Heart Surgeries

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• QWhat happens during percutaneous transluminal angioplasty (PTA)?

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  A Brigham and Women's Hospital answered

  Percutaneous transluminal angioplasty (PTA) is a minimally invasive (without a large incision) procedure used to open the blocked or narrowed femoral artery and to restore arterial blood flow to the lower leg without open vascular surgery. Generally, a PTA of the femoral artery procedure follows this process:
  

  1. An intravenous (IV) line will be started in your hand or arm prior to the procedure for injection of medication and to administer IV fluids, if needed.
  2. You will be placed in a supine (on your back) position on the procedure table.
  3. You will be connected to an electrocardiogram (ECG) monitor that records the electrical activity of the heart and monitors the heart during the procedure using small, adhesive electrodes.
  4. You will receive a sedative medication in your IV before the procedure to help you relax. However, you will likely remain awake, but sleepy, during the procedure.
  5. Your pulses below the insertion site will be checked and marked so that the circulation to the limb below the site can be checked after the procedure.
  6. A local anesthetic will be injected into the skin at the insertion site. You may feel some stinging at the site for a few seconds after the local anesthetic is injected.
  7. Once the local anesthetic has taken effect, a sheath, or introducer, will be inserted into the blood vessel. This is a plastic tube through which the catheter will be inserted into the femoral artery.
  8. A special catheter/guidewire will be inserted into the femoral artery and advanced to the site of the blockage.
  9. The proper position of the catheter may be confirmed by injecting a small amount of contrast dye into the artery, which may then be seen on a TV-like monitor.
  10. The physician will insert an angioplasty catheter and advance it to the location of the blockage. A balloon at the tip of the catheter will be inflated to open the artery.
  11. The physician may inflate and deflate the balloon several times to open the artery. In some situations, a stent (a tiny, expandable metal coil) may be inserted into the newly opened area of the artery to help keep the artery from narrowing or closing again.
  12. Once it has been determined that the artery is opened sufficiently, the angioplasty catheter will be removed.
  13. The insertion site may be closed with a closure device that uses collagen to seal the opening in the artery or with sutures. Your physician will determine which method is appropriate for your condition.
• QWhat is valvuloplasty?

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  A Intermountain Healthcare answered

  For some patients, valvuloplasty (or PTBV, for percutaneous transluminal balloon valvuloplasty) is used to treat a hardened, narrowed heart valve (heart valve stenosis). This cath lab procedure is an alternative to heart surgery.
  
  Here's how it works:
  

  1. A catheter with a deflated balloon at its tip is threaded through an artery or vein into your heart.
  2. The catheter is placed inside the narrowed valve and the balloon is inflated.
  3. As the balloon expands, it stretches the narrowed valve, separating the valve leaflets (flaps) and helping the valve move better.

  When the balloon is deflated and removed, blood flows more easily through the valve. This means your heart doesn't have to work as hard to push blood through the valve.

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• QWhat is my pneumonia risk after CABG surgery if I had a blood transfusion?

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  A The Society of Thoracic Surgeons answered

  People who receive red blood cell transfusions during coronary artery bypass grafting (CABG) surgery are at an increased risk of developing pneumonia. Pneumonia is a known risk following CABG surgery, and developing it has been shown to significantly increase a person’s risk of morbidity and mortality. Previous research has shown that one in every 20 people who have CABG develops a major infection, with pneumonia being the most common type of infection.
  
  Researchers examined data on 16,182 people who underwent CABG surgery and found a significant association between red blood cell transfusion and the occurrence of pneumonia. They also found that the risk of developing pneumonia increased with the volume of red blood cells transfused. Results showed that people receiving one or two units of red blood cells had double the odds of developing pneumonia compared to people not receiving transfusion, while those who received six units or more of red blood cells had 14-fold increased odds of developing pneumonia.
  
  The ability to store and transfuse blood is one of medicine's greatest accomplishments, but doctors are continuing to see that receiving a blood transfusion may alter a person's ability to fight infection. Doctors must remain vigilant for the onset of pneumonia and initiate therapy early in hopes of shortening its course and severity. They can also initiate preventive therapies in people who have been transfused.
• QHow will elective aortic surgery affect my quality of life?

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  A Columbia University Department of Surgery answered

  For patients who undergo aortic surgery in order to prevent problems from developing, elective surgery should provide a brief period of recovery followed by a return to quality and length of life that is identical to a person who never had an aortic problem. In the short term, certain precautions are necessary, such as protecting the breastbone while it is healing. After the initial period of healing, patients may resume a normal quality of life including exercise and active living.
  
  It should be emphasized that there are some parameters regarding what constitutes "normal" life. For example, patients who are active weightlifters can resume weight training within reason. Previous studies have demonstrated that lifting 80% of one's body weight will raise the blood pressure in the aortic root to over 300, which is extremely high and should be avoided. Weight training to 50% of one's body weight will still keep you toned and will avoid creating additional problems in your aorta. If you have a connective tissue disorder, you will need follow-up monitoring each year on the rest of your aorta. You are also at risk of developing joint issues, so be careful with contact sports.
  
  For all patients who had an elective procedure, you should approach life as if you had a perfect repair. Go live and enjoy yourself! In patients with valve-sparing operations, you will need follow-up of your repaired valve. An echocardiogram should be performed at six months and then every year afterward, so we can keep an eye on the quality of the repair. If you had an aortic valve replacement, similarly, you should have follow-up with an echocardiogram at six months and then each year.
• QWhen can I return to activities after angioplasty and stenting?

