If your heart problem cannot be managed successfully with medicine or lifestyle changes alone, Providence St. Peter Hospital offers you the latest treatments and the expertise of the region's most skilled surgeons. The following procedures are performed regularly at our Heart Program: Beating heart surgery
Beating heart surgery, also known as minimally invasive direct coronary artery bypass (MIDCAB), is a revolutionary procedure that allows surgeons to perform a bypass procedure without stopping their patient's heart. Providence St. Peter Hospital is a regional leader in beating heart surgery, performing more than half of heart bypass procedures in this manner. What is a "bypass"?
When a blocked artery cannot be adequately opened with less-involved procedures, bypass surgery creates a "detour" around the failing artery using a healthy vein (see endoscopic vein harvesting) taken from the leg or breast. Much like open heart bypass surgery, the goal of beating heart surgery is to restore blood flow to the heart. Though it normally is difficult for a surgeon to work on beating heart, beating heart surgery is made possible by a special suction device that keeps a specific area of heart still during the operation. With beating heart surgery there is no need to halt and restart the heart, and it requires only a three to four inch incision in the chest. Typically, the beating heart surgery results in less trauma to the patient and quicker recovery time. Heart surgeons use the beating heart surgery for patients who are not good candidates for angioplasty or stent procedures, or who have tried them without success, as well as for those whose health puts them at a risk for an open heart procedure.
Endoscopic vein harvesting
Bypass surgery, whether done on a beating heart or as a traditional open heart procedure, has two parts: using a healthy blood vessel to detour around a damaged or blocked artery in heart, and actual removal of the healthy blood vessel. In the past, heart surgery patients reported more post-operation pain from their legs than from their chest, largely because the vein used in surgery traditionally was removed through an incision the length of the entire leg. The Providence St. Peter Hospital Heart Program routinely performs endoscopic vein harvesting (EVH), which requires only four small incisions in the leg. An endoscope (small, hollow tube with a camera) is used to look for and then remove the vein. This cutting-edge procedure results in minimal muscle and tissue damage and less pain and scarring than the traditional surgery. Patients are able to walk soon after the procedure, and are at relatively low risk for infection.
Cardiac catheterization procedures
The catheterization procedure most commonly used to treat rather than diagnose narrowed or blocked arteries is called percutaneous transluminal coronary angioplasty (PTCA), but is better known as balloon angioplasty. In a procedure similar to coronary angiography, balloon angioplasty involves the insertion of a small, hollow tube (catheter) into the artery at the groin or forearm that is then guided through the main artery and into the heart. Next, a smaller catheter with a balloon at its tip is inserted into the guide catheter. When the balloon catheter reaches the area of obstruction, it is inflated briefly to compress the plaque buildup and reduce the narrowing of the artery. Finally, the balloon is then deflated, leaving a wider opening, and removed. Other less common uses of catheterization to treat obstructed arteries are laser angioplasty, in which a laser obliterates the blockages, and rotoblator, in which the catheter's tiny tip is driven at high speed to break up plaque particles that are then removed through the bloodstream. Each of these cardiac catheterization procedures typically is done under local anesthesia and requires the patient to stay several hours at the hospital following surgery. Most are able to return to work after a week or so.
Stent procedures
Stent procedures are used as an alternative to, or in combination with, balloon angioplasty. The stent, a wire mesh tube, first is collapsed to a small diameter. It is placed over an angioplasty balloon catheter, which is inserted into the artery and threaded to the area of blockage. The balloon is inflated and the stent expands and locks into place, pressing against the artery wall and holding it open permanently.
Open heart surgery
Though minimally invasive procedures have become an important part of heart care, they aren't the answer for everyone. In some cases, your physician may decide that your condition would be best treated with an open heart procedure. At Providence St. Peter Hospital Heart Program, the most common open heart procedure we perform is bypass surgery. Much like beating heart surgery, during open heart bypass surgery the surgeon creates a "detour" around the failing artery using a healthy vein (see endoscopic vein harvesting) taken from the leg or breast. Open heart surgery always is done under general anesthesia. The surgeon must open the chest to expose the heart. The heart temporarily is stopped and a heart-and-lung machine takes over the work of the heart and lungs for the duration of the surgery. While the heart is still, the surgeon has a clear and motionless view of the heart, and can work on grafts that will reroute the blood flow around the damaged artery. After the operation is over, the heart-lung machine is slowed down and the heart gradually starts beating and regaining its strength. A six- to seven-day stay in the hospital is typical for open heart surgery patients, usually including a day or two in the special cardiac care unit.
|
