Heart Defect Surgery: Information & Specialists in Heart Defect Surgery

The coronary arteries supply the heart muscle with oxygen and nutrients. Atherosclerosis can cause these arteries to gradually narrow. As a result, less blood can flow through them. As a result, parts of the heart muscle receive insufficient blood flow and can be damaged over time (coronary heart disease).

If the coronary arteries become completely blocked, the heart muscle dies. This is known as a heart attack.

Doctors try to prevent this life-threatening situation for the patient. For example, blood-thinning medications may be prescribed. Balloon angioplasty is another option for widening narrowed vessels.

However, if these methods are no longer effective, cardiac surgery is performed. A bypass allows the narrowed sections of the vessels to be bypassed. In other words, an alternative “route” for blood flow is created.

Performing Bypass Surgery

The procedure is performed under general anesthesia. The surgeon makes a 15 cm incision at the level of the sternum and then cuts it open down the middle. The heart is now exposed.

Since the surgery cannot be performed on a beating heart, it must be stopped. A heart-lung machine maintains circulation during this time.

The surgeon uses a section of vein taken from the leg or forearm to create a bypass around the narrowed coronary arteries. This restores the blood supply to the heart.

At the end of the procedure, a drain is inserted to remove wound fluid. The surgeon then sutures the sternum closed.

The patient is monitored in the intensive care unit for several days.

Prognosis After Bypass Surgery

Bypass surgery is now considered a standard procedure in cardiac surgery. However, it does not cure the underlying conditions. Rather, it addresses the symptoms of atherosclerosis. Atherosclerosis itself persists, and further narrowing of the blood vessels may occur.

Therefore, the patient must also play an active role in the treatment of atherosclerosis. This includes, for example, adopting a healthy lifestyle with a balanced diet and sufficient exercise.

If the patient successfully makes these dietary and lifestyle changes, they can prevent the progression of atherosclerosis. In that case, bypass surgery can successfully alleviate heart symptoms for several years.

If atherosclerosis progresses, the bypass grafts may also narrow over time. In principle, additional bypass surgeries are possible at a later date. However, each additional open-heart procedure carries an increased risk of infection and complications.

The heart valves are located

• between the atria and ventricles, as well as
• in front of the pulmonary artery and
• in front of the aorta.

If their function is impaired, backflow of blood or blood congestion occurs. This can lead to further heart damage.

The goal of cardiac surgery for valve defects is to repair or replace the heart valves. Only when the heart valves function properly can a person lead a normal, healthy life. 

In most cases, the surgeon can only decide during the operation whether a repair is possible. Otherwise, heart valve replacement is the better alternative.

For heart valve replacement, the options are generally biological or artificial heart valves.

A biological valve replacement typically remains functional for 10 to 15 years. An artificial valve remains functional for life. However, it requires lifelong use of blood thinners.

The choice of valve type is made in close consultation between the Center for Cardiac Surgery and the patient. It depends

• the patient’s age,
• any comorbidities that may pose a risk during surgery, and
• the type of heart valve disease.

For younger heart patients, doctors tend to prefer an artificial heart valve. Otherwise, they would have to undergo another surgery if the replacement valve fails—and this could happen several times over the course of a few decades.

For older patients, the longevity of the replacement valve is not as critical. In return, they do not have to take blood-thinning medication.

After a successful operation, the patient’s physical endurance improves in the vast majority of cases. Some of their former physical capacity is restored.

The heart has its own pacemaker cells that control its rhythm. However, these specialized cells can be disrupted by disease or infection. When this happens, the heart loses its rhythm. Pacemakers take over as soon as the heart’s own electrical impulse fails to occur or is triggered too late.

Cardiac surgery has made significant advances in treating conduction disturbances in the heart’s conduction system. Pacemakers now function for several years before their built-in batteries run out.

The procedure is standard practice at many cardiac centers and can be performed on an outpatient basis under local anesthesia.

A probe is inserted endoscopically into the ventricle, where it measures the heart rate. The pacemaker itself is often located below the collarbone. It processes the signals from the probe and responds with its own electrical impulses to synchronize the heartbeat.

In cases of sudden cardiac death, ventricular fibrillation occurs unexpectedly, particularly in older adults. This is followed by circulatory collapse, and the patient dies shortly thereafter. There is hardly any time to act.

People

• who have already suffered a heart attack or
• suffer from life-threatening arrhythmias, including ventricular fibrillation,

are at increased risk of dying from sudden cardiac death. Cardiac surgery can help restore the heart’s normal rhythm in an emergency.

During an outpatient cardiac surgery procedure, a sensor and a metal coil are implanted in the ventricle. A pacemaker is placed beneath the collarbone. The procedure to implant the defibrillator is performed under local anesthesia. It is usually done on an outpatient basis.

In the event of cardiac arrhythmias, the metal coil generates a strong electrical impulse. This forces the heart back into its normal rhythm. In this way, the defibrillator prevents circulatory collapse and thus the patient’s death.

Resynchronization therapy is currently the only available treatment for heart failure (cardiac insufficiency).

The system consists of three leads and a pacemaker. The leads are implanted in the right atrium and in each of the ventricles. There, they control the heart’s muscle contractions.

Cardiac catheters are used to implant the leads. Open-heart surgery is not required for this procedure. It is a “keyhole procedure” in which the doctor creates an opening in the blood vessels to insert the catheter. As a result, patients regain mobility quickly, and pain can be minimized.

