Coronary artery disease, or CAD, is the most common type of heart disease and the leading cause of death in the US for both men and women. CAD occurs when the arteries that supply blood to the heart muscle become narrow and hardened. A buildup of plaque on the inside walls of the arteries, called atherosclerosis, prevents the heart from receiving the oxygen it needs and therefore can result in chest pain or a heart attack. Over time, CAD weakens the heart muscle and can lead to heart failure and arrhythmias (irregular heartbeat).

 

Symptoms and Causes of Coronary Artery Disease
If your coronary arteries cannot supply enough blood to your heart, you may experience signs and symptoms of the disease. These symptoms can include:

● Chest pain (angina)
● Shortness of breath
● Heart attack
● Extreme fatigue with exertion

 

Atherosclerosis of the coronary artery can be caused by various factors, including:

● Smoking
● Hypertension
● High cholesterol
● Diabetes
● Sedentary lifestyle
● Obesity
● High stress
● Family history of the disease
● Increasing age

 

Coronary Artery Bypass Grafting (CABG) Procedure
Patients with severe CAD may need a Coronary Artery Bypass Graft (CABG). In this procedure, a healthy artery or vein will be taken from the body and grafted to bypass the blocked portion of the coronary artery. A new path for oxygen-rich blood to the heart muscle is created. The CABG surgery is typically an open-heart procedure and the patient is under general anesthesia. The CABG surgery is typically a 3-6 hour open-heart procedure and the patient is under general anesthesia. Your surgeon will share with you their techniques and methods for the treatment.

 

Risks of a CABG
Every surgery comes with risks, and a CABG is no different. Risks may include but are not limited to:

● Bleeding
● Infection
● Arrhythmia
● Pneumonia
● Breathing issues
● Kidney failure
● Fever and pain
● Blood clots
● Heart attack
● Stroke

Mitral valve regurgitation is when the mitral valve in your heart leaks and lets backward flow back into the heart. Mitral stenosis is a narrowing of the mitral valve, causing circulation to the main pumping chamber of the heart to be blocked. Over time, both regurgitation and stenosis can cause the heart to have to work harder to pump blood to the body and can result in heart failure. Both these conditions may require a Mitral Valve Replacement or Repair surgery as treatment.

 

Symptoms of Mitral Regurgitation and Stenosis
Signs of Mitral Valve Regurgitation may include:

● Shortness of breath
● Fatigue and weakness
● Buildup of fluid in legs and feet
● Heart palpitations
● Fast heart rate
● Lightheadedness
● Confusion
● Chest pain (angina)
● Heavy coughing
● Excessive urination

 

Symptoms of Mitral Valve Stenosis may include:

● Shortness of breath
● Fatigue and weakness
● Swelling in feet and legs
● Dizziness or fainting
● Heavy coughing
● Severe headache
● Chest pain (angina)
● Heart palpitations

 

The Mitral Valve Replacement and Repair Procedure
When the mitral valve is severely diseased it can lead to heart failure or other conditions. Depending on the condition and its severity, your surgeon will discuss with you the best plan to fix your heart issue. The most likely method for mitral regurgitation will be a mitral valve repair surgery, while a replacement is more common for those with mitral stenosis.

 

Mitral Valve Repair
In mitral valve repair surgery, patients are taken to the operating room and put under general anesthesia. Methods vary from a full open-heart procedure, to more minimally invasive techniques such as robot assisted surgeries. There are a lot of new developments in technology to aid this procedure; new devices and methods are being created to lessen the recovery time and make it more minimally invasive. The patient will be put on a heart lung machine to take over the job of oxygenating the blood while the surgeon repairs the heart. In this procedure, the surgeon may attach new pieces to the structure, but the patient is left with their original valve.

