Cardiac Surgery
10. MAZE / ATRICURE SET
Open Heart Concomitant ProceduresDuring elective open heart surgical procedures such as bypass or valve surgery, cardiothoracic surgeons use the AtriCure bipolar ablation system to treat patients with atrial fibrillation. Surgeons use this system to create sets of lesions that may vary depending on the length of time a patient has been diagnosed with AF and its classification. Patients who have been diagnosed with AF for a longer duration and have more continuous AF generally receive more ablation treatment than patients who have been diagnosed with AF for a shorter duration or who have intermittent AF.Sole Therapy, Minimally Invasive Treatment for Atrial FibrillationFor patients with AF who do not require an open heart surgical procedure, there is a sole therapy, minimally invasive treatment (AtriCure)for AF. In order to perform this minimally invasive treatment, surgeons insert a lighted scope and other instruments through small incisions in the patient’s chest. Surgeons report that the entire procedure takes approximately two to three hours and that the typical recovery time is approximately three to four days. The Minimally Invasive AtriCure Procedure consists ofPulmonary Vein IsolationAtriCure’s Isolator® ENDO Ablation clamps are specifically designed to electrically isolate the pulmonary veins to treat atrial fibrillation.
Removal of the Left Atrial Appendage
One of the key potential advantages of the sole therapy, minimally invasive treatment is the excision/excising of the left atrial appendage. In patients with atrial fibrillation, 90% of all atrial thrombi occur in the left atrial appendage. Dissection of the Ligament of MarshallThe Ligament of Marshall (LOM) is a remnant of a vein that was required during fetal development, but is no longer needed. In the AtriCure Procedure, the ligament is dissected, removing a potential cause of atrial fibrillation.
11. ASD (Atrial Septal Defect) Repair
Atrial septal defect is an abnormality of the atria, the upper chambers of the heart wherein the wall between the right and left atria does not close completely. This is a congenital defect (present at birth).
In fetal circulation, there is normally an opening between the two to allow blood to bypass the lungs. This opening usually closes about the time the baby is born. If the ASD is persistent, blood continues to flow from the left to the right atria which is called a shunt.
Treatment
ASD may not require treatment if there are few or no symptoms, or if the defect is small. Surgical closure of the defect is recommended if the atrial septal defect is large or if symptoms occur.
Expectations
When the atrial septal defect is small or moderate, a person may live a normal life span without symptoms. Larger defects may cause disability by middle age because of increased blood flow and shunting of blood back into the pulmonary circulation.
12. VSD (Ventricular Septal Defect) Repair
Ventricular septal defect is when there is one or more holes in the wall that separates the right and left ventricles of the heart. It is one of the most common congenital heart defects.
Before a baby is born, the right and left ventricles of its heart are not separate. As the fetus grows, a wall normally forms to separate these two ventricles. If the wall does not completely form, the hole remains which is known as a ventricular septal defect, or VSD. The baby may have no symptoms, and the hole may eventually close as the wall continues to grow after birth.
If the hole is large, then too much blood will be pumped to the lungs, leading to congestive heart failure. These babies often have symptoms related to heart failure and they may need medicine to control the symptoms and surgery to close the hole.
In adults, interventricular septal defects are a rare, but serious complication of heart attacks. These holes are related to the heart attack and are not a result of a birth defect.
Treatment
No treatment is usually needed if the defect is small. However, the baby should be closely monitored by a doctor to make sure that the hole eventually closes properly and signs and symptoms of heart failure do not occur.
If symptoms continue despite medication, surgery to close the defect with a Gore-tex patch is needed.
Expectations
Small defects will usually close on their own. However, for those defects that do not spontaneously close, surgical repair normally brings good results. Complications may result if a large defect is not treated.
