Procedures

The Consultant Cardiac Surgeons carry out all aspects of heart surgery including coronary artery bypass grafting, valve repair and replacement surgery, redo operations, aortic root surgery and surgical pulmonary vein isolation and arrhythmia surgery. The only exception is heart transplants.

The highly experienced Southampton cardiac surgeons perform around 2000 cases per year across the Spire Southampton Hospital and Southampton University Hospital Trust.

It is natural to feel anxious before surgery but knowing what to expect can help.

Coronary Artery Bypass Grafting (CABG)

Coronary artery bypass graft (CABG) surgery is open heart surgery to improve the blood flow to the heart. It can relieve symptoms such as angina, improve your ability to exercise and reduce the chance of a heart attack.

The coronary arteries, the arteries that supply blood to the heart, can become narrowed or blocked, restricting the supply of oxygen and nutrients.

During bypass surgery, a new blood vessel is attached to the coronary artery from the aorta, your main artery coming from the heart. The new blood vessel is called a graft and is usually created from lengths of vein taken from your leg, arteries from your arm, or by diverting the internal mammary artery from the chest wall.

Blood is re-routed through this new vessel, bypassing the narrowed or blocked coronary vessel.

Most people have three grafts done during one operation but the range may be from one to six. The body will usually function perfectly well without the blood vessels used for the grafts.

Bypass surgery does not cure coronary artery disease, so it is possible for narrowing and blockages to recur in both the grafts and other coronary vessels.

The operation usually requires a hospital stay of 5-7 days. It is performed under general anaesthesia, which means you will be asleep during the procedure, and will feel no pain.

The operation lasts approximately three hours. If leg or arm veins are being used for grafts, these will be removed (harvested) and prepared first. Your surgeon will them make an incision, typically about 25cm long, down the middle of your breastbone (sternum) and open the ribcage to reach the heart.

The heart may be temporarily stopped using medication, and blood is re-routed to a heart-lung (bypass) machine. This takes over the pumping action of the heart and lungs, adding oxygen to the blood and maintaining the circulation.

With the heart not moving, the grafts are attached. Blood is then re-directed from the machine back to your heart, and the heart is restarted with small electrical shocks.

Occasionally, CABG is performed while the heart is still beating. Your surgeon can discuss the exact technique he recommends with you.

The breastbone is re-joined using wires and the skin on your chest is sealed using dissolvable stitches. Temporary drainage tubes are put into small holes in your chest to drain blood and fluid that collects as part of the normal healing process.

After the Operation

You will be taken from the operating theatre to the ITU where you will be closely monitored for around 24 hours. While you wake up from the anaesthesia, you will be connected to machines that record the activity of your heart, lungs and other body systems.

You may have a tube in your mouth, which passes into your windpipe, and is connected to a ventilator (a machine to help you breathe). This will be removed once you are alert and can breathe by yourself. A clip on your finger will measure the oxygen level in your blood.

Once you are stable, and the medical team are satisfied with your progress, you will be able to return to your private room.

Recovering from your Coronary Artery Bypass Graft (CABG) SURGERY

Once you have returned to your room, your nurse will make you comfortable, monitor your heart rate, blood pressure and temperature at regular intervals and check your wounds.

It's normal to carry on getting oxygen through a plastic mask over your nose and mouth to help with your recovery. You will also have drips in your arms

Having Your Heart Valve Replaced OR REPAIRED

Mitral Valve Repair/Replacement

The heart has 4 valves which maintain blood flows in the correct direction. The mitral valve lies between the upper (atrium) and lower (ventricle) heart chamber of the left side. This valve has 2 curtain like leaflets which open and close with every heartbeat. Both the leaflets are attached to the heart muscles with thread like structures called chords. The mitral valve may leak if there is a problem, through disease or infection, with the chords or leaflets or if the opening of the valve is enlarged.  Alternatively, the valve may be narrowed if the leaflets become thick and stiff and prevent blood flowing through the valve opening. In both of the cases you may have symptoms such as breathing difficulty or fainting episodes and you may need surgery to either repair or replace the mitral valve.

