• Coronary Artery Bypass Grafting (CABG)/Off Pump CABG ñ with Endoscopic Vein Harvesting
• Valve Repairs/Replacement
• Maze Procedures for treatment of Atrial Fibrillation
• Minimally Invasive Maze Procedures (stand alone procedure for treatment of atrial fibrillation)
• Complex Aortic Procedures
• Vascular Procedures including Thoracoscopies and Thoracotomies
• Blood Conservation Program ñ Perfusion Services
• Pre and Post-op Blood Conservation Techniques (used to minimize use of blood products)
• State-of-the-art Equipment
• Autotransfusion (during procedures)
• Platelet Gel Therapy (to promote wound healing and regeneration)
Coronary Artery Bypass Surgery
If one or more of the coronary arteries (the vessels that carry blood to your heart muscle) are blocked, blood cannot flow to the heart muscle. In this case, the muscle may die (heart attack). Coronary artery bypass surgery creates a path for blood to flow around the blockage and prevent a heart attack.
First, a healthy blood vessel (graft) is taken for another part of the body:
• The saphenous vein, which is located in the leg;
• The radial artery, which is located in the arm;
• The internal thoracic (mammary) artery, which is located in the chest wall.
Once the graft has been attached, blood will start flowing through this new pathway to bypass the blockage.
Coronary artery bypass surgery can be done with the heart still beating (off pump) or with the heart still (on pump).
On Pump Procedure
A machine does the work of the heart and lungs during surgery. Blood is circulated through a heart-lung machine. The machine supplies the blood with oxygen and pumps it back through the body. In these cases, the heart may be stopped temporarily before the graft is attached. Your own heart and lungs start working again after the bypass is completed.
Off Pump Procedure
The heart-lung machine is not used and the heart is not stopped. This is sometimes called the "beating heart" procedure.
Endoscopic Vein Harvesting
This procedure is the actual removal of a healthy blood vessel, typically the saphenous vein in a patient's leg, which will be used to construct the bypass. Recent advances in technology have made it possible to perform this procedure through endoscopic (small incision) surgery.
An endoscope, a special instrument used to view the inside of a hollow area, is connected to a video camera and inserted through one to three small incisions in the leg. The endoscope is used to view the saphenous vein inside the leg and allows the vein to be removed with minimal stress to the leg.
This new procedure generally results in less muscle and tissue damage and therefore, may reduce the surgical trauma to the patient and decreases the incidence of wound healing complications.
• You should experience less tissue scarring;
• Your leg wounds should be less painful;
• You will be able to concentrate on your cardiac rehabilitation.
Heart Valve Surgery
The three basic ways to treat valve problems during surgery are:
1. Repair of the valve
Whenever possible, surgeons prefer to repair a valve rather than replace it. The most common kind of repair involves sewing a ring around the entrance to a valve to improve its size and shape. Another involves cutting tissue to let leaflets open or close better. When repair isn't possible, the valve will need to be replaced.
2. Replacement with a mechanical valve
Mechanical valves are made of metal or hard carbon. There are many designs. Valves can last for decades. But blood tends to stick to them, forming clots. So if you receive a mechanical valve, you have to take Coumadin, an anticoagulant medication, for life to prevent blood clots.
3. Replacement with a tissue valve
A tissue valve usually comes from a pig or a cow. Blood does not clot as easily on tissue valves. So patients getting tissue valves may need Coumadin for only a short period of time. Aspirin is sometimes used. Tissue valves may wear out faster than mechanical valves so they may have to be replaced sooner.
The Maze procedure is a surgical intervention that cures atrial fibrillation by interrupting the circular electrical patterns that are responsible for this arrhythmia. Strategic placement of incisions in both atria stops the formation and the conduction of errant electrical impulses and channels the normal electrical impulse in one direction from the top of the heart to the bottom. Scar tissue generated by the incisions permanently blocks the travel route of the electrical impulses that cause atrial fibrillation, thus eradicating the arrhythmia.
The Maze procedure has resulted in a 98.5 percent cure rate of atrial fibrillation. The Maze procedure is frequently performed with other cardiac surgical procedures such as coronary artery bypass surgery, mitral valve repair and/or replacement.
The Mini Maze is a minimally invasive cardiac procedure that has been found to be a potentially curative therapy for atrial fibrillation. Lesion lines are created to block the abnormal electrical impulses that cause an irregular heartbeat, thus allowing the heart to beat normally. Unlike other heart surgeries, the Mini Maze does not require a sternotomy (cutting the breast bone). The Mini Maze takes advantage of small incisions located between the ribs on both sides of the chest to access the beating heart. The surgeon inserts a small camera and uses a device to create the lesions necessary. This procedure usually takes a few hours to complete.
A thoracoscopy is often used to repair a collapsed lung; to examine, biopsy and stage a mass in the lung; or to drain fluid from around the lungs. During a thoracoscopy, the surgeon can look into the chest and perform the procedure through small incisions in the chest wall. The surgeon inserts a thin, tubelike instrument containing a tiny camera through one of the incisions. This camera allows the surgeon to view the lung on a video monitor. Surgical instruments are inserted through the other incisions.
During a thoracotomy, the surgeon directly views the lungs and the area around them. The surgeon then makes an incision across your side. Your rib cage is separated to expose the lungs. In some cases, part or all of the lung and nearby lymph nodes may be removed.