Presbyterian Heart and Vascular Care is fortunate to have a cardiothoracic surgical team that is among the most innovative in New Mexico, using some of the most advanced techniques for heart the incision, faster recovery, and a quicker return to work and full activity.
Our cardiothoracic surgical team also performs:
- The MAZE procedure, used to treat atrial fibrillation (an abnormal heart rhythm that causes irregular beating of the heart) by ablation (purposeful tissue destruction) of particular areas in the left atrium (the upper chamber on left side of heart).
- The transmyocardial revascularization (TMR) procedure. TMR is performed on those suffering from angina due to coronary artery disease. Small canals are made through the heart wall to the left ventricle (the pumping chamber) to increase blood flow and relieve pain.
For more information about cardiothoracic surgery services at Presbyterian Heart and Vascular Care, please call 505-563-2500, or toll free at 1-800-734-4278.
Whether present at birth, acquired over time, or resulting from an infection, heart valve disease—when one or more of the heart valves doesn't function properly—can prove fatal if not diagnosed and treated in time.
The Valve Clinic at Presbyterian Heart and Vascular Care provides integrated cardiac care for patients with a wide range of valvular heart disease conditions, including:
Our specialists use advanced imaging to diagnose and evaluate complex valve conditions to determine which surgical, minimally invasive, or nonsurgical treatment is best for you.
If you need a diagnostic study, we can perform the following tests:
Treatment options for valvular heart disease include:
Your treatment depends on your current health, past medical history, and anatomy.
Collaborative Cardiac Consultation
When you are referred to the Valve Clinic, your physician or cardiologist will continue to be involved and updated on your status. This collaborative consultation keeps the referring physician updated on your progress so the doctor can continue to provide any needed medical care once you complete your treatment.
Coronary Artery Bypass Surgery - CABG
In this surgical procedure, blocked coronary arteries are bypassed by a blood vessel graft to restore normal blood flow to the heart. These grafts usually come from the patient’s own arteries and veins located in the chest (thoracic), leg (saphenous) or arm (radial). The graft goes around the blocked artery (or arteries) to create a new pathway for oxygen-rich blood to flow to the heart.
The goals are to relieve symptoms of coronary artery disease (including angina), to enable the patient to resume a normal lifestyle, and to lower the risk of a heart attack or other heart problems.
At Presbyterian, CABG surgery may be performed in combination with other heart surgeries, when necessary, such as valve surgery, aortic aneurysm surgery or surgery to treat atrial fibrillation (an irregular heart beat).
Who is eligible to receive coronary artery bypass graft surgery?
Diagnostic tests help your heart doctor identify the location, type and extent of your coronary artery disease. To determine what type of treatment is best for you, your cardiologist, surgeon, and you will then consider the results of these tests, the structure of your heart, your age, the severity of your symptoms, the presence of other medical conditions, and your lifestyle.
What happens during the cardiac bypass surgery?
After general anesthesia is administered, the surgeon removes the veins or prepares the arteries for grafting.
The surgeon decides which graft(s) to use, depending on the location of the blockage, the amount of the blockage and the size of the coronary arteries.
- Internal mammary arteries [also called IMA grafts or internal thoracic arteries (ITA)] are the most common bypass grafts used, because they have shown the best long-term results. In most cases, these arteries can be kept intact at their origin because they have their own oxygen-rich blood supply. They are then sewn to the coronary artery below the site of the blockage. If the surgeon removes the mammary artery from its origin, it is called a “free” mammary artery. Over the last decade, more than 90% of all patients received at least one internal artery graft.
- The radial (arm) artery is another common type of arterial graft. There are two arteries in the arm, the ulnar and radial arteries. Most people receive blood to their arm from the ulnar artery and will not have any side effects if the radial artery is used. Careful preoperative and intraoperative tests determine if the radial artery can be used. If the radial artery is used as the graft, the patient may be required to take a calcium channel blocker medication for several months after surgery. This medication helps keep the artery open. Some people report numbness in the wrist after surgery. However, long-term sensory loss or numbness is uncommon.
- Saphenous (leg) veins can be used as bypass grafts. Minimally invasive saphenous vein removal does not require a long incision. One to two incisions are made at the knee and a small incision is made at the groin. This results in less scarring and a faster recovery. Your surgeon will decide if this method cardiac bypass surgery is a good option for you.
What are the Risks?
As with any surgery, there are risks involved. Your surgical risks are related to your age, the presence of other medical conditions and the number of procedures you undergo during a single operation. Your cardiologist will discuss these risks with you before surgery. Please ask questions to make sure you understand why the procedure is recommended and what all of the potential risks are.
To bypass the blockage, the surgeon makes a small opening just below the blockage in the diseased coronary artery. If a saphenous (leg) or radial (arm) vein is used, one end is connected to the coronary artery and the other to the aorta. If a mammary artery is used, one end is connected to the coronary artery while the other remains attached to the aorta. The graft is sewn into the opening, redirecting the blood flow around this blockage.
The procedure is repeated until all affected coronary arteries are treated. It is common for three or four coronary arteries to be bypassed during surgery.
Before you leave the hospital, the doctor or nurse will explain the specific bypass procedure that was performed.
