Cardiovascular Interventions

Overview

Because of advances in medical technology, a wide range of cardiac interventions are now accessible to improve and protect your cardiovascular health. Cardiac intervention is the clinical name for a wide range of operations used to prevent and treat cardiovascular diseases such as heart attacks and coronary artery disease.

While cardiovascular intervention isn't always required to treat heart problems, doctors may recommend it for a variety of reasons, such as treating or preventing heart attacks and blood clots, addressing irregular heartbeats, opening blocked or narrowed arteries, repairing congenital heart problems, and replacing damaged or diseased heart valves.

Some cardiovascular problems necessitate open surgery, although many are addressed with minimally invasive procedures such as catheters and robots.

Indications for Cardiovascular Interventions

Abdominal aortic aneurysm: An abdominal aortic aneurysm is an expanded region in the lower section of the primary blood artery that feeds the body with oxygen and nutrients (aorta). The aorta is a blood vessel that goes from the heart to the middle of the chest and belly. Because the aorta is the body's major blood artery, a ruptured abdominal aortic aneurysm can result in life-threatening hemorrhage. Treatment options range from cautious waiting to emergency surgery, depending on the size and rate of growth of the aneurysm.
Aortic dissection: Aortic dissection is a dangerous disorder in which the inner layer of the body's major artery tears (aorta). Blood rushes through the rip, forcing the aorta's inner and middle layers to break (dissect). Aortic dissection is generally fatal if the blood passes through the outer aortic wall. Aortic dissection is a rather rare condition. It often affects males in their 60s and 70s. Aortic dissection symptoms might mirror those of other disorders, causing diagnostic delays. When an aortic dissection is diagnosed early and treated promptly, the chances of survival rise dramatically.
Aortic valve disease: The aortic valve is a form of heart valve disease. The valve between the lower left heart chamber (left ventricle) and the major artery to the body (aorta) does not function correctly in aortic valve disease. The aortic valve keeps blood flowing through the heart in the right direction. Blood flow to the rest of the heart and body can be affected by a damaged or diseased aortic valve.

Aortic valve disease includes:

Aortic valve stenosis. The flaps (cusps) of the aortic valve become thick and stiff, or they fuse together. These problems cause the valve opening to become narrow. The narrowed valve reduces or blocks blood flow from the heart to the rest of the body.
Aortic valve regurgitation. The aortic valve doesn't close properly, causing blood to flow backward into the left lower heart chamber (ventricle).

4. Cardiomyopathy: Cardiomyopathy is a cardiac muscle disease that makes it difficult for the heart to pump blood to the rest of the body. Cardiomyopathy may result in heart failure. Cardiomyopathy is classified into three types: dilated, hypertrophic, and restricted. Treatment varies depending on the kind of cardiomyopathy and its severity, and may involve drugs, surgically implanted devices, heart surgery, or, in extreme situations, a heart transplant.

5. Coarctation of the aorta: The aorta is the body's largest artery. It is responsible for transporting oxygen-rich blood from the heart to the rest of the body. The aorta narrows due to aortic coarctation. It makes the heart work harder to push blood through the aorta. Coarctation of the aorta is common during birth (congenital heart defect). The severity of the symptoms might range from minor to severe. The condition may not be discovered until maturity. Coarctation of the aorta is frequently associated with other congenital cardiac abnormalities. Treatment is typically effective, although the condition need lifetime monitoring.

6. Coronary artery disease: Coronary artery disease is a common kind of heart disease. The primary blood vessels that supply the heart (coronary arteries) are having difficulty delivering enough blood, oxygen, and nutrients to the heart muscle. Coronary artery disease is generally caused by cholesterol deposits (plaques) in the heart arteries and inflammation. Coronary artery disease frequently develops over time. Symptoms may go unnoticed until there is a significant blockage or a heart attack occurs. A heart-healthy lifestyle can aid in the prevention of coronary artery disease.

7. Congenital heart disease: Congenital heart disease refers to one or more structural disorders with the heart that have existed since birth. Congenital means that you were born with the disorder. Adults and children with congenital heart disease might experience changes in the way blood flows through the heart. Congenital cardiac disease might be mild in some cases. However, complicated defects might result in life-threatening problems. Advances in diagnosis and therapy, on the other hand, continue to increase survival for those with congenital heart disease.

8. Heart failure: Heart failure, also known as congestive heart failure, happens when the heart muscle fails to pump blood as efficiently as it should. When this occurs, blood frequently backs up and fluid can accumulate in the lungs, causing shortness of breath. Certain cardiac problems, such as coronary artery disease or excessive blood pressure, progressively weaken or stiffen the heart, making it unable to fill and pump blood effectively. However, heart failure can be life-threatening. People with heart failure may have severe symptoms, and some may need a heart transplant or a ventricular assist device (VAD).

