Heart surgery is done to correct problems with the heart. Your provider may recommend surgery after lifestyle changes, medicines, or other procedures no longer work. Heart surgery may also be done in an emergency situation, such as a heart attack. Each year, more than 2 million people around the world have open-heart surgery to treat various heart problems.
People of all ages can have heart surgery. This topic has information about heart surgery for adults.
Depending on your heart problem, your healthcare provider may suggest different types of heart surgery. These can range from minimally invasive surgical options to open-heart surgeries that may require a longer recovery time. Before surgery, your provider may order tests to determine which type of heart surgery will work best for you.
Many heart conditions can be treated with heart surgery. For example, using surgical techniques, surgeons can:
- Repair or replace heart valves, which control blood flow through the heart
- Repair abnormal or damaged structures in the heart
- Implant medical devices that help control the heartbeat or support heart function and blood flow
- Replace a damaged heart with a healthy heart from a donor
Conditions Treated by Heart Surgery
Heart surgery can be used to treat a variety of heart problems. The type of surgery you have will depend on what heart problem you have, your age, and your overall health, as well as other factors.
The most common conditions treated by heart surgery are listed below.
An aortic aneurysm is a balloon-like bulge that occurs in the aorta, the main artery carrying oxygen-rich blood to your body. A healthy aorta has thick walls, but certain medical problems, genetic conditions, and trauma can damage or weaken these walls. The force of blood pushing against the weakened or injured walls can cause an aneurysm.
There are two main ways that surgeons can repair aortic aneurysms: endovascular aneurysm repair (EVAR) and open surgical repair. The best procedure for you will depend on the size and location of the aneurysm and your age and overall health.
- Surgeons perform EVAR using a method called cardiac catheterization. This makes it a less invasive option compared to open surgical repair. During the procedure, your surgical team will make a small cut, usually in the groin, then guide a stent graft (a tube covered with fabric) through your blood vessels up to the aorta. The stent graft then expands and attaches to the aortic walls to provide support which helps restore normal blood flow in the vessel.
- Open surgical repair is a type of open-heart surgery. During this procedure, your surgeon will make an incision (cut) in your chest to remove the aneurysm and sew a graft in its place. This graft is typically a tube made of leak-proof polyester.
Arrhythmias are problems with the rate or rhythm of the heartbeat. The heart can beat too quickly, too slowly, or with an irregular rhythm. If medicines or other procedures do not treat your arrhythmia, you may need surgery to place a device inside your body that helps control arrhythmias. These include pacemakers and implantable cardioverter defibrillators (ICDs).
- Pacemakers send electrical pulses to help your heart beat at a normal rate and steady rhythm. You may need a temporary (short-term) or permanent (long-term) pacemaker. A temporary pacemaker is normally inserted through a vein in the neck and remains outside your body. You will need surgery to have a permanent pacemaker placed in your chest or abdomen.
- ICDs are placed through surgery in the chest or stomach area, where the device can check for arrhythmias. An ICD can give off a low-energy shock that speeds up or slows down an abnormal heart rate, or a high-energy shock to correct a fast or irregular heartbeat.
Atrial fibrillation is one of the most common types of arrhythmias. Arrhythmias are problems with the rate or rhythm of the heartbeat.
To treat atrial fibrillation, surgeons can perform a type of surgery called a maze procedure (also called surgical ablation) to stop the faulty electrical heart signals that cause the heart to beat irregularly. During this procedure, a surgeon uses intense cold, heat, or a surgical knife called a scalpel to make several cuts in the upper chambers of the heart. These cuts form a maze of scar tissue. Because scar tissue cannot conduct electricity, the tissue blocks the faulty electrical signals that cause atrial fibrillation.
The procedure may require open-heart surgery, especially if it is done at the same time as another procedure, such as to repair heart valves. The maze procedure has a very high success rate in treating people with atrial fibrillation.
