CARDIOTHORACIC SURGERY

Heart and Vascular Disease

Heart Disease—also called cardiovascular disease and coronary heart disease—is a simple term used to describe several problems related to plaque buildup in the walls of the arteries. As plaque builds up, the arteries narrow, making it more difficult for blood to flow and creating a risk for heart attack or stroke.

Other types of heart disease include heart failure, irregular heartbeat and heart valve problems.

Heart & Vascular procedures and conditions treated by Dr. Bradford

Coronary Artery Disease/ Coronary Artery Bypass Grafting (CABG)

Coronary artery disease, also called coronary heart disease, is the most common type of heart disease. It is the leading cause of death in the United States in both men and women.

Coronary artery bypass grafting or "CABG" (often pronounced "cabbage") is the most commonly performed "open heart" operation in the United States. Coronary artery bypass helps prevent heart attacks and reduces the use of heart medication.

Cardiothoracic surgeons perform the procedure to bypass blockages or obstructions of the coronary arteries—the blood vessels that supply the heart with oxygen and nutrients. After CABG, the new open “bypass system” improves the pumping ability of the heart muscle, allowing the heart to receive much needed oxygen and nutrient enriched blood.

There are two types of bypass surgery.

Traditional Bypass Surgery - “pump” bypass surgery where surgeons use the assistance of a heart-lung machine, along with medications, to stop the heart so the bypass can be performed on a motionless field. The heart-lung machine is referred to as a "pump" because it continues to mechanically pump oxygen and nutrients to the body during surgery.

Beating Heart Bypass Surgery - “off-pump” bypass surgery is very similar to the traditional bypass surgery, only the heart-lung machine is not used. Rather than stopping the heart, today’s technological advances allow the surgeon to hold stabilized portions of the heart during surgery and bypass the blocked artery. Dr. Bradford has performing more than 2,000 off-pump bypass surgeries and is an expert in this advanced technique.

There is no one treatment guaranteed to be effective for all cases of coronary artery disease. But because there are different treatment options, it is important for every patient to speak with their doctors and have the information and resources necessary to make informed decisions.

Valve Repair / Valve Replacement

Valvular heart disease encompasses any disease of the four valves in the heart. The two valves that separate the upper and lower chambers of the heart—the mitral and tricuspid valves—and the two valves that separate the heart from the rest of the body—the aortic and the pulmonary valves. In adults, the most commonly affected are the aortic and the mitral valves.

Aortic Valve - the “outflow valve” for the left side of the heart. Blood flows out of the heart and into the aorta through this valve. The aortic valve is the most commonly diseased valve in the heart. A normally functioning aortic valve opens easily and does not let blood leak back into the heart when it closes.

Mitrial Valve - the "inflow valve" for the left side of the heart. Blood flows in to the heart from the lungs, where it picks up oxygen, through this valve.

Tricuspid Valve - regulates blood flow from the upper-right chamber of the heart to the lower-right chamber.

Pulmonic Valve- directs blood to the lungs.

Some valves become narrowed (stenosis) and block the flow of blood to and from the heart. Other valves regurgitate (leak)—allowing blood to flow backwards through the the valve after the heart pumps the blood out. These valves may be either repaired or replaced.

Valve repair - parts of the narrowed valve that are stiff or hardened are cut and separated to help open the valve. Parts of an insufficient valve may be strengthened or shortened to help the valve close more tightly.

Valve replacement - Valves that may not be repaired are replaced with a prosthetic valve. There are two types of prosthetic valves.

Mechanical Valve - manmade from materials such as carbon, titanium, Teflon, polyester and Dacron

Bioprosthetic Valve - tissue taken from an animal or a human donor

Surgeons often do not know whether a valve can be repaired or a will need replacement until after surgery begins. It is important to discuss your options and plans with your surgeon prior to surgery.

Arrythmia MAZE Surgery

Heart rhythm problems known as Atrial Fibrillation (AF) is an abnormality of the electrical system of the heart. When AF cannot be successfully controlled with medications or exercise, arrhythmia surgery is an option. This procedure is known as the MAZE.

American Heart Association – Watch, Learn and Live: Interactive Cardiovascular Library

The MAZE procedure is performed to disrupt the path of abnormal electrical impulses and prevent erratic electrical signals from recurring. After MAZE, the atrium can no longer fibrillate and the normal sinus rhythm of the heart is restored.

Maze can be performed through either an open chest or minimally invasive procedure.

Pacemaker Implant Placement

Pacemakers are most frequently prescribed when the heartbeat decreases under 60 beats per minute at rest (severe symptomatic bradycardia). They are also used in some cases to slow a fast heart rate over 120 beats per minute at rest (tachycardia).

A pacemaker is a small battery-operated device that helps your heart beat in a regular rhythm. It does this with a small electric stimulation that helps your heart to beat regularly. The pacemaker is placed under the skin on your chest, just under your collarbone and is hooked up to your heart with tiny wires. The pacemaker device delivers rhythmic electrical signals to stimulate the ventricles to contract.

Fluid around the heart

The heart is surrounded by a double-layered, sac-like structure called the pericardium. The space between the layers normally contains a very small amount of fluid.

When the volume of fluid exceeds the pericardium's "full" level, pericardial effusion puts pressure on the heart, causing poor heart function and if left untreated, heart failure and death.

The following procedures drain fluids around the heart or prevent fluids from accumulating again.

Pericardiocentesis - With this procedure, your doctor uses a needle to enter the pericardial space and then a small tube (catheter) to drain fluid from the pericardium. The doctor will use imaging devices — either echocardiography or a type of X-ray technology called fluoroscopy — to guide the work. Your heart is monitored during the procedure with an ECG machine. In most cases, the catheter will be left in place to drain the pericardial space for a few days to help prevent reaccumulation of fluid.

Open-heart surgery - If there's bleeding into the pericardium, especially due to recent heart surgery or other complicating factors, you may undergo surgery to drain the pericardium and repair any related damage. Occasionally, a surgeon may drain the pericardium and create a "passage" that allows it to drain as necessary into the abdominal cavity where the fluid can be absorbed.

Intrapericardial Sclerosis - With this procedure, a solution is injected into the space between the two layers of the pericardium that essentially seals the layers together. This procedure is usually used if you have recurring pericardial effusion or if the effusion is caused by cancer.

Pericardiectomy - Pericardiectomy is the surgical removal of all or a portion of the pericardium. This rarely performed procedure is usually reserved for treatment of recurring pericardial effusions despite catheter drainage. The heart can function adequately without the pericardium.

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