Adult Congenital Heart Surgery
Myocardial Revascularization Surgery
Valvular Heart Disease
º Mitral Valve Replair
º Aortic & Mitral Valve Replacement
º Homograft Replacement of Aortic & Mitral Valves
Surgery of the Thoracic Aorta
º Complex Reconstructions
º Thoracic Aneurysm Repair
º Acute Aortic Dissection Repair
Arrhythmia Surgery
Ventricular Aneurysm
Minimally Invasive Cardiac Surgery
Minimally Invasive Valve Surgery
Beating Heart Surgery - OBCAB
Three major cardiac procedures performed at UCSF:
Coronary Artery Bypass Surgery (CABG)
Surgery of the Aorta
Heart Valve Surgery
Coronary Artery Bypass Surgery (CABG)
Coronary Artery Bypass grafting or CABG is a heart surgery procedure in which blocked coronary arteries are bypassed by a blood vessel graft to restore blood flow to the heart. These bypass grafts usually come from the patient’s own arteries and veins located in the chest (mammary artery), leg (saphenous vein) or arm (radial artery). The graft leapfrogs over the blocked artery to create new pathways for oxygen-rich blood to flow to the heart.
The goals of a CABG procedure are to relieve symptoms of coronary artery disease such as chest pain (angina) and /or shortness of breath (including angina), which enables the patient to resume a normal lifestyle and to lower the risk of a heart attack or other heart problems.
The procedure consists of connecting one end of the vein or artery to the coronary artery that is blocked beyond the blockage. The other end of the vein or artery is connected to the aorta. Usually the other end of the mammary artery is left connected to the main artery from which it branches. By creating this new passageway for blood flow to the heart muscle, the graft is said to "bypass" the narrowed or blocked section of the coronary artery. Depending on the number and location of blockages, patients typically have anywhere from 1 to 5 bypasses.
A heart-lung or bypass machine is used to pump and oxygenate the blood while the surgeon works on the stopped heart. The heart is accessed by cutting the patient's breastbone with a 10-12" long incision. After the bypasses are complete, the heart is restarted until it is beating normally, and the patient is removed from the heart-lung machine. Stainless steel wires are used to close the sternum, and sutures or staples are used to close up the chest and leg wounds.
Surgery of the Aorta
Surgery for the aorta may be needed when the patient has an aneurysm or a dissection.
Aneurysm:
An aneurysm is a balloon-like bulge in a blood vessel or in the wall of the heart. An aneurysm occurs when the wall of a blood vessel or the heart becomes weakened. Pressure from the blood forces it to bulge outward, forming what you might think of as a blister. An aneurysm can often be repaired before it bursts.
Surgery involves replacing the weakened section of blood vessel or heart with a patch or artificial tube (called a graft).
Aortic dissection:
Aortic dissections most often occur because of a tear or damage to the inner wall of the artery. This usually occurs in the thoracic (chest) portion of the aorta, but may also occur in the abdominal portion.
While the exact cause is unknown, it is often seen with uncontrolled high blood pressure, use of cocaine and Marfan’s syndrome.
Type A aortic dissections require emergency surgery to repair the aorta. Type B aortic dissections may be treated with medication.
Surgery to repair or replace the damaged section of aorta can cure the condition in some cases. If the aortic valve is damaged, valve replacement is necessary. If the coronary (heart) arteries are involved, a coronary bypass is also performed.
Heart Valve Surgery
Blood is pumped through your heart in only one direction. Heart valves help the blood flow in this one-way, by opening and closing with each heartbeat. They open their flap-like "doors" (called cusps or leaflets) at just the right time, then close them tightly to prevent a backflow of blood. Your heart moves about 100 gallons of blood through your body every hour.
There are 4 valves in the heart:
º Tricuspid valve
º Pulmonary valve
º Mitral valve
º Aortic valve
Two of the most common kinds of valve problems that require surgery are
Stenosis:
The leaflets do not open wide enough and only a small amount of blood can flow through the valve. Stenosis occurs when the leaflets thicken, stiffen, or fuse together.
Regurgitation:
Also called insufficiency or incompetence, means that the valve does not close properly and blood leaks backward instead of moving in the proper forward direction. Surgery is needed to either tighten/repair or replace the valve.
Surgical repair of a valve involves the surgeon rebuilding the valve so that it will work properly. Valve replacement means that the valve is replaced with a biological valve (made of animal or human tissue) or a mechanical valve (made from materials such as plastic, carbon, or metal).
If valve damage is mild, doctors may be able to treat it with medicines. If damage to the valve is severe, surgery to repair or replace the valve may be needed.
Valve Replacement
Severe valve damage means that the valve will need to be replaced. Valve replacement is most often used to treat aortic valve problems and severely damaged mitral valves that are not able to be repaired. It is also used to treat any valve disease that is life-threatening. Sometimes, more than one valve may be damaged in the heart, so patients may need more than one.
There are 2 kinds of valves used for valve replacement:
Mechanical valves:
These valves are usually made from materials such as plastic, carbon, or metal. Mechanical valves are strong, and they last a long time. Because blood tends to stick to mechanical valves and create blood clots, patients with these valves will need to a take “blood thinner”, usually warfarin (Coumadin) for the rest of their lives.
Tissue valves:
These valves are made from animal tissue, usually a pig or a cow. They may also be taken from the human tissue of a donated heart. Patients with biological valves usually do not need to take blood-thinning medicines. These valves are not as strong as mechanical valves, though, and they may need to be replaced every 10- 15 years or so.