Surgical and Other Invasive Procedures for Heart Attack
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Surgery for heart attack does not cure the heart per se. Instead, the various surgical procedures listed here restore and/or improve blood flow to the heart muscle, which helps the heart perform better.
Coronary Artery Bypass Grafting (CABG)
A ]]>coronary artery bypass graft]]> (CABG) is performed to re-establish blood flow to the heart muscle by moving blood vessels from other parts of the body to the heart, providing a route around the obstructed coronary (heart) arteries. It is often recommended when there is a severe blockage in the main artery or obstructions in several arteries.
The surgeon cuts through the skin and breastbone, opens the chest, and connects the heart-lung machine. This machine pulls blood from the heart, adds oxygen to it, and pumps it back into the bloodstream while the surgeon is working on the heart and/or lungs.
To harvest a blood vessel to graft onto the heart, the surgeon may detach an artery from the chest wall, or make one of several incisions in the leg and remove a section of vein from the leg. Sometimes two surgeons work together, one on the chest and one on the leg to remove a vessel for grafting. The harvested vessels are connected (grafted) to the blocked arteries above and below existing obstructions.
When the grafts are in place, the blood (and thus the body temperature) is rewarmed to normal temperature, and therapeutic electric shocks are used to start the heart beating again. The heart-lung machine is disconnected, the breastbone wired together, and the chest closed. The surgery normally takes between four and five hours.
Newer techniques allow the surgeon to operate on a "beating heart," avoiding the use of a heart-lung machine. While the results are encouraging, it is a relatively new procedure. Talk to your doctor about what options are available and which one might be best for you.
According to a review of 23 studies, patients who received CABG had more angina relief and less need for another, similar procedure than those who received percutaneous coronary intervention (PCI). PCI involves techniques using ]]>balloon angioplasty]]> or ]]>coronary stenting]]> . ]]>*]]>
Angioplasty (Percutaneous Transluminal Coronary Angioplasty)
]]>Angioplasty]]> is a procedure to open a blocked artery. The doctor will insert a catheter with a balloon mechanism through an artery in the groin. Once it reaches the blockage, the doctor will inflate the balloon to push the plaque toward the vessel walls, creating space in the artery and restoring blood flow. A mesh device called a stent may be inserted to hold the artery open. You will be awake and lying on your back during the procedure.
Medication to prevent additional clot formation may be given. You will be asked to lie on your back for several hours after the catheter is removed to prevent dislodging of the clot.
Implantable Cardioverter Defibrillator (ICDs)
Patients with a history of heart attack and diminished pumping function are at increased risk for heart arrhythmias including life-threatening ventricular fibrillation. Those patients may benefit from having an ]]>ICD device]]> implanted in their chests The device responds to the presence of an abnormal heart rhythm by delivering an electrical shock to jumpstart the heart and return it to a normal rhythm.
Coronary Order Brachytherapy
Radiation is sometimes used to open coronary arteries that have narrowed after stent placement.
Transmyocardial laser revascularization (TMLR) is a technique that uses laser to create small channels into a wall of heart muscle to allow new blood vessels to grow and ultimately improve blood flow.
American Heart Association website. Available at: http://www.americanheart.org . Accessed August 14, 2008.
Current Surgical Diagnosis and Treatment. 11th ed. McGraw-Hill Medical; 2002.
National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/ .
Racz MJ, Hannan EL, Isom OW, et al. A comparison of short- and long-term outcomes after off-pump and on-pump coronary artery bypass graft surgery with sternotomy. J Am Coll Cardiol. 2004;43:557.
Sharony R, Bizekis CS, Kanchuger M, et al. Off-pump coronary artery bypass grafting reduces mortality and stroke in patients with atheromatous aortas: a case control study. Circulation. 2003;108(suppl)1:II15.
Hauer RN, Aliot E, Block M, et al. Indications for implantable cardioverter defibrillator (ICD) therapy. Study Group on Guidelines on ICDs of the Working Group on Arrhythmias and the Working Group on Cardiac Pacing of the European Society of Cardiology. Eur Heart J. 2001;22:1074.
Waksman R, Weinberger J. Coronary brachytherapy in the drug-eluting stent era: don't bury it alive. Circulation. 2003;108:386.
Mukherjee D, Comella K, Bhatt DL, et al. Clinical outcome of a cohort of patients eligible for therapeutic angiogenesis or transmyocardial revascularization. Am Heart J. 2001;142:72.
Updated Outcome section on 11/7/2007 according to the following study, as cited by DynaMed's Systematic Literature Surveillance : Bravata DM, Gienger AL, McDonald KM, et al. Systematic review: the comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery. Ann Intern Med. 2007 Nov 20. [Epub ahead of print]
Last reviewed July 2008 by ]]>Michael J. Fucci, DO]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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