 

Mitral Valve Replacement
Mitral valve replacement surgery is typically the best option when the majority of the mitral valve is not functioning properly. This procedure is typically done as an open-heart surgery, but new minimally invasive and catheter techniques may be another option. The surgeon will discuss with you the plan for the surgery and what type of replacement valve is the best option for you; there are both tissue valve replacements and mechanical ones. The patient will be put on a heart lung machine to take over the job of
oxygenating the blood while the surgeon operates on the heart.. The old valve will be removed, and a new one will be attached.

 

Risks of Mitral Valve Replacement or Repair
The specific risks of the procedure will depend on the patient’s general health, as well as the condition and its severity. Risks may include but are limited to:

● Bleeding
● Infection
● Reactions to anesthesia
● Blood clotting
● Rejection or failure of the valve
● Need for another surgery
● Arrhythmia
● Endocarditis
● Heart attack
● Stroke
● Kidney failure

Aortic valve disease is a condition in which the valve between the left ventricle of the heart and the aorta isn’t functioning properly. The condition can be congenital or can result from other causes. Aortic valve disease includes aortic stenosis, or the narrowing of the valve that prevents it from fully opening; and aortic regurgitation, where the valve does not close properly causing backward blood flow into the left ventricle.

 

Symptoms of Aortic Stenosis and Regurgitation
Signs of Aortic Valve Stenosis may include but not limited to::

● Shortness of breath
● Fatigue and weakness
● Swollen legs and feet
● Heart palpitations
● Fainting or lightheadedness
● Chest pain (angina)

 

Symptoms of Aortic Valve Regurgitation

Signs of Aortic Valve Regurgitation may include but not limited to:

● Shortness of breath
● Fatigue and weakness
● Swollen legs and feet
● Fainting or lightheadedness
● Heart murmur
● Arrhythmia
● Chest pain (angina)
● Heart palpitations

 

The Aortic Valve Replacement Procedure
When the aortic valve is severely diseased, it can lead to many conditions including heart failure. Depending on the condition and its severity, your surgeon will discuss with you the best plan to fix your heart issue. There are new laparoscopic and minimally invasive techniques that may be available, but most often aortic valve replacements require an open-heart approach. The patient will be put on a heart lung machine to take over the job of oxygenating the blood to bypass the heart so the surgeon can repair the valve. The old valve will be removed and replaced with a new one. There are both tissue valves (can come from a pig, cow, or cadaver donor) or mechanical ones. Your physician will likely prescribe medications along with your surgery to prevent clots and infections.

 

Risks of an Aortic Valve Replacement Procedure

While this surgery typically has a high rate of success, there are risks to every surgical procedure. Some risks of the surgery may include but not limited to:

● Blood clotting
● Need for another replacement valve
● Rejection or failure of the valve
● Bleeding
● Infection
● Heart attack
● Stroke
● Reactions to anesthesia
● Arrhythmia
● Kidney failure

A transcatheter aortic valve replacement, or TAVR, is a minimally invasive procedure to replace the aortic valve due to aortic valve stenosis. This procedure is a good option for patients who cannot undergo open-heart surgery, have too poor health, or have too many risk factors. This procedure is a good option for patients in poor health or those who have multiple risk factors that would make them a poor candidate for open heart surgery. TAVR might be a good option for you if:

● Lung or kidney disease is present
● Previously replaced aortic tissue valve that needs new repair
● General health is poor
● Several other risk factors are present

 

The TAVR Procedure
The patient will be under general anesthesia. A heart lung bypass machine is typically not necessary for this procedure. During TAVR, the surgeons may access the heart either through the femoral artery in the groin, or through the chest. A catheter with a small balloon attached will be guided up to the heart and inflated between the valve to widen it and to press the replacement valve into place. When the valve is secure, the catheter is removed and the doctor will check for proper circulation. Medications to prevent blood clot or infection will likely be prescribed by your doctor. The new artificial valve will take over for the old one and provide proper blood flow through the aorta.

