Cardiac Surgery can repair or replace malfunctioning valves, or direct blood flow around a blockage using bypass grafts. Bypass grafts require taking (“harvesting”) blood vessels from other parts of the body in order to redirect blood flow around (bypass) a blocked vessel.
Minimally Invasive Vein Harvesting
With the help of a tiny TV camera attached to a surgical device, surgeons can cleanly and safely remove sections of veins from the leg to use as bypass grafts in the heart. This is accomplished using an endoscopic device, which requires an incision of only about an inch and a half (compared to one to two feet using old procedures). Mohawk Valley Heart Institute surgeons are able to see the vein on a screen, and use this device to remove the vein, undamaged, through the tiny incision.
This technique improves patient outcomes and limits the occurrence of complications such as blood clot formation, leg infections and painful swelling.
Using Arteries For Grafts
Recent evidence shows that arterial grafts last longer than vein grafts, so MVHI surgeons are much more likely to use these better grafts in their bypass patients. At least one internal mammary artery, or if possible, a radial artery from the arm, is used.
Off-Pump Open Heart Surgery
Most open heart surgery is performed with the support of a heart-lung machine to supply blood and oxygen to the patient while his or her heart has stopped beating. Some high-risk patients that have diseased aortas or other conditions that may favor avoiding the heart-lung machine, require bypass surgery with a special device that helps immobilize only the small area of the beating heart being grafted. Hence, this method of performing open heart surgery is sometime called “beating heart” surgery.
Echocardiography During Surgery
An echocardiogram is essentially a sonogram of the heart, and offers heart surgeons a real-time view of blood flow and heart muscle and valve function during surgery. This enables them to fully understand the patient’s heart problem and manage it for the best possible results. It also allows the surgeons to evaluate their work in the operating room and make appropriate adjustments, if necessary. MVHI's Frederic Joyce, MD, a Cleveland Clinic-trained valve specialist, is the only heart surgeon in the United States who is board-certified in surgical echocardiography.
Surgical Treatment of Atrial Fibrillation: Maze
Atrial fibrillation (AF) is the most common arrhythmia (unusual speed or rhythm of the heartbeat). A disorder in the heart’s electrical system causes AF and other types of arrhythmia when rapid, disorganized electrical signals in the heart’s two upper chambers (the atria) cause them to contract very fast and irregularly (fibrillation). As a result, blood pools in the atria and isn’t pumped completely into the heart’s two lower chambers. When this happens, the heart’s upper and lower chambers don’t work together as they should. People who have AF often may not even feel symptoms, and are at a greater risk for strokes.
Our cardiothoracic surgeons have been treating atrial fibrillation with a cryoablation (removal by freezing) technique for several years as part of open cardiac procedures. The Maze procedure helps prevent AF by disrupting the disorganized signals causing the problem.
We are also now using a different technology called radio frequency ablation, which can still be used during conventional open cardiac procedures such as coronary artery bypass or the newer Minimally Invasive Mini-Maze. Mini-Maze involves only a few small incisions on the side of the chest and a tiny camera to find and ablate the tissue that causes the atrial fibrillation. This procedure does not require a large incision in the sternum, and patients do not need to go on a heart-lung machine, so they spend fewer days in the hospital, and can return to their daily activities much sooner than with an open cardiac procedure.