Today’s advances in heart surgery include the introduction of new operations for conditions not previously treatable with surgery, the development of safer and less complicated operations and improvements in patient care both in preparation for surgery and in rapid recovery following it.

The most common open-heart operation performed in the United States is coronary artery bypass surgery. Patients with atherosclerosis or hardening of the arteries, develop blockages in the arteries that carry blood to the heart—a process that leads to chest pain, also known as angina, and to heart attacks. Coronary artery bypass surgery has been found to be very effective in improving the blood supply to the heart, thereby relieving chest pain, reducing heart attack, and allowing patients to live longer, more active lives.

Most coronary artery bypass operations (CABG) are done using the heart-lung machine. Veins from the legs are used to reroute blood around coronary artery blockages. By the 1980s, however, it was apparent that mammary arteries from the chest wall and forearm arteries last longer than vein grafts. Nearly all CABG operations now use a combination of arteries and veins. Many patients successfully undergo “redo” operations, and in selected patients CABG can now be done through small incisions and without the heart-lung machine. The number of CABG cases has declined because of better medical care and the use of stents and angioplasty which cardiologists perform in the catheterization lab without open-heart surgery. Unfortunately, stents can become blocked and in general do not last as long as bypasses. In the near future, many patients may receive a combination of bypass grafts and stents at the same time.

The human heart contains four valves whose function is to keep blood moving smoothly and in one direction through the different chambers. These heart valves may become narrowed so that the blood has trouble getting across them, or they may develop leakage so that blood goes in the wrong direction. When the damage to heart valves is severe enough, they need to be either repaired or replaced with artificial valves. All the artificial valves, however, have a tendency to wear out, or to develop blood clots on their surfaces so that the patient must take a powerful blood thinner. Major advances in heart-valve surgery have been the development of better and more durable valves, as well as more effective techniques for repairing the patient’s own diseased valves and avoiding the use of artificial devices.

Heart failure occurs when the heart muscle is unable to pump an adequate amount of blood to the body. This may be caused by diseases or infections of the heart muscle itself, heart-valve problems, frequent heart attacks resulting in damage to the muscle, or other conditions such as high blood pressure. Heart failure can be improved with medications, but frequently this is not adequate. In patients with terminal heart failure, heart transplantation is the best option available. The problems with it are that the procedure is very expensive, requires lifelong medications to avoid rejection and infection, and is limited by the supply of available hearts to transplant. Mechanical artificial hearts have been developed to pump blood temporarily while the patient is awaiting a heart transplant. Much work is being done to develop a total mechanical heart that can be implanted inside the body, but there does not seem to be a practical device for long-term use on the horizon. Again, the need is for mechanical parts that do not destroy blood cells, develop clots, or wear out. A major problem with the mechanical heart is the lack of a reliable, high-output power supply that can be placed inside the body and can provide enough energy to enable the artificial heart to work continuously.

Heart surgery for most cardiac conditions can be performed today with a very low rate of complications, a very high rate of survival and relief of heart symptoms leading to a more active and satisfying life. Future advancements in surgery will center on improved devices such as heart valves and less invasive procedures that give equal results with smaller incisions, shorter operations, quicker recovery and briefer hospital stays.

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