Coronary heart disease
Coronary heart disease is a type of heart disease that occurs when the coronary arteries cannot deliver enough oxygen-rich blood to the heart. Depending on how serious your condition and symptoms are, you may need coronary artery bypass grafting (CABG), also called heart bypass surgery.
CABG, pronounced like “cabbage,” uses healthy blood vessels from another part of the body and connects them to blood vessels above and below the blocked artery. This creates a new route for blood to flow that bypasses the narrowed or blocked coronary arteries. The blood vessels are usually arteries from the arm or chest, or veins from the legs.
CABG may be performed in one of three ways.
- Minimally invasive CABG can be performed through small cuts in the chest.
- In traditional CABG, the chest is cut open and a machine pumps your blood.
- In “off-pump” CABG, the chest is cut open, but a machine for pumping blood is not used.
Heart failure, also known as congestive heart failure, develops when your heart doesn’t pump enough blood for your body’s needs. This can happen if your heart can’t fill up with enough blood. It can also happen if your heart is too weak to pump properly.
If you have heart failure that does not improve with medicines or lifestyle changes, you may need surgery. The type of surgery depends on the cause of your heart failure.
- A biventricular pacemaker, also called cardiac resynchronization therapy, helps both sides of your heart contract at the same time to relieve your symptoms.
- An implantable cardioverter defibrillator (ICD) checks your heart rate and uses electrical pulses to correct irregular heart rhythms.
- A mechanical heart pump, such as a ventricular assist device, helps the heart pump blood through the body when it can’t pump enough blood on its own. A different pump called a total artificial heart can be placed to provide circulation and replace heart chambers (called ventricles) that are diseased or damaged.
- A heart transplant replaces a diseased heart with a healthy heart from a deceased donor. This option is typically used when other treatments do not work. Though there are risks to this surgery, survival rates are 85% to 90% one year after surgery.
Heart valve disease
For the heart to work well, blood must flow in only one direction. The heart’s valves make this possible. Healthy valves open and close in a precise way as the heart pumps blood. Heart valve repair or replacement may be necessary if something happens to the valves that leads to problems with blood flow in the heart’s chambers.
Heart valve repair surgery
Depending on the type of heart valve disease you have, there are several ways surgeons can repair a valve. For example, your surgeon may fix the flaps of your heart valve by patching tears or reattaching loose flaps. They may also use a balloon that stretches the opening of a valve and allows blood to flow through more effectively. They may also insert devices or stents to help valves that leak. The repair may be minimally invasive or require open-heart surgery.
Heart valve replacement surgery
Sometimes faulty or diseased heart valves cannot be repaired and must be replaced. Your surgeon will replace the faulty or diseased valve with either a mechanical or a biological heart valve.
Surgeons replace heart valves during open-heart surgery or with a minimally invasive procedure using a catheter — a thin tube threaded through a blood vessel to the heart. A common example of the procedure using a catheter is transcatheter aortic valve replacement (TAVR). TAVR, which is sometimes called transcatheter aortic valve implantation (TAVI), replaces the aortic valve to treat aortic stenosis, a condition in which the aortic valve is narrowed.
Like any surgery, heart surgery has risks. Your provider will talk with you about the benefits and risks of your procedure before you have surgery. Risks will vary depending on the heart problem, type of surgery, and your overall health. Some risks include:
- Arrhythmias (irregular heartbeats)
- Blood clots that can cause stroke or venous thromboembolism (VTE)
- Damage to tissues including the heart, kidneys, liver, and lungs
- Infection, fever, swelling, or other signs of inflammation at the incision site
- Memory loss and other issues, such as problems concentrating or thinking clearly, which often improve within a year after surgery
Death is also a risk of heart surgery. However, heart surgery is more likely to be life-threatening in people who are very sick before the surgery.
In general, the risk of complications is higher if heart surgery is done in an emergency situation (for example, during a heart attack). The risk is also higher if you have other diseases or conditions, such as diabetes, kidney disease, lung disease, or peripheral artery disease (PAD).