South Texas Cardiothoracic surgeons perform hundreds of different surgeries related to the heart, lung, major vessels, the chest cavity, etc. on a monthly basis. Some of the more commonly done or asked about procedures are listed below.

Coronary Artery Bypass Surgery (CABG)

A coronary artery bypass graft operation is a type of heart surgery, sometimes referred to as CABG or "cabbage." The surgery re-routes, or "bypasses," blood vessels around clogged arteries and improve the supply of blood and oxygen to the heart. These arteries become clogged over time by the buildup of fat, cholesterol and other substances.

The narrowing of these arteries is called atherosclerosis. It slows or stops the flow of blood through the heart's blood vessels and can lead to a heart attack.

How is coronary bypass done?

During bypass surgery, your doctor may "borrow" blood vessels from other places in your body:

• A piece from a long vein in your leg may be removed and one end is sewn onto the large artery leaving your heart — the aorta. The other end of the vein is attached or "grafted" to the coronary artery below the blocked area.
• An artery may be detached from your chest wall and the open end attached to the coronary artery below the blocked area.

Either way, blood can then use this new path to once again flow freely to the heart muscle.

Cardiopulmonary bypass with a pump oxygenator (heart-lung machine) is used for most coronary bypass graft operations. This means that besides the surgeon, cardiac anesthesiologist and a competent perfusionist (blood flow specialist) is required. Off-pump (beating heart) procedures, where the patient is not placed on the heart-lung machine, are now becoming commonplace.

What happens after a bypass operation?

After a bypass operation, patients are often advised to modify their diets to reduce their consumption of fat and cholesterol. They may also be advised to walk or perform other physical activity to help them regain their strength. Doctors also often recommend following a home routine of increasing activity — doing light housework, going out, visiting friends, climbing stairs. The goal is to help a patient return to a normal, active lifestyle.

Most people who have sedentary office jobs can return to work in four to six weeks; those who have physically demanding jobs will have to wait longer and in some cases may have to find other employment.

Beating Heart Bypass Surgery or Off-Pump Coronary Artery Bypass (OPCAB)

In traditional bypass surgery, medications are used to stop the heart, while the heart-lung machine pumps the blood throughout the body and the surgeon repairs the heart.

Beating heart surgery differs from traditional bypass surgery in that the heart continues to beat during the operation. The surgeon uses instruments to stabilze a localized area of the heart where the bypass is being performed. The heart continues to beat and keep the natural flow of blood to all parts of the body.

A South Texas Cardiothoracic surgeon may choose this technique for a patient because it generally allows for faster recovery and shortened hospital stays.

Carotid Endarterectomy

Carotid endarterectomy is a surgical procedure in which the atherosclerotic plaque is removed from the carotid artery. This is a widely used as a method of reducing stroke risk. There is some risk that the surgery may induce the condition it is designed to prevent stroke, due to cerebral infarction.

The number of cases of this complication varies among surgeons and medical institutions. Newer studies have shown carotid endarterectomy to be of value for certain patients.

Left Ventricular Assist Device (LVAD)

The left ventricle is the large, muscular chamber of the heart that pumps blood out to the body. Left ventricular assist device (L.V.A.D.) is a mechanical pump-type device that is surgically implanted. It helps maintain the pumping ability of a heart that is unable to effectively function on its own. This device is sometimes referred to as a "bridge to transplant." People awaiting a heart transplant often have to wait for a long time before a suitable heart becomes available. During this wait, the patient's already weakened heart may deteriorate and become unable to pump enough blood to sustain life. An LVAD can assist the weakened heart and "buy time" for the patient.

How does an LVAD work?

A typical type of LVAD will have a tube going into the left ventricle that pulls blood from the ventricle into a pump. The pump then sends blood into the aorta (the large blood vessel leaving the left ventricle). This effectively "bypasses" the weakened ventricle. The pump is placed in the upper part of the abdomen. Another tube attached to the pump is brought out of the wall of the abdomen to the outside of the body and attached to the control system for the pump. LVADs are typically used for weeks to months.

Transmyocardial Revascularization (TMR)

In TMR, a laser cuts a series of channels in the heart muscle of a sick heart to increase blood flow to the organ. It is also called laser revascularization.

To do this procedure, a surgeon makes an incision on the left side of the chest and inserts a laser into the chest cavity. With the laser, the surgeon shoots holes through the heart's left ventricle in between heartbeats. (The laser is fired when the chamber is full of blood so the blood can protect the inside of the heart.)

From 15 to 30 channels, each a millimeter in diameter, are opened. Then the surgeon presses a finger on the holes on the outside of the heart. This seals the outer openings but lets the inner channels stay open, allowing oxygen-rich blood to flow through the heart muscle.

How does TMR compare to other treatments?

Transmyocardial revascularization has produced early promising results. Eighty to ninety percent of patients who have had this procedure have improved from Class IV (the most severe chest pain) to Class I or II, enabling them to live relatively normal lives. There is limited follow-up data at this time, however.

Transmyocardial revascularization probably won't replace coronary artery bypass or angioplasty as the most common method of treating coronary artery disease, however. These alternatives have been proven over time to be safe, effective ways to restore blood flow to the heart muscle. But TMR may be used for:

• people who are high-risk candidates for a second bypass or angioplasty.
• people whose blockages are too diffuse to be treated with bypass alone.
• some patients with heart transplants who develop atherosclerosis on the graft.

Five of the eight South Texas Cardiothoracic surgeons are trained in the TMR procedure.