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Surgical and Other Invasive Procedures for Heart Attack

Surgery can be done to restore and/or improve blood flow to the heart muscle, which helps the heart perform better. When heart attacks are severe, surgery may be done immediately.

Surgery to Improve Blood Flow (Relieve Heart Attack)

Coronary Artery Bypass Grafting
Coronary artery bypass grafting (CABG) is more commonly known as bypass surgery. It is the most common type of heart surgery in the United States. During this operation, a healthy blood vessel is removed from the leg or another area of the body. The healthy blood vessel is connected to a coronary artery just above and just below the blocked or partially blocked area. The attached blood vessel creates a new pathway so that the blood can move around the blocked artery. If more than one area is blocked, a bypass can be done for each area. Multiple bypasses are referred to as a double, triple, or quadruple bypass. There are variations of this procedure.
CABG is considered open-heart surgery. On-pump surgery is done while the heart is stopped. A heart-lung machine is used to circulate blood and oxygen throughout the body while the surgeon works on the heart. The heart is restarted when the surgeon is done.
No heart-lung machine is used during off-pump CABG. The surgeon works on the heart while it is still beating. This technique is more specialized, but several studies indicate that on- and off-pump CABG have similar short- and long-term results.
Another option may allow you to have a less invasive heart surgery. During this procedure, small incisions are made along the left side of the chest and between the ribs to access front-facing blood vessels. It is a fairly new off-pump procedure that may not be an option for everyone or as widely available.
Talk to your doctor about which option is better for you.
Coronary Angioplasty
Coronary angioplasty may also be referred to as a percutaneous coronary intervention (PCI). During this procedure, a catheter is inserted into an artery in your groin and passed through the blood vessels until it reaches the heart and the problem artery. Imaging is done throughout the procedure to monitor blood flow and the location of the catheter.
Variations of angioplasty include:
  • Balloon angioplasty—The catheter is placed in the near-blocked artery and a small balloon is quickly inflated and deflated. The quick pressure from the balloon can press the plaque on the walls of the artery to open the artery and restore blood flow. Once the blood flow has been adequately restored, the balloon and catheter are removed.
  • Stent —During an angioplasty, a mesh stent may be placed in the artery to keep it open. The stent may be coated with a medication to reduce the chances of the artery renarrowing.
  • Laser angioplasty—The plaque is vaporized by a laser beam at the end of the guided catheter, which opens the artery.
  • Atherectomy—Once the blockage is reached, a shaver on the tip of the guided catheter is used to slice the plaque away.
Although these procedures may relieve symptoms, it does not cure heart disease. You still must maintain a healthy lifestyle that includes achieving a healthy weight, eating a heart healthy diet, not smoking, and taking medications.
Although these procedures may relieve symptoms, it does not cure heart disease. You still must maintain a healthy lifestyle that includes achieving a healthy weight, eating a heart healthy diet, not smoking, and taking medications.

Surgery to Treat Damage from a Heart Attack

Heart attacks can cause permanent heart damage. Damage can affect the structure and function of the heart. Surgery can improve your quality of life by restoring blood flow around damaged tissue or regulating heart rhythms. Procedures include:
  • Intra-aortic balloon counterpulsation (IABP)—A small balloon is threaded into the aorta, the main artery that exits the heart and delivers blood to the entire body. It expands and contracts with your heart rhythm, increasing blood flow to the heart muscle.
  • Transmyocardial laser revascularization (TMR)—Generally used in people who have severe angina (recurrent and prolonged chest pain). A laser is used through small incisions on the left side of the chest to create small channels in the affected part of the heart.
  • Implantable cardioverter defibrillator (ICD)—A device that can be implanted in your chest. People having a heart attack are more prone to certain heart arrhythmias. ICDs are implanted in people to prevent such arrhythmias from occurring.
  • Coronary artery radiation—Radiation is sometimes used to reopen coronary arteries that have narrowed after stent placement.

References

Acute coronary syndrome. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 31, 2014. Accessed April 10, 2014.

Cardiac procedures and surgeries. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/HeartAttack/PreventionTreatmentofHeartAttack/Cardiac-Procedures-and-Surgeries%5FUCM%5F303939%5FArticle.jsp. Updated March 22, 2013. Accessed April 10, 2014.

Intra-aortic balloon pump. Texas Heart Institute website. Available at: http://texasheart.org/Research/Devices/iabp.cfm. Accessed April 10, 2014.

ST-elevation myocardial infarction (STEMI). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 31, 2014. Accessed April 10, 2014.

Shekar PS. Cardiology patient page. On-pump and off-pump coronary artery bypass grafting. Circulation. 2006;113(4):e51-e52.

What is coronary artery bypass grafting? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/cabg. Updated February 23, 2012. Accessed April 10, 2014.

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