Duke University and the Cleveland Clinic recently completed studies indicating that patients whose doctors have more experience performing life-saving procedures are less likely to experience complications and more likely to survive procedures. We perform more open-heart procedures on an annual basis than any other health system in Southeast Georgia. With recent technological changes, cardiothoracic surgeons can select different surgical approaches and techniques to accomplish revascularization of the heart muscle.
Heart Valve Repair and Replacement
Heart valves may either be repaired or replaced to restore them to normal function. A heart valve replacement is necessary when the valve is degenerated beyond repair. The old valve is removed and replaced with a new valve mechanism-either biological (tissue) or mechanical (artificial). Biological valves are made from animal tissue. Mechanical valves are constructed from metal and cloth.
Coronary Artery Bypass
The most common surgical treatment for coronary artery disease is a procedure known as coronary artery bypass grafting (CABG). CABG redirects blood in the heart using small sections of the patient's own arteries or veins. During this procedure, the surgeon makes an incision down to the center of the breastbone to gain access to the heart. The heart is stopped and the patient continues to receive oxygen-rich blood from a heart-lung machine, used temporarily as a substitute for the beating heart. A blood vessel is then taken from the tissues of the chest, arms or legs and placed in areas of narrowing in the heart to restore circulation.
Off-pump surgery seeks to avoid using the heart-lung machine. It is a minimally invasive technique that enables the surgeon to perform CABG surgery on multiple vessels within the beating heart. During the procedure, a mechanical stabilizing device is used to restrict heart movement so the surgeon can operate while it is beating. Patients may be given a drug to slow the heart rate, but the heart maintains its own rhythm without the assistance of the heart-lung machine. The benefits of off-pump surgery include shorter hospital and recovery time, less bleeding, less potential for infection and less trauma.
A type of off-pump procedure known as MIDCAB (minimally invasive direct vision coronary artery bypass) offers a select group of patients with coronary artery disease an alternative to the standard coronary artery bypass grafting. MIDCAB uses a smaller modified incision, requires less operative time and eliminates the risk involved in cardiopulmonary bypass.
Single or multiple vessels are re-vascularized while the heart remains warm and beating. Movement of the beating heart is dampened in the area of the targeted bypass vessel with the use of mechanical stabilizers. The anesthetist may slow the heart rate. The combination of slowed heart rate and stabilizers may lead to profound hemodynamic (blow flow and circulation) and ischemic (lack of blood flow and oxygen) changes poorly tolerated in a patient with multiple vessel disease and concurrent disease processes.
Extubation (removal of breathing tube) and recovery times are far shorter for MIDCAB procedures, leading to earlier discharge and substantial cost savings. It is the combination of anesthetic monitoring, quick response to hemodynamic changes and manipulation of physiologic parameters that make providing anesthesia for minimally invasive cardiac bypass surgery exceptionally challenging.