of breath;
  • Fatigue, feeling tired with a lack of energy.

The fluid the body retains to compensate for the leaky valve tends to gravitate toward the feet during the day, causing ankle swelling, and manifests itself as tightness of shoes in the evening. In a prone position at night, the fluid that has gravitated to the feet moves back into the bloodstream, causing increased lung congestion. This requires patients to wake up and sit up, preferably near an open window, in order to obtain relief.

Treatment of Mitral Valve Disorders:

Once it's determined that a diseased heart valve needs treatment, the available choices are valve repair or valve replacement:

  • Valve repair - which preserves the patient’s valve and leaflets. Sometimes repairs require a minimal surgery procedure and other times repairs need a more extensive surgery. Repair is most often possible for mitral valve regurgitation and tricuspid valve regurgitation.
    • Transcatheter Mitral Valve repair. This procedure uses an implant that goes onto the center of the mitral valve. This is a minimally invasive procedure called transcatheter mitral valve repair. This reduces the mitral regurgitation and allows the valve to continue to open and close, allowing blood to flow. The procedure takes 1-2 hours with an average of a one-night stay at the hospital.
  • Valve replacement - which may include transcatheter aortic valve implantation or replacement (TAVR or TAVI), or other minimally invasive procedure. In many cases, the best long-term solution may require a more involved surgery such as the Ross procedure or the insertion of a new tissue or manufactured valve. Treatment with medications, including diuretics, may be recommended.

After mitral valve repair, all patients are kept on a medication to thin the blood for two to three months to allow for healing to occur within the heart. These blood thinners are usually stopped unless the patient has an irregular heartbeat. Patients who have had a mitral valve replacement are required to continue taking Coumadin for life.

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Pacemaker

Sometimes patients with abnormally slow heart rhythms, or congestive heart failure require the use of a pacemaker. This device helps to coordinate the pumping action of the heart by sending electrical signals, allowing the heart to pump more effectively.

Pacemakers may also be used to stop the heart from triggering impulses or from sending extra impulses. These are called cardioverter defibillators.

A pacemaker is a small, implantable device. It is made up of two parts -- a pulse generator, which includes the battery and several electronic circuits, and leads, which are wires that are attached to the heart wall. Depending on the type of pacemaker to be used, there may be one, two or three leads.

About the procedure: Most pacemaker surgery is done under anesthesia. The patient is typically asleep during the procedure, which usually takes between one and three hours.

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Pulmonary Valve Surgery

The pulmonary valve in the heart is the valve separating the right ventricle (one of the chambers of the heart) and the pulmonary artery. The pulmonary artery carries oxygen-poor blood to the lungs.

Pulmonary Valve Stenosis

Pulmonary valve stenosis is a rare disorder. In some cases, the problem runs in families. Pulmonary valve stenosis is a heart valve disorder that involves narrowing of the pulmonary valve. This is most often present at birth (congenital). It is caused by a problem that occurs as the baby develops in the womb before birth. The cause is unknown, but genes may play a role. Narrowing that occurs in the valve itself is called pulmonary valve stenosis. There may also be narrowing just before or after the valve. The defect may occur alone or with other heart defects that are present at birth. The condition can be mild or severe.

Pulmonary Valve Surgery

Some people may need heart surgery to repair or replace the pulmonary valve. The new valve can be made from different materials. If the valve cannot be repaired or replaced, other procedures may be needed.

Learn more about Pulmonary Valve Surgery.

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