Traditional Heart Surgery
If minimally invasive cardiac surgery is not an option for your condition, your cardiac care team may recommend a more traditional surgical option as treatment. The Cardiac Surgery Program at Cedars-Sinai understands that having heart surgery can be daunting. Our multidisciplinary team of nationally recognized experts work with you to provide you comprehensive and compassionate care, tailored to your unique needs, delivering optimal results.
What is Traditional Heart Surgery?
Traditional cardiac surgery, or open heart surgery as it is often referred, is performed by making a large incision, roughly 6-8”, in the chest to gain access to the heart. Once the heart is exposed, the heart is actually stopped and the patient is connected to a heart-lung bypass machine that does the work of the heart and lungs to allow the surgeon to perform the surgery.
Open heart surgery is often performed to treat:
- Aortic Disease
- Atrial Fibrillation
- Coronary Artery Disease
- Congenital Heart Disease
- Heart Failure
- Heart Transplants
- Valvular Heart Disease
- Place ventricular assistive devices (VADs) and total artificial heart (TAHs)
Though similar heart conditions can be treated with minimally invasive methods, traditional surgery may be recommended for some patients based on factors such as age, previous heart treatments and overall health. Each patient will be evaluated to determine which surgical care option is best suited for their specific heart condition.
Types of Surgeries
Common traditional heart surgeries performed at Cedars-Sinai include:
Coronary artery bypass graft surgery (CABG), also called coronary artery bypass, coronary bypass or bypass surgery, is the most common type of heart surgery. More than 300,000 people have successful bypass surgery in the United States each year.
In this procedure, a section of vein or artery from your leg, chest or another part of your body is used to bypass the blocked or diseased portion of a coronary artery, which brings blood to the muscle of your heart. This creates a new, clear way for the blood to flow to get oxygen to your heart muscle so it can work properly. This type of surgery is done to the outer walls of the heart; it doesn't require opening up the chambers of the heart.
Sometimes people talk about single, double, triple or quadruple bypass surgery. This refers to the number of blocked arteries that had to be bypassed. However, the need for more bypasses doesn't necessarily mean the heart condition is worse.
Typically during bypass surgery, the breastbone (sternum) is divided. The heart itself is stopped and cooled. The blood that normally would be pumped by the heart is sent through a heart-lung machine. Unlike other kinds of heart surgery, the chambers of the heart are not opened during bypass surgery.
A long piece of vein may be removed. Today, Cedars-Sinai heart surgeons use an artery from inside the chest wall (in 95% of cases because studies have shown that it improves long-term survival for the patient). In some cases, a small vessel from the lower arm, the radial artery, may be used for the bypass.
This is called a graft. One end will be attached to the ascending aorta, the large artery that carries oxygen-rich blood from the heart to the rest of the body. The other end of the graft will be attached to a coronary artery below the blocked area. The surgery takes two to six hours depending on the number of bypasses needed.
Off Pump Bypass Surgery
Cedars-Sinai heart surgeons also perform what is called off-pump or "beating-heart" bypass surgery. For most bypass surgeries, a heart-lung machine is used to do the work of the heart while the surgeon operates on it. In off-pump heart surgery, this machine is not used. New technologies now allow surgeons to stabilize a specific part of the heart, rather than the whole heart muscle. While the surgeon works on the controlled part of the heart, the rest of the organ continues to function. All arteries can be bypassed with this method. The off-pump technique is used for patients who have complications that put them at risk if using the traditional heart-lung machine method of bypass surgery.
Between 20 to 30% of bypass patients need a second bypass operation within 10 years. It is important that you take steps to prevent your heart disease from getting worse. This means limiting the amount of fat and cholesterol in your diet, maintaining a healthy weight, quitting smoking and learning new ways to cope with stress. Your doctor may recommend that you join to strengthen your heart and develop new behaviors.
When one or more of the four heart valves is damaged due to disease or defect, replacing or repairing through surgical treatment may be necessary.
Mitral Valve Surgery
Cedars-Sinai has a long history of performing mitral valve repair operations. Gaining expertise over the last 30 years has made our medical center the largest mitral valve repair center in the Los Angeles area. More than half of our mitral valve surgeries are the preferable mitral valve repairs.
The mitral valve opens and closes, controlling the blood flowing into the left side of the heart. Mitral valve repair may be needed because of aging, damage caused by a heart attack or other disease, or because of an abnormality present from birth.
Whenever possible, a heart valve should be repaired, not replaced. By repairing the valve rather than replacing it, a patient can avoid long-term use of blood thinners and problems, such as an infection.
A mitral valve can also be replaced using mechanical valves, tissue valves or homografts (valves donated by another person).
When the heart is severely damaged, other treatment options have failed or the heart is unable to be repaired, a heart transplant may be needed.
Cedars Sinai performs the most heart transplants in the nation. Learn more about our comprehensive heart transplant care—from evaluation, during treatment and through recovery.
Though benefits can vary depending on age, procedure performed and the individuals overall health, results of traditional heart surgery are very promising and include:
- Reduced symptoms, such as chest pain and shortness of breath
- Improves the supply of blood and oxygen to the heart
- Can reduce the risk of heart attack
- Less chance of vascular complications and stroke
- Improved quality of life