Surgery

Bypass surgery, also known as coronary artery bypass surgery (CABG) or Aorta Coronary Bypass (ACB) is one of the most frequently performed heart procedures in the United States.  The surgery treats a disease called coronary atherosclerosis (blockages in the coronary arteries), which if not treated can lead to a heart attack.  Blockages in the coronary arteries can be detected based on patient symptoms, an abnormal EKG, abnormal stress test or other non-invasive tests on the heart.  The presence of blockages must be confirmed by a heart catheterization, in which contrast dye is injected into these arteries to determine the location and extent of blockages prior to treatment.

              Bypass surgery is one method used to treat blockages, the others being medicine or stents.  Deciding which procedure is best for each patient is complicated and is usually based on thorough knowledge of anatomic factors, patient factors and carefully studied data.  The goal as always is to provide the best solution for each individual and may require collaboration between many specialists.

              Bypass surgery uses either arteries or veins taken from the body to reconstruct blood flow to the heart muscle, creating a bridge around the area where the vessel is blocked.  As each patient is unique regarding the size and configuration of these vessels, as well as the location of blockages and other health issues. Your surgeon and cardiologist will evaluate each case and determine which procedure you may benefit from.

              Traditional on pump bypass surgery

                             This method uses the heart lung machine to temporarily stop the heart to perform the surgery.  This allows excellent visualization of the arteries of the heart and allows the procedure to be performed in a “bloodless” and still manner.  The most frequently performed method used in the United States, on pump bypass surgery has the advantages of precise control of the heart, stability of vital signs and the ability to perform multiple procedures on the heart in one setting if necessary.

              Beating heart off pump bypass surgery

                             Pioneered decades ago with a resurgence in popularity, off pump or beating heart surgery allows the blockages to be grafted without stopping the heart or interrupting the blood flow to the body.  Advantages could include less blood loss, less risk of stroke and kidney damage, as well as reduced inflammation after the surgery.

At the UT Health East Texas Heart and Vascular Institute, our surgeons are experienced in both types of surgical methods, allowing us to tailor each surgical approach to the patient’s needs.

The human heart contains four valves, which are flaps of tissue designed to allow blood to flow in one direction.  Each of the four heart valves (tricuspid, pulmonary, mitral and aortic) separates each chamber of the heart from the next.  Although incredibly efficient, problems can arise with each valve.  Most commonly, the main problems are with the valves not opening enough (stenosis) or not closing all the way (regurgitation or insufficiency).  These problems can lead to excessive strain on the heart and pressure in the heart chambers to be elevated.

              The most common symptoms patients develop include shortness of breath, fatigue, swelling, abnormal heart rhythms or dizziness.  Longstanding valve conditions can weaken the heart muscle and lead to congestive heart failure.

              Evaluation can detect a murmur, which is the sound the blood makes during turbulent flow.  The most reliable test to confirm a heart valve condition is an ECHO, which is a non-invasive test that uses sound waves to generate pictures of the heart and measure the flow of blood within the heart.

              For more than a decade, UT Health East Texas has offered a dedicated heart valve center that brings providers from different backgrounds to care for these sometimes complicated disorders.  In addition to screening hundreds of patients with heart valve disorders, the Heart Valve Center has been on the forefront of offering patients the most up to date treatments for these issues.

Valve Repair

This is a surgical procedure that involves correcting a leaking valve by reshaping it.  Depending on what is wrong with the valve, the surgeon my remove a portion of the leaking valve, close a gap using suture, change the shape of the valve using an implantable ring or re-support a portion of the valve using suture.  In many cases, valve repair is superior to valve replacement because it uses the body’s own tissue, allowing the valve to function longer and avoid the need for anticoagulants.  In order to be a candidate for valve repair, the valve tissue must still be healthy and pliable.  This is frequently the case in earlier stages of valve disease.

 

Minimally invasive valve repair

This is when valve repair is performed through a “minimal access” incision.  If feasible, it can lead to less postoperative pain, faster recovery and avoidance of complications associated with larger incisions. The UT Health East Texas Heart and Vascular Institute has been a pioneer of this innovative procedure and has the most experience in East Texas.

Valve replacement

In some patients, the valve damage is not repairable, leading the surgeon to choose to implant an artificial heart valve.  Fortunately, valve replacement can be a durable solution, offering lifetime freedom from structural problems of the heart.  These premanufactured valves act similar to normal valves allowing blood through and preventing blood from travelling backwards.  You and your surgeon will discuss the advantages of different types of valve options, including mechanical valves which use metallic leaflets or biologic valves made of animal tissue.  Both options are available and are recommended based on age, patient preference and other factors which may affect valve longevity.  In addition, minimally invasive valve replacement techniques allow quicker recovery and less pain.

The UT Health East Texas Heart and Vascular Institute has extensive experience in the use of many types of artificial valves and base our recommendations on studied data regarding valve function long term outcomes.  We are proud to offer some of the most innovative (On-X mechanical valve requiring less long term anticoagulation) and best durability (Edwards Insipiris Resilia uses advanced tissue) valves on the market. 

 

Transcatheter valve replacement/repair

              Advancements over the past decade has allowed some patients with heart valve disorders a truly game changing option.  Patients with aortic stenosis are frequently treated by TAVR (transcatheter aortic valve replacement).  In this procedure, the new artificial valve is able to be placed within the damaged heart valve via a catheter based approach, eliminating the need for an incision.  Advantages of this approach include minimal pain, shorter (1-2 day) hospital stay and return to full activity in less than one week.  The surgeons and cardiologists at UT Health East Texas have been on the forefront of this ground breaking procedure and have one of the largest experiences in East Texas.

              For patients with leaking mitral valve disorders, our team has extensive experience with MitraClip therapy.  In this revolutionary procedure, mitral regurgitation can be treated via a vein in the groin by placing a small clip on the leaking portion of the valve, thus restoring the correct direction of blood flow in the heart.

Disorders of the vessels coming from the heart include aneurysms, tears and abnormal communications to other vessels.  Not uncommonly, aneurysms of the aorta can be noticed in patients whom have imaging done for another reason.  Because of the proximity to the heart and potential need to interrupt blood flow to other organs during repair, cardiac surgeons play a vital role in the management of these disorders.  Our cardiac surgeons, cardiologists and vascular surgeons have developed an extensive program to care for patients with these disorders including surveillance, surgical and endovascular treatments.

Although rare, tumors, clots and infections of the heart can cause life-threating symptoms.  Prompt diagnosis and treatment however, can lead to normal recovery and resolution of symptoms.  The most common cardiac tumors are Myxomas, which are benign tumors usually located in the atria.  If found early, many tumors can be removed via minimally invasive surgical approaches. 

Diseases of the sac around the heart are infrequent but when present, can limit cardiac function.  Common conditions include pericardial fluid buildup around the heart, tumors that have spread to the heart sac or rarely inflammatory diseases of the pericardium.  A multidisciplinary approach including cardiac imaging, fluid management and surgery can resolve or improve patients with these disorders.

If a patient’s heart function deteriorates due to a heart attack or disease of the heart muscle, the rest of the body can suffer due to a lack of blood flow.  When medications are insufficient to support blood pressure and heart function, temporary and permanent pumps can be placed in the heart to support a patient until are more definitive solution can be devised.  The physicians at UT Heath East Texas are experienced at both placing these heart pumps and caring for the sometimes critical problems that can arise in the acute setting of these diseases.  Our dedicated cardiovascular intensive care unit (CVICU) provides 24/7 care for patients with life threating cardiovascular shock using cutting edge technology and critical care nurses with years of experience.