The Department of Cardiac Surgery at Boston Medical Center (BMC) has provided outstanding cardiac surgical care to our patients since the 1940s. One of the first departments of its kind in the United States, BMC surgeons offer a full range of interventions from traditional surgery to newer, minimally invasive procedures. Bypassing blocked arteries, repairing or replacing heart valves, and correcting cardiac defects and aortic aneurysms are just a few of the life-saving procedures for which they are known.
Blood travels into the heart through arteries. Through diet, age, and genetics, arteries can become narrower than they should be because of plaque, a sticky substance that builds up over time. When plaque loosens and breaks off, a blood clot forms, which can block blood flow to your heart, resulting in chest pain or heart attack. One way to restore normal blood flow to the heart is through an operation called coronary artery bypass graft surgery (CABG) to restore blood flow to the heart.
During a CABG, the surgeon uses a piece of artery or vein from another part of the patient's body to reroute blood around the blockage. Traditional CABG requires the surgeon to open the chest by separating the breast bone and stopping the heart and lungs. When the heart and lungs are stopped, the patient is on a heart-lung bypass machine, which keeps oxygenated blood flowing through the body without passing through the heart and lungs.
Sometimes, the surgery can be performed without stopping the heart and lungs. This is called beating heart surgery, or off-pump CABG. The patient is given medication to slow the heart rate during the procedure and the surgeon uses special tools that stabilize and position the heart to provide access to the blocked arteries. With one part of the heart stabilized, the surgeon can perform the bypass while the rest of the heart pumps oxygen-rich blood to the patient's body. Compared to traditional CABG, the benefits this procedure offers include a less likely need for blood transfusion, less risk of bleeding, stroke, or kidney failure, shorter hospital stays, and quicker recovery times.
Transmyocardial laser revascularization (also called TMR) is a treatment for patients with coronary artery disease who have not responded to or are not eligible for procedures such as angioplasty and stenting, medication, and coronary artery bypass graft surgery. For these patients, this surgical procedure is used to relieve angina (chest pain) that is generally caused by a lack of oxygen and blood flow to the heart.
During the procedure, the surgeon makes a small incision in the left side of the chest and uses a special laser to create channels in the heart muscle which will improve blood flow. A computer directs the laser beams to the appropriate area of the heart in between heartbeats, which helps prevent electrical disturbances
The advantage of TMR is that it provides a last-resort option to patients with severe angina (chest pain). It can be especially effective in patients with other conditions - such as diabetes – that make it impossible to do bypass surgery. Although clinical data are still somewhat limited, 80 to 90 percent of patients have seen significant improvement in their symptoms (at least a 50 percent improvement) at one-year follow up. A New England Journal of Medicine study concluded that patients who had TMR had relief of chest pain as well as improved quality-of-life, improved blood flow to the heart, and decreased hospital admissions.
The Maze procedure, also sometimes called the Cox-Maze procedure, is a surgical treatment for atrial fibrillation (AF). AF is the most common irregular heart rhythm in the United States, and it originates in the atria, or the heart's upper chambers. With AF, a risk factor for stroke, the electrical signal that normally causes the heart’s atria to contract in an orderly fashion circles through the heart muscles in an uncoordinated manner, causing the heart to quiver rapidly.
To perform the surgery, the surgeons deflates the right lung to gain access to the heart and the patient breathes through the left lung and a ventilator. Once three small incisions are made in the right side of the chest, a video camera and small instruments are inserted. Through catheters (small, thin tubes), radiofrequency energy is applied in the atria muscle in an intricate "maze" pattern, and scars form when these areas heal. Because scars do not carry electrical signals, they interrupt the conduction of abnormal impulses and allow the heart to return to a regular, coordinated beat. This procedure has an overall success rate of approximately 90 percent - and post-procedure freedom from stroke has been estimated at 99 percent.
The advantages of minimally invasive Maze are:
- It can cure atrial fibrillation;
- It cures afib without the invasiveness of the standard surgical method;
- Less recovery time and less risk of complications;
- Many require no further treatment and do not need medications such as blood thinners; and
- It reduces the risk of stroke and blood clots as well as symptoms such as fainting.
A thoracic aortic aneurysm occurs when the aorta, a larger artery shaped like a cane that that feeds blood to the body, has a weakened area near the heart. The weakened area balloons our, causing blood that should flow through the artery to pool and become stuck in the ballooned area. Left untreated, the aneurysm can rupture, or pop, causing death. Traditional surgery involving open the chest is the main treatment, especially if the aneurysm has grown large or is causing symptoms. But a less invasive approach is also available.
Boston Medical Center's cardiac vascular surgeons specialize in the minimally invasive treatment of thoracic aortic aneurysms. To repair the aneurysm, a thoracic aortic graft is used. The graft is inserted through a small incision in the groin area and fed up to the aneurysm location. This graft form a tight seal with the healthy artery above and below the aneurysm. This restores normal blood flow through the artery and eventually the aneurysm shrinks. Advantages to treatment with a graft include:
- Minimal scarring at that site of insertion;
- Fewer complications;
- Shorter stay in the intensive care unit;
- Shorter hospital stay;
- Quicker recovery time; and
- Faster return to normal activities.
The heart has four valves inside of it (aortic, mitral, pulmonary, and tricuspid) whose job are to push blood from one part of the heart to another. Sometimes, these valves do not function properly. This occurs most frequently with the aortic and mitral valves. When that happens, surgeons work to repair or replace the valves. When valves need to be replaced, surgeons use either tissue or titanium mechanical valves, depending on the patient’s diagnosis and medical history.
For patients with aortic valve disease, a new procedure called a TAVR may be an option. TAVR or transcatheter aortic valve replacement, replaces the faulty valve without removing it. Performed in a specially equipped procedure room, an incision is made in the patient’s groin and then a catheter with a replacement valve is threaded up into the heart and the new valve is placed. This procedure is excellent for patients who need an aortic valve replacement but whose health cannot tolerate a traditional, open heart surgery.
The heart is made up of four chambers, two called atria and two called ventricles. A ventricular aneurysm occurs when one of the ventricles has a weakening and is expanded and bulged like a balloon. This is a serious side effect that can occur after a heart attack. It happens when, after a heart attack, scar tissue forms which can then calcify, causing complications. Symptoms generally include shortness of breath, chest pain, or heart rhythm disturbances (arrhythmias). If left untreated, ventricular aneurysm can lead to heart failure or dangerous blood clotting.
When a patient is diagnosed with a ventricular aneurysm, cardiac surgeons open the chest, remove the weakened area of the ventricle wall, and sew the walls of the ventricle back together. Aneurysm repair is often followed by medication therapy. This procedure is important because it cures the aneurysm and reduces the potential for heart failure and blood clots.