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Heart Failure Preparation & Management

Daignosing Heart Failure Building a Team Optimal Medicine Therapy Minimally Invasive Surgery Invasive Surgery Recovery
Diagnosing A Heart Condition Building A Team Optimal Medicine Therapy Minimally Invasive Surgery Invasive Surgery Recovery

Minimally Invasive Surgery

Obviously, heart surgery is the biggest step in handling heart failure. The patient’s condition and their stage and classification of heart failure, determine the choices that have to be made when approaching surgery. There are two basic categories of heart surgery 1) minimally invasive and; 2) invasive. This section will cover minimally invasive heart surgery options.

To determine whether a patient is a candidate for a minimally invasive surgery, a surgeon will evaluate and assess the patient’s medical and family history and the diagnostic tests including blood tests, urine tests, a Chest X-ray, an Echocardiogram, an Electrocardiogram, Coronary Catheterization (Angiogram), MRI, Nuclear Scan, and Ejection Fraction analysis (See Diagnosis).

There are many differences between minimally invasive and invasive heart surgery. The most obvious is the incision that is made during the procedure. With minimally invasive surgery the incision required is approximately 3 to 5 inches instead of 6 to 8 inches in traditional invasive heart surgery. In some minimally invasive procedures much smaller, keyhole incisions are made to perform the surgery.

In minimally invasive surgery specialized surgical instruments such as a catheter are used. Small incisions, ports, or needles are utilized to gain access to various areas of the body to perform the procedure

The basic types of minimally invasive heart surgery include:

  • Atrial FibrillationCoronary
  • Artery Bypass Graft (CABG)
  • Cardiac Resynchronization Therapy (CRT)
  • Valve Surgery

ATRIAL FIBRILLATION

Atrial Fibrillation concerns the hearts electrical system (as opposed to the blood circulation or pumping system). AFIB, as it is commonly referred to, is brisk, irregular activity in the upper chambers of the heart-in the right or left atrium. AFIB patients complain of a fluttering sensation in their chest.

Electrophysiologists specialize in the heart’s electrical system. They are specifically trained in arrhythmias such as AFIB.

Atrial Fibrillation surgery may involve the use of radiofrequency ablation. Radiofrequency is a non-surgical procedure that uses heat to destroy a certain area of dead or affected tissue. The use of Radiofrequency allows surgeons to identify the exact area of affected tissue. It is performed through a small incision in the chest. The procedure will create scars on the heart’s surface. The scars are supposed to redirect electrical impulses to a normal pathway through the heart. A heart/lung machine may not be used during this procedure as it can be performed on a beating heart.

New techniques in treating AFIB include using Cryoblation, which is a procedure involving insertion of a tube below 0°C (With cooling abilities to -130°C). The device is designed to destroy abnormal or dead tissue in any number of organs, including, but not limited to the heart.

CORONARY ARTERY BYPASS GRAFT (CABG)

Coronary Artery Bypass Graft (CABG) is a surgical procedure that uses arteries or veins to bypass blockages in the coronary arteries. This procedure includes using healthy veins from parts of the body like the forearms or legs.

Before the procedure the patient is placed under anesthesia and mechanical ventilation, through the use of a heart lung machine. A median sternotomy, which involves cutting through the sternum (The long, flat bone that connects the ribs in the frontal portion of the body) is then performed. The Bypass Grafts are then placed in the thoracic (chest) arteries, the radial (forearm) arteries, and/or the saphenous (leg) veins. The heart is stopped or there are devices placed to stabilize the heart. Each Graft is sewn onto the arteries and the aorta, bypassing the blockages. At this point either the surgeon will restart the heart or remove the stabilizing devices. The sternum will then be wired together and the chest will be closed with stitches (sutures).

The most minimally invasive CABG is when the heart lung machine is not used. With MIDCAB, the surgeon will enter the chest cavity through the ribs with a 2 to 3 inch incision. This approach is generally practiced when only one or two arteries need to be bypassed.