Complications
- Congestive heart failure
- Infective endocarditis (bacterial infection of the heart)
- Aortic insufficiency (leaking of the valve that separates the left ventricle from the aorta)
- Damage to the electrical conduction system of the heart during surgery (causing arrhythmias)
- Delayed growth and development (failure to thrive in infancy)
- Pulmonary hypertension (high blood pressure in the lungs) leading to failure of the right side of the heart
13. Patent Ductus Arteriosus (PDA) Repair
Patent ductus arteriosus is the abnormal blood circulation between 2 of the major arteries near the heart. It is a heart problem that usually manifests itself after birth in some babies. Before birth, the aorta and the pulmonary artery, 2 of the major arteries, are normally connected by a blood vessel, the ductus arteriosus. This vessel should close within the first few days of life. However, in some babies, the ductus arteriosus remains open. This puts a strain on the heart and can cause breathing or growth problems. Surgery may be needed to close it.
Procedure
Surgery to repair a patent ductus arteriosus involves patching or sewing shut the abnormal opening. This can be done through an incision in the side of the chest or by catheterization. In cardiac catheterization, a thin tube (catheter) is inserted into a blood vessel in the groin and threaded up to the heart. Through the catheter, a small plug or coil may be deployed to close the ductus arteriosus. In surgery, the ductus is closed with a metal clip.
14. Modified MAZE Procedure
This procedure is designed to eliminate atrial fibrillation. The availability of newer devices using radio frequency or microwave energy to ablate areas in the pulmonary veins, left atrium and right atrium has simplified this operation and has gained wide acceptance among cardiologists and cardiovascular surgeons.
15. SVR – Surgical Ventricular Restoration
This is an operation to treat congestive heart failure caused by myocardial infarction (heart attack). Following a heart attack, a scar or an aneurysm may develop resulting in an enlarged heart which may lead to congestive heart failure. The goal of this procedure is to restore the heart to a more normal size and shape, thereby improving function. The SVR procedure is usually combined with coronary artery bypass grafting (CABG) to ensure optimal blood supply to the heart. This operation works very well for patients with heart failure secondary to ischemic dilated cardiomyopathy.
16. Mitral Valve Repair
Mitral valve repair is an open heart procedure performed by cardiothoracic surgeons to treat stenosis (narrowing) or regurgitation (leakage) of the mitral valves. Most often, repair is done to correct a leaking valve. It is definitely safer and has a better long term result than replacement. The mitral valve is the "inflow valve" for the left side of the heart. Blood flows from the lungs, where it picks up oxygen, and into the heart through the mitral valve. When it opens, the mitral valve allows blood to flow into the heart's main pumping chamber called the left ventricle. It then closes to keep blood from leaking back into the lungs when the ventricle contracts (squeezes) to push blood out to the body.
There are two repair techniques: valvuloplasty and annuloplasty.
Valvuloplasty is a technique aimed at making sure the flaps of the valves (or leaflets) close properly, preventing blood from backing up into the atrium. In the healthy heart, blood flows from the upper chamber (atrium) to the lower chamber (ventricle), and from the ventricle to the body.
Commissurotomy is a special form of valvuloplasty. Commissurotomy is used when the leaflets of the valve become stiff and actually fuse together at the base, which is the ring portion (or annulus) of the valve. Sometimes a scalpel is used to cut the fused leaflets (commissures) near the ring, which may help them open and close better. In other cases, a balloon catheter, similar to a catheter used during angioplasty, is inserted into the valve. The balloon is inflated, splitting the commissures and freeing the leaflets to open and shut fully. Unlike other valvuloplasty procedures, this procedure can be done in the cardiac catheterization lab, and the chest does not have to be opened.
Annuloplasty is a technique aimed at repairing the fibrous tissue at the base of the heart valve (the annulus). Sometimes, the annulus becomes enlarged, which enables blood to back up into the atrium. To repair this, sutures are sewn around the ring to make the opening smaller. This creates a purse string effect around the base of the valve and helps the leaflets meet again when the valve closes.
Sometimes when repairing the annulus, it is necessary for the surgeon to implant an annuloplasty ring. A ring is used to correct a problem, provide support for the valve, and reinforce other repair techniques or any combination of these.