If you have a leaky mitral valve and if it is deemed to be repairable, then generally it is fixed or repaired by replacing the chords with artificial chords, repairing any abnormality of the leaflets and also by putting an artificial ring around the valve opening to support or reduce it. 

If your mitral valve is not repairable then it will be replaced with a tissue valve (usually bovine or porcine in origin) or a mechanical valve (made from synthetic materials). Your surgeon will open the heart chamber, remove the faulty valve and sew in a replacement. The choice of whether a tissue or mechanical valve is best for you is made by yourself and your surgeon depending on your particular circumstances.

Aortic Valve Replacement

The aortic valve opens and closes to allow blood to flow out of the left upper chamber (ventricle) of the heart into the main artery (aorta) of the body. It usually consists of three leaflets. If they are damaged (through infection or disease) they either do not open properly so the valve opening is narrowed (aortic stenosis) or do not close tightly enough and the valve leaks (aortic regurgitation). Both problems mean the heart has to pump harder. A new valve will relieve this strain and aims to ease symptoms such as breathlessness and chest pain due to angina. You may also live longer as you have a reduced risk of developing heart failure. Your operation involves replacing a damaged valve in your heart with a mechanical valve (made from synthetic materials) or a tissue valve (usually bovine or porcine in origin). Your surgeon will open the aorta, remove the faulty valve and sew in a replacement. The choice of whether a tissue or mechanical valve is best for you is made by yourself and your surgeon depending on your particular circumstances.

About HEART VALVE Operations

The operation typically requires a hospital stay of 5-7 seven days and is done under general anaesthetia. This means you will be asleep during the procedure. Once the anaesthetic has taken effect, your surgeon will make a cut, about 25cm long, down the middle of your breastbone and open the ribcage to reach the heart. The heart is slowed or stopped (using medication) and blood is re-routed to a heart-lung machine. This takes over the pumping action of the heart and lungs, adding oxygen to the blood and maintaining the circulation. Your surgeon will open the heart chamber or aorta, remove the faulty valve and sew in a replacement, or repair the valve as described above. Blood is then redirected back to your heart and the heart is restarted. The breastbone is re-joined using wires and your chest is closed using either dissolvable sutures, stitches or staples. The operation usually takes about 2-3 hours.

After the Operation

You will be taken from the operating theatre to the ITU where you will be closely monitored for around 24 hours. When you wake up from the anaesthesia, you will be connected to machines that record the activity of your heart, lungs and other body systems.

You may have a tube in your mouth, which passes into your windpipe, and is connected to a ventilator (a machine to help you breathe). This will be removed once you are alert and can breathe by yourself. A clip on your finger will measure the oxygen level in your blood.

Once you are stable and the medical team are satisfied with your progress, you will be able to return to your private room.

Preparing for your Cardiac Surgery

Having a General Anaesthetic

The exact type of anaesthetic you are given depends on the procedure you are having. For most operations, anaesthesia is started with a drug injected through the cannula. Within seconds you will fall asleep and won't wake up again until after your operation is completed. This is known as the 'induction' of anaesthesia. It is also possible to induce anaesthesia with anaesthetic gases, breathed through a mask. Your anaesthetist will stay with you during the operation.

To keep you asleep, you will be given a mixture of oxygen and anaesthetic gases through a flexible tube put into your windpipe. This part of anaesthesia is known as 'maintenance'.

During the operation, you will be connected to machines that monitor the activity of your heart and other body systems. Your anaesthetist will keep a close check on your heart rate, blood pressure, and the amount of oxygen in your bloodstream.

Going Home

Before you go home, a nurse will advise you on diet and caring for the healing wound, hygiene and bathing. You will be given a contact telephone number for the hospital and follow up arrangements will be made.

After you return home

If you need them, continue taking painkillers as advised by the hospital.

If you have a mechanical valve, you will need to take anticoagulants such as warfarin daily, possibly for life.

The stainless steel wires holding your chest together are permanent, as they do no harm once your sternum (breastbone) has healed. Your breastbone will take about 12 weeks to heal. You should not drive a car or do any heavy lifting or carrying for the first 6 weeks after the operation. Stitches or staples are usually removed before you leave the hospital, by your GP, or at your follow up consultation.