 

Risks of TAVR
Like all surgical procedures, TAVR does carry a risk of complications. These may include but not limited to:

● Bleeding
● Infection
● Injury to blood vessels
● Functional issues with the valve
● Heart attack
● Stroke
● Arrhythmia
● Kidney disease

A transcatheter mitral valve repair, or TMVR, is a minimally invasive procedure to repair the mitral valve due to mitral valve regurgitation. This procedure is a good option for patients in poor health or have multiple risk factors that would not make them a candidate for open heart surgery. TMVR might be a good option for you if:

● Lung or kidney disease is present
● Previously replaced aortic tissue valve that needs new repair
● General health is poor
● Several other risk factors are present

 

The TMVR Procedure
During the procedure, your surgeon will access the femoral artery through an incision in the groin, through which a catheter will be threaded and placed into the heart. Once the catheter is properly placed into the mitral valve, a device called MitraClip will be deployed onto the leaky part of the valve. This clips the defective part of the valve closed and reduces regurgitation. Once proper blood flow is confirmed, the catheter is removed and the incision is closed. The MitraClip becomes a permanent part of the heart after this procedure to allow the correct amount of blood flow.

 

Risks of TMVR
Like all surgical procedures, TAVR does carry a risk of complications. These may include:

● Bleeding
● Infection
● Injury to blood vessels
● Functional issues with the clip
● Heart attack
● Stroke
● Arrhythmia
● Kidney disease

A cardiac lead is the wire that connects an ICD (Implantable Cardioverter Defibrillator) or Pacemaker to the heart. These two devices ensure proper heart rhythm, and so if they are not working properly or if the area is infected, they might need to be removed. Reasons for needing lead extractions may include:

● A damaged lead
● Scar tissue buildup
● Infection at the site of implantation
● Interference with blood flow
● Interference with another lead

New techniques for extracting leads involves catheter-guided lasers that can safely and effectively free the lead from scar tissue.

 

The Laser Lead Extraction Procedure
During a laser lead extraction procedure, the patient will be under general anesthesia. An incision in the chest will be made to disconnect the lead from the pacemaker or ICD, then a catheter will be guided into the vein where the lead needs to be removed. A laser delivers energy that removes scar tissue around the lead until it detaches from inside the vein. The lead and the catheter will then be pulled out through the incision. Depending on the reason for the extraction, a new lead might be placed at this time. The doctor will then close the incision and check that the surgery was successful.

 

Risks of Laser Lead Extraction
Lead extraction is a complex surgical procedure with some unavoidable risks. Risks may include but not limited to:

● Damage to blood vessels
● Perforation of heart
● Bleeding
● Fluid accumulation around heart or lungs
● Swelling of arms
● Heart attack
● Stroke
● Blood clotting

An inferior vena cava (IVC) filter is a device that is placed into the inferior vena cava in order to prevent pulmonary embolism caused from a deep vein thrombosis. This means that if a blood clot breaks off from a deep vein and travels toward the lungs, it will get caught in the filter before it can reach the pulmonary artery and cause a blockage. Placement of an IVC filter is a good option for patients who cannot take anticoagulant medications (blood thinners), those who continually develop deep vein thrombosis or pulmonary embolism, or those who have large clots in the inferior vena cava or iliac veins.

 

IVC Filter Placement and Retrieval
IVC filters can be permanent or temporary (retrievable). Permanent filters cannot be removed or repositioned. Patients at long term risk of embolisms usually need a permanent filter, and retrievable filters are best for patients who have short term risk and will not always need the filter. Patients are usually sedated with anesthetic rather than asleep under general anesthesia for IVC procedures. IVC filters are usually placed by a catheter through the jugular vein or through the vein of the upper leg. From here, the filter is guided up to the inferior vena cava where it is opened and secured. The small basket-like structure then can collect any clots. Removable filters have small hooks on the end so they can later be pulled out with a catheter.

 

Risks of IVC Filters
All surgical procedures come with associated risks. IVC filters can be associated with:

● Infection
● Bleeding
● Damage to blood vessels
● Bruising
● Dislodging of the filter
● Excessive clot gathering that blocks circulation
● Swelling in legs
● Allergic reaction
● Tissue growth over retrievable filter that causes it to no longer be removable