Getting Ready for Cardiovascular Interventions

Follow the instructions carefully. If you are coming in from home on the day of your operation, there are some things you’ll need to do to prepare. Please follow these instructions carefully. This will help make sure things go as smoothly as possible. If you are already in the hospital waiting for your surgery, your nurse will take care of all of this for you.
Do not smoke. Please do not smoke. If you smoke, make sure that your surgeon is aware. You will be asked to stop smoking permanently at least one week prior to surgery.
Nurse Case Manager. Some people find it helpful to talk with a nurse case manager before surgery. A case manager is someone who can help you think about what your needs might be following surgery, and talk with you about making appropriate plans for your discharge and recovery.

The Day Before Surgery

Late in the day, a nurse from our office will contact you. Someone from our office will contact you the evening before your operation to inform you of the time you should come at the hospital in the morning. The final operating room schedule is frequently not known until the evening before. Please be aware that if an emergency patient has to be seen first, your procedure may be postponed.

The Night Before Surgery

Pre-operative scrub. Before surgery you can play an important part in your health. Because skin is not sterile, we need to be sure that your skin is as free of germs as possible before surgery. You can reduce the number of germs on your skin by carefully washing before surgery. You will need to shower with the special antiseptic soap called chlorhexadine gluconate (CHG) given to you in pre-admission testing or by the nurse in the hospital.

Wash and rinse your hair first using your normal shampoo.
Make sure you completely rinse the shampoo from your hair and body.
Wet your entire body.
Turn the water off in the shower or move away from the water spray to
avoid rinsing the antiseptic soap solution off.
Apply the antiseptic CHG soap solution to your body starting at the neck
and lather your entire body from the neck down.
Never use the antiseptic solution near your eyes, ears or mouth.
Gently wash your body.
Scrub the areas where the incision(s) will be located for about 3 minutes.
Avoid scrubbing you skin too hard.
Once you have completed the scrub, rinse the CHG soap off your body
completely using shower water.
Do not wash with regular soap after you have used the antiseptic CHG
soap solution.
Do not shave any areas where surgery will be performed (chest, legs).
Pat yourself dry with a clean freshly washed towel.
Do not apply any powders, deodorants or lotions.
Dress with clean, freshly washed clothes.
Do not eat or drink anything after midnight.

The Day Of Surgery

Pre-operative scrub. Shower again using the antiseptic CHG soap solution following “The Night Before Surgery” pre-operative scrub procedure above.
Pre-Surgery Do's:

Keep your stomach empty. Do not eat any food, including mints, gum or
candy, or drink any liquids. This is for your safety.
Brush your teeth. You may brush your teeth or use mouthwash without swallowing.
Only take medications you were instructed to with a very small sip of water. You should have been given instructions as to which medications to take in the morning prior to your surgery.
Please take your aspirin and beta-blocker if you have been prescribed one. Beta-blockers include medications such as atenolol (Tenormin), labetalol, metoprolol (Toprol, Lopressor), nadolol.
Do not take any diuretics. Diuretics include medications such as Lasix (Furosemide) and hydrochlorothiazide, and are also in combination medicines like Quinapril-HCT.
Do not take any ACE-Inhibitors. ACE-Inhibitors include medications such as lisinopril, captopril and enalapril and are also in combination medicines like Captopril-HCT.
If you take coumadin or plavix, you should have received instructions as to if and when to stop these medications. If you didn’t please call.
Leave your personal belongings at home. Your family may bring you a small suitcase the day after surgery. Please do not bring more than toilet articles (toothbrush, comb, etc.), your slippers and a robe. If you wear glasses, contact lenses, or dentures, you may wear them to the hospital, but please send them home with your family before you go to the preoperative area.

3. Pre-Surgery Don’ts:

Do not eat food or drink liquids. Do not eat any food, including mints, gum or candy, or drink any liquids.
Do not wear make-up or nail polish. Do not wear any make-up, nail polish, or toenail polish.
Do not wear jewelry. Please leave all jewelry, including wedding rings,

at home. Your hands and fingers will become swollen during and after

surgery. When rings are left on, they can interfere with circulation and may have to be cut off.

Types of Cardiovascular Intervention

There are many types of heart surgery. The National Heart, Lung, and Blood Institute, which is part of the National Institutes of Health, lists the following as among the most common coronary surgical procedures.