This procedure is usually performed under local anesthesia and can be completed within 90 minutes.

Cardiac surgery also offers options for treating life-threatening atrial fibrillation.

Atrial fibrillation carries the risk

• of blood clots forming and
• insufficient blood ejection into the circulatory system.

Blood clots can block blood vessels, including the coronary arteries, which can lead to embolisms or heart attacks.

The goal of cardiac surgery for atrial fibrillation is therefore to deactivate the “affected” areas of the atrium. Various procedures using

• radiofrequency,
• cryotherapy,
• ultrasound, or
• microwaves.

The heart’s “pacemaker cells,” which have lost their rhythm, are selectively destroyed. This prevents atrial fibrillation from recurring.

In some cases, standard treatment using pacemaker technology is not possible. There are also special considerations for children and adolescents due to the body’s growth processes. Modern cardiac surgery has developed specialized cardiac rhythm surgery procedures for these cases.

In some patients, access via the venous system cannot be established. Consequently, a lead cannot be inserted into the ventricle. In these cases, the leads and pacemaker can be implanted externally on the heart muscle.

Normally, the pacemaker is implanted in the shoulder area near the heart. For some people, however, it is too large. This mostly affects children and particularly petite individuals. In such cases,

• restricted shoulder mobility or
• a cosmetically noticeable “hump” in the front of the shoulder area.

In these cases, the pacemaker must be implanted in an alternative location. The pacemaker is also implanted using a minimally invasive technique.

Patients suffering from heart failure also benefit from a very new procedure in cardiac surgery: cardiac support via probes. In this procedure, cardiac probes are inserted into the ventricles.

They emit a pulse that forces the heart muscle to contract more strongly. This increases the heart’s pumping power, and patients experience a short-term improvement in their physical performance.

Open-heart surgery is not the only method of cardiac surgery. In recent years, non-invasive cardiac surgery has become increasingly common. In these cases, opening the chest is not necessary; the procedure is performed endoscopically. This is the case, for example, with

• heart valve repairs or
• septal defect surgeries

.

The endoscope and other instruments are inserted into the heart through a very small incision.

The advantages of this method include

• a barely visible surgical scar,
• faster recovery after the procedure, and
• significantly less pain, since, for example, the sternum remains intact.

Heart transplantation—that is, the implantation of a donor heart—is the last resort in cardiac surgery. It is performed when no other treatment options can save the heart.

Heart patients need a suitable donor heart for the transplant. Donor organs are rare, so the wait can be very long.

But even with a “new” heart, transplant recipients must follow certain rules for the rest of their lives. This includes, for example, taking medications that suppress the body’s own immune system. Otherwise, the immune system could reject the foreign heart.

Heart transplantation is the most invasive method in cardiac surgery, but it is also the pinnacle of the entire field.

The Use of an Artificial Heart

Even though artificial hearts are now available, their use is strictly limited in time. They usually support the function of only one ventricle. They are primarily intended to bridge the waiting period until the actual heart transplant.

Blood is diverted from the apex of the heart muscle through an elastic plastic tube into the pumping chamber of the artificial heart. The pumping chamber is integrated into the abdominal wall muscles below the diaphragm.

Both the filling of the pumping chamber with blood and its ejection are electronically controlled. To do this, a cable is routed through the subcutaneous fatty tissue from the skin and connected to a central control unit. A second plastic tube directs the blood into the aorta.

The heart and the pump operate in parallel and are, in fact, completely independent of one another.

The heart now only has to pump a small portion of the blood into the body itself. This reduces the strain on the heart. The body’s other organs receive a better blood supply and oxygenation thanks to the additional pumping capacity.

Preparation and Procedure for a Heart Transplant

Through various tests, doctors assess what needs to be considered during preparation.

• Are replacement measures necessary to maintain heart function?
• How long is the patient likely to survive with the current heart damage?
• Are there any comorbidities that would preclude a heart transplant?

If a heart transplant is the only remaining option, the patient is placed on the waiting list for a donor heart. The wait time is several months.

During the waiting period, additional problems such as shortness of breath and heart failure may develop. Therefore, close collaboration between

• the primary care physician,
• the local hospital, and
• the heart center

is vital.

A donor heart must be harvested within a few hours and transplanted into the waiting patient. The patient must therefore always be reachable during the waiting period.

Once a suitable donor heart is available, the patient must be transported to the hospital as quickly as possible.

There, everything is prepared for the upcoming surgery, and the patient is placed under general anesthesia. During the procedure, a heart-lung machine takes over ventilation and circulatory control.

The diseased heart is completely disconnected from the bloodstream and removed. The “new heart” is then implanted and literally connected to the body.

Postoperative care for this type of heart surgery begins in the intensive care unit. The medical staff monitors

• circulation,
• rejection reactions, and
• infections.

Within the first year after surgery, rejection reactions are monitored via heart muscle biopsy. Immune status and infection status must continue to be assessed regularly. In an emergency, further treatment takes place in a hospital to prevent rejection.

Conclusion and Prognosis of Heart Transplantation

Heart transplantation is intended to enable the patient to return to a normal daily life. This process is usually very gradual and can take several months. Being able to walk longer distances without shortness of breath or heart problems is a first step in this process.

Gradually, the patient will be able to actively participate in life again. Nevertheless, close monitoring is essential, especially in the first few years following heart surgery. This is the only way to respond to complications as quickly as possible.

The patient will work very closely with the hospital or heart center. Ultimately, returning to work can help complete the journey toward a self-determined life.