CARDIAC RESYNCHRONIZATION THERAPY (CRT)

Cardiac Resynchronization Therapy (CRT) is another minimally invasive surgery. CRT, also referred to as Biventricular Pacing, involves surgically implanting a battery operated device under the skin. The purpose of the biventricular pacemaker is to synchronize the right and left pumping chambers of the heart to improve overall pumping efficiency of the heart.
Part of Heart Failure diagnosis may include an Echocardiogram (ECG) to determine a patient’s QRS Interval. An Echocardiogram (ECG) is a test that shows a picture of the heart’s movements. It shows the heart’s four chambers and the heart valves. This test is administered to evaluate the overall performance of the heart. The patient will feel no discomfort, as this test is non-invasive.

An ECG graph is set up like a grid with small squares (They are the machines that are frequently shown on Medical Drama TV shows-SEE Figure 1). Each square on the grid is labeled with a letter of the alphabet (ABC…..JKL….QRS…XYZ). The QRS Interval is between the letters between P and T on the graph and represents the time that it takes the lower chambers of the heart (ventricles) to come together during a breathing cycle. If there is blockage in either ventricle, the longer the QRS Interval; thus signifying a slow heart beat.


Figure 1

There are four chambers of the heart; the left and right atriums (upper chambers) and the left and right ventricles (lower chambers). Conventional pacemakers are used to correct slow heartbeats through wires (leads) that send electrical impulses to 1 or 2 chambers of the heart (generally the right atrium and the right ventricle).

If a patient is diagnosed with advanced Heart Failure (Class III or IV-see Classifications of Heart Failure) their surgeon my suggest implanting a Biventricular pacemaker rather than a standard pacemaker. If an ECG determines that there is not a sufficient amount of blood pumping from the left ventricle, a BiV pacemaker may be an alternative.

The difference with a BiV pacemaker is that, in addition to the electrical leads being attached to the right atrium and the right ventricle, a third lead will be placed in the vein that controls the blood flow action of the left ventricle (the coronary sinus vein). The BiV device transmits electrical signals through the leads to the heart muscle. The electrical signals will force the lower chambers (ventricles) to contract simultaneously. This synchronized contraction is meant to improve cardiac function.

As stated earlier, advanced Heart Failure patients are candidates for a BiV pacemaker. If a physician has determined that a patient is experiencing severe Heart Failure symptoms (see-Symptoms of Heart Failure), has a history of Heart Failure or heart attack, or is taking Heart Failure medications, they may be eligible for placement of a Biventricular Pacemaker.

MITRAL VALVE SURGERY

Robotic Mitral Valve surgery is another option if your physician determines that you are a candidate for minimally invasive surgery. The Mitral Valve is the valve that closes the orifice between the left atrium (LA) and the left ventricle (LV) during breathing. The surgery is used to treat a narrowing or leakage in the Mitral Valve.

When the Mitral Valve opens blood flows into the left ventricle. It then closes to keep blood from leaking back into the lungs so that blood may flow freely throughout the body. If the valve is damaged or becomes narrow, surgery may be an option. But, not all Mitral Valves can be repaired. An echocardiogram, a non-invasive test, can help your physician determine the extent of damage to the valve.

During valve surgery a catheter with a balloon on the end is used to repair the valve. Once inside the valve, the balloon is expanded causing the valve to stretch.

If a patient qualifies for a minimally invasive surgery, as the ones mentioned above there are definite benefits. Aesthetically speaking, there will be a smaller incision which results in a smaller scar. But physically speaking the benefits may include less bleeding and less pain and a lower risk of infection. There will probably be less time spent in the hospital and less time recovering.

As with all heart conditions it is imperative to consult your physician and your surgeon to ensure that you receive the right treatment.

This information is not intended to replace the advice of a doctor. The Heart Failure Center does not provide medical advice, diagnosis or treatment. The contents of The Heart Failure Center Site ("Content") are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or any symptoms you may have. If you think you may have a medical emergency, call your doctor or 911 immediately.

 

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