Coronary artery bypass grafting (CABG). The surgeon attaches a healthy artery or vein from elsewhere in your body to deliver blood through the blocked coronary artery in CABG, the most frequent kind of heart surgery. The grafted artery or vein creates a new conduit for blood to circulate to the heart muscle by bypassing the blocked part of the coronary artery. This is frequently done for more than one coronary artery at the same surgery. CABG is also known as heart bypass surgery or coronary artery bypass surgery.
Heart valve repair or replacement. Surgeons either repair or replace the valve with an artificial or biological valve produced from pig, cow, or human heart tissue. Inserting a catheter into a major blood artery, guiding it to the heart, then inflating and deflating a tiny balloon at the tip of the catheter to enlarge a narrow valve is one repair option.
Insertion of a pacemaker or an implantable cardioverter defibrillator (ICD). Arrhythmia, a condition in which the heart beats too quickly, too slowly, or in an irregular rhythm, is typically treated with medication first. If medicine is ineffective, a surgeon may implant a pacemaker beneath the skin of the chest or belly, with wires connecting it to the heart chambers. When a sensor identifies an aberrant cardiac rhythm, the gadget utilizes electrical pulses to regulate it. When an ICD detects a hazardous arrhythmia, it provides an electric shock to restore a normal rhythm.
Maze surgery. To redirect electrical signals down a regulated channel to the lower heart chambers, the surgeon produces a pattern of scar tissue within the upper chambers of the heart. The procedure disables the incorrect electrical signals that cause atrial fibrillation, the most frequent kind of severe arrhythmia.
Aneurysm repair. A weak section of the artery or heart wall is replaced with a patch or graft to repair a balloon-like bulge in the artery or wall of the heart muscle.
Heart transplant. The diseased heart is removed and replaced with a healthy heart from a deceased donor.
Insertion of a ventricular assist device (VAD) or total artificial heart (TAH). A VAD is a mechanical pump that supports heart function and blood flow. A TAH replaces the two lower chambers of the heart.\
Transmyocardial revascularization (TMR). A procedure used to relieve severe angina or chest pain in patients who aren't candidates for bypass surgery or angioplasty.

Transcatheter structural heart surgery is a minimally invasive alternative to open-heart surgery that is becoming more popular. This entails inserting a long, thin, flexible tube called a catheter into your heart via blood veins accessible by the groin, thigh, belly, chest, neck, or collarbone. A little incision is required. Transcatheter aortic valve implantation, which replaces a defective aortic valve with an animal tissue valve, MitraClip® insertion for mitral valve defects, and WATCHMAN® installation for patients with nonvalvular atrial fibrillation are all examples of this type of surgery.

Recovery

The initial stage of cardiac surgery recovery might last 6 to 8 weeks. When you are discharged from the hospital, you will be given post-surgery care instructions. These will assist you in physically healing and feeling better.

Wound Care

Keep the cut your surgeon made clean and dry. You should be able to take a bath or shower within a few days.

Call the doctor if you have any signs of an infection, including:

More drainage or oozing than usual.
Edges pulling apart.
Redness or warmth around the cut.
Fever greater than 100 F.

Pain Relief

Before you leave the hospital, your doctor will most likely prescribe pain medicine.

It is typical to have some discomfort around the cut and in your muscles, including itching, tightness, and numbness around the incision. However, it should not be as painful as it was before your operation.

If your bypass surgeon uses leg veins as grafts, your legs may pain more than your chest. The stiffness and discomfort will go away with time. Gentle exercise and daily routines will also aid to alleviate your leg pain and stiffness.

Activity and Driving

For the first 6 to 8 weeks, gradually build up your activity, such as doing household chores. In general, doctors recommend:

Don't stand in one place longer than 15 minutes.
Don't lift things that weigh more than 10 pounds.
Don't push or pull heavy things.

Every day, take a walk. Follow the instructions provided by your doctor or cardiac rehabilitation professional. You can climb stairs unless you've been warned not to, but it's not a good idea to do it several times a day.

Your doctor will tell you when you may drive again, which is generally around a month following surgery. It may be done sooner if the surgeon only made a little incision. It is not necessary to wait to travel as a passenger.

Diet

Healthy eating habits aid in the healing process. Your doctor will advise you on whether you should consume or avoid certain foods.

After your operation, you may not feel like eating for a while. It is usual to have a loss of appetite at initially. Try eating smaller meals more frequently.

In a few weeks, your appetite should return. If it doesn't, talk to your doctor about it.

Conclusion

If you've had a heart attack, you may have already gone through specific treatments to help you survive and identify your problem. Many heart attack victims, for example, have had thrombolysis, a technique that involves injecting a clot-dissolving chemical into a coronary artery to restore blood flow. This surgery is normally performed within a few hours following a heart attack.

If this medication is not administered quickly after a heart attack, many individuals will require coronary angioplasty or coronary artery bypass graft surgery (CABG) to increase blood flow to the muscle later on.