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  A SCAI answered

  Recovery from angioplasty and stenting is typically brief and many patients are able to return to work within a few days to a week after a procedure.    Always follow your doctor’s instructions about the activity level appropriate for you. A general guide is:
  
  • For the first five days, do only light activities. Walking, climbing stairs and taking care of routine activities are fine. After five days, you may resume moderate activities, but you should avoid over-exertion that leads to shortness of breath, tiredness or chest pain.
  
  • If your doctor performed the procedure from a puncture in the groin (upper leg) area, do not sit in a bath tub, go swimming, apply powders or lotions to the area, or go to a sandy beach area for about one week after the procedure.
  
  • Wait three to four weeks before lifting heavy objects or doing strenuous exercise. Get clearance from your doctor before very strenuous activity or manual labor.
  
  If you underwent angioplasty to stop a heart attack, your doctor may ask you to take a stress (treadmill) test three to six weeks after your procedure. The results of the test will help guide your doctor in recommending an appropriate level of activity for you. The results may lead to a recommendation that you enroll in a cardiac rehabilitation program, which includes an exercise program supervised by health professionals. Supervised cardiac rehabilitation programs are designed to help you build a stronger heart and reduce risk factors for more blocked arteries in the future.

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• QCan too many blood tests be harmful if I'm having heart surgery?

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  A The Society of Thoracic Surgeons answered

  Laboratory blood tests for people undergoing heart surgery can lead to the removal of too much blood, which can increase the risk of developing hospital-acquired anemia and the need for blood transfusion, according to an article in the March 2015 issue of The Annals of Thoracic Surgery.
  
  “Prior research shows that patients who receive blood transfusions during heart surgery have more infections after surgery, spend more time on the ventilator, and die more frequently—even after adjusting for how sick they were prior to surgery,” said Colleen G. Koch, MD, MS, MBA, from the Cleveland Clinic in Ohio, who led the current study.
  
  Dr. Koch and colleagues examined every laboratory test from 1,894 patients who underwent cardiac surgery from January 2012 to June 2012 at the Cleveland Clinic. The number and type of blood tests performed were recorded from the time patients met their surgeons until hospital discharge. The researchers then tallied up the total amount of blood taken from each patient.
  
  Results showed a total of 221,498 laboratory tests were performed during the study period, which equaled 116 tests per patient. “We were astonished by the amount of blood taken from our patients for laboratory testing. Total phlebotomy volumes approached 1 to 2 units of red blood cells, which is roughly equivalent to 1 to 2 cans of soda,” Dr. Koch said.
  
  More complex procedures were associated with more blood tests. For example, people having combined coronary artery bypass grafting surgery and valve procedures had the highest number of blood tests. The researchers also found that the more tests that were performed, the greater the need for transfusions. They also found that more blood was taken the longer a person was hospitalized, which increased the need for transfusions.
• QIs the heart stopped during coronary artery bypass?

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  A Dr. Mehmet Oz, MD , Cardiology (Cardiovascular Disease), answered

  

  In most coronary artery bypass procedures performed today, the heart is stopped during surgery. A heart-lung machine takes over the function of the heart and lungs during the procedure. This animation demonstrates how this process works.
  
  
  
  
• QWhat is arterial dissection?

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  A Dr. Carolyn D. Brockington, MD , Neurology, answered

  

  Arteries are pipes that transport blood around our bodies; arterial dissection is when there is a tear in the artery lining, causing blood to flow to the wrong places. Watch neurologist Carolyn Brockington, MD, explain how this can lead to a stroke. 
• QWhat can I eat in the hospital after my heart surgery?

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  A Columbia University Department of Surgery answered

  Your physician and registered dietitian will plan a diet that is tailored to your special needs. It's up to you to follow these recommendations conscientiously. Don't worry if you are unable to eat everything you are served; just try to eat something at every meal. Let your nurse know if you experience nausea; your healthcare team may be able to offer some assistance in relieving your discomfort.
• QWhat exercises can I do while recovering from heart surgery?

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  A Columbia University Department of Surgery answered

  As you recover from heart surgery, walking represents the best form of exercise for you. You should consult with your doctor before taking up more vigorous forms of activity such as swimming or biking.
  
  When you begin a walking routine, pick a time that is convenient and stick to it. Walk on level ground, in a rhythmic and even pace, letting your arms swing at your sides. Wear comfortable walking shoes and dress appropriately for the weather.
  
  Avoid exercise for up to 1½ hours after eating, and don't walk outdoors when the temperature or weather makes you uncomfortable. When the weather is severe, walk indoors at a shopping mall or at a health club with an indoor track or treadmill.
  
  If you begin to feel very tired, short of breath, or dizzy, rest immediately and reduce the distance you walk the next day. If you experience chest pain, nausea or vomiting, headache, or pain in your jaws, teeth, arms or ears, or any symptom similar to your previous angina, contact your doctor immediately and do not resume walking unless your physician approves.
  
  Most patients should be capable of walking at least 1 to 1.5 miles/day at one month after surgery.
  
  Studies have shown that people who exercise at least 30 minutes per day, five days a week remain healthier and experience fewer problems. They may also live longer.

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