During “on-pump” surgery, the heart-lung bypass machine takes over for the heart and lungs, allowing the circulation of blood throughout the rest of the body. The heart’s beating is stopped so the surgeon can perform the bypass procedure on a “still” heart.
Off-pump or beating-heart bypass surgery allows surgeons to perform surgery on the heart while it is still beating, so the heart-lung machine is not used. The surgeon uses advanced operating equipment to stabilize (hold) portions of the heart and bypass the blocked artery in a highly controlled operative environment. Meanwhile, the rest of the heart keeps pumping and circulating blood to the body.
How long does the procedure last?
The surgery generally lasts from three to five hours, depending on the number of arteries being bypassed.
After the grafts have been completed during the “on pump” procedure, the heart-lung machine is turned off, the heart starts beating on its own, and the flow of blood returns to normal.
Temporary pacing wires and a chest tube to drain fluid are placed before the sternum is closed with special sternal wires. Then the chest is closed with internal stitches or traditional external stitches. Sometimes a temporary pacemaker is attached to the pacing wires to regulate the heart rhythm until your condition improves.
You are transferred to an intensive care unit for close monitoring for about one to two days after the surgery. The monitoring during recovery includes continuous heart, blood pressure and oxygen monitoring and frequent checks of vital signs and other parameters, such as heart sounds.
Then you are transferred to a step-down nursing unit, where you stay about three to five more days.
How will I feel after surgery?
For a while after the surgery, you may feel worse than you did before surgery. This is normal and is usually related to the trauma of surgery, not necessarily to the functioning of your heart valves. It may take you from four to ten weeks to fully recover from surgery.
How you feel after surgery depends on your overall health, the results of the surgery, and the way that you take care of yourself after surgery. After recovering from surgery, most patients do feel better. To some extent, though, how you feel will depend on how you felt before surgery.
Patients with more severe symptoms before surgery may experience a greater sense of relief after surgery. Call your doctor if you are concerned about your symptoms or rate of recovery.
Full recovery from coronary artery bypass graft surgery takes about two months, or perhaps less if minimally invasive surgery techniques were used. Most patients are able to drive in about three to eight weeks after surgery.
Your doctor will provide specific guidelines for your recovery and return to work, including specific instructions on activity and how to care for your incision and general health after the surgery.
During the first few months after surgery, you will probably need to visit a few times with the doctor who referred you for surgery. You will need to schedule regular appointments with your cardiologist (even if you have no symptoms).
Your follow-up appointments may be scheduled every year, or more often, as recommended by your doctor. Your appointments should include a medical exam. Diagnostic studies (such as an echocardiogram) may be repeated at regular intervals.
You should call your doctor if your symptoms become more severe or frequent. Don’t wait until your next appointment to discuss changes in your symptoms.
Importance of Making Lifestyle Changes
Coronary artery bypass graft surgery increases the blood supply to your heart, but it does not cure coronary artery disease. To prevent future disease you will still need to decrease your risk factors by making lifestyle changes, taking medications as prescribed and following your doctor’s recommendations. Lifestyle changes include:
- Quitting smoking
- Treating high cholesterol
- Managing high blood pressure and diabetes
- Exercising regularly
- Maintaining a healthy weight
- Eating a heart-healthy diet
- Controlling stress and anger
- Taking prescribed medications as directed
- Participating in a cardiac rehabilitation program, as recommended
- Following up with your doctor for regular visits
Transcatheter Aortic Valve Replacement
Transcatheter aortic valve replacement (TAVR) is a groundbreaking, minimally invasive therapy for patients who suffer from severe symptomatic native aortic valve stenosis (AS), or narrowing of the aortic heart valve. The less invasive procedure provides a new lifesaving option for elderly or high-risk patients who could not otherwise tolerate open-heart surgery. The option also is available to those patients who are just considered high risk, in other words, individuals who could have open-heart surgery but who would not do well undergoing such an invasive procedure.
Presbyterian Heart and Vascular Care is one of a select group of medical centers across the country—and one of the first sites in New Mexico—to offer this innovative procedure to patients who qualify.
Presbyterian Heart and Vascular Care was selected to perform TAVR for a variety of reasons, including Presbyterian Hospital's advanced facilities, our surgeons' vast experience in performing aortic valve replacement, and our multidisciplinary 'heart team' approach, which is required for the effective screening of patients and subsequent TAVR surgery. This TAVR team comprises specialists from varying disciplines, including:
- Cardiothoracic surgeons
- Vascular surgeons
- Interventional cardiologists
TAVR therapy is offered using two different valves, which include the Edwards SAPIEN transcatheter heart valve, approved by the FDA in November 2011, and the Medtronic CoreValve, approved by the FDA in January 2014.
There can be multiple access sites for the transcatheter procedure. For example, the new prosthetic aortic valve is implanted via a catheter inserted in the femoral artery in the patient's thigh and advanced to the heart using a specially designed and X-ray-guided delivery catheter. Positioned and implanted with an expandable balloon system or self-deployment system, the entire aortic valve is replaced without the use of incisions and without stopping the heart.
The new treatment is not suitable for everyone. To determine whether TAVR is an appropriate therapeutic option, prospective patients must undergo an extensive series of screenings and evaluations, including:
To be referred for a TAVR therapy evaluation at Presbyterian Heart and Vascular Care, please call 505-563-2542.