The Stitch

Six Common Myths about Heart Surgery

Through the years, I’ve had patients come to me with facts, figures and concerns gathered from the internet or heard from friends and family. While I think it is essential for anyone dealing with a medical issue to collect information from a variety of reliable sources, I also have noticed that there are some common myths that tend to surface. I will debunk six of them here.

Doctor and Patient showing a patient information on a chart.1. They take my heart out of my chest to perform the surgery

It is a common misperception that your heart is taken out of your body during heart surgery. I am happy to confirm that this is not really true. The only heart surgery in which the heart is physically removed from the chest is heart transplantation. Most common heart procedures can even be completed with minimally invasive techniques, which means less scarring and faster recovery.

2. Heart surgery will cause a stroke or hurt my brain function

While old medical reports cite high occurrence of stroke and brain damage after open heart surgery, targeted improvements in surgical techniques have significantly reduced these risks. However, it is always best to discuss your specific medical condition with your doctor before surgery. Postoperative complications are always possible, but the risk of stroke and brain damage after open heart surgery is much lower than it used to be.

3. Robotic surgery is better

Not necessarily. First, let’s understand what robotic surgery actually is. Robotic surgery is a minimally invasive surgery that uses very small cuts to enter the chest and tiny robotic tools to perform the procedures. While there are many benefits to robotic surgery, it is generally more expensive than minimally invasive surgery performed by a surgeon and is not required for equally good results.

4. I won’t be able to drive or resume normal activities for 6 weeks after surgery

This is not true. While some healing goes on for a long time after surgery, you should be up and walking around the day after and be resuming light activities by the time you go home 3 to 5 days later. We typically recommend at least 2 weeks before engaging in more involved activities like driving. The most important aspect of recovery from heart surgery is to be patient with yourself, understanding that it will take time for you to feel 100% back to your normal capacity. Keep in touch with your doctor and ask questions in the process to make sure you are on track.

5. Angioplasty is safer than bypass surgery

Before we address this myth, let’s get a better understanding of what these two procedures entail.

Angioplasty is a minimally invasive procedure that opens arteries around the heart that have become blocked. To help blood to flow again, a tiny, deflated balloon is inserted into the vessel and then inflated to open the passageway. Usually, a stent is placed during the procedure, which maintains the opening.

Coronary artery bypass grafting (CABG) surgery, or bypass surgery, is a procedure in which the surgeon takes a vessel from another part of the body (the chest or the leg) and then grafts it above and below the blocked artery. This allows blood to “bypass” the blockage and flow to the heart muscle.

Angioplasty has a quicker recovery and requires smaller incisions than bypass surgery; however, patients who initially only get angioplasty usually wind up needing more procedures down the line (often another angioplasty or a CABG). Therefore, in some cases, it may be better to do the CABG first.

From a safety standpoint, initial outcomes of angioplasty vs. bypass surgery are comparable, but CABG provides better long-term results. Well-known clinical trials such as the SYNTAX trial (2008) and the BEST trial (2015) give CABG a leg up for people at higher risk for more blockages or with other complications such as diabetes.

6. TAVR is better than valve surgery

Again, let’s first get a basic understanding of these two procedures.

Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure in which a damaged heart valve is replaced by a valve inserted using a catheter from another part of the body (usually the femoral artery in the leg). In this procedure, the damaged valve is not removed. The new valve simply takes over the job of controlling blood flow. The TAVR valve is made from animal tissue. TAVR, performed by a interventional cardiologist and a heart surgeon working together, is a quick procedure with a relatively easy recovery.

In a surgical aortic valve replacement (SAVR), a damaged valve is repaired or replaced using a mechanical metal valve, a tissue valve from an animal, or one made from human heart tissue. Depending on the specific needs of the patient, there are several different types of valve surgeries available. Generally, SAVR is more taxing than TAVR, but has a demonstrated history of safety, durability and effectiveness over time. SAVR is performed by a heart surgeon.

Currently, the decision to undergo TAVR or SAVR is based on surgical risk, patient age and anatomic factors. A “Heart Team” consisting of cardiologists and cardiac surgeons reviews the patient and imaging to determine the feasibility of TAVR based on anatomy and other factors. SAVR mechanical valves have the advantage of high flow and durability for the entirety of the patient’s life. Some studies have suggested that patients with a mechanical valve live longer than similar patients who receive a tissue valve. SAVR tissue valves last approximately 15 years before degeneration reduces performance and another procedure is required to re-replace the valve. TAVR tissue valves have unknown long-term durability.

Current American Heart Association Guidelines, recommend TAVR as primary valve replacement choice in patients  > 80 years of age or those with high or prohibitive risk for surgery. For patients between 65 and 80 years of age, either TAVR or SAVR are reasonable choices. For patients less than 65 years of age, SAVR is generally the first choice valve replacement unless there are additional risk factors. Patients of all ages with coronary artery disease in addition to valvular heart disease may be recommended for SAVR plus CABG. For patients who need a valve replacement due to a leaky aortic valve (aortic valve insufficiency), SAVR is usually the choice due to anatomic reasons. Importantly, the multidisciplinary “Heart Team” and shared decision making with the patient has emerged as an important development in the comprehensive evaluation of how to manage patients with aortic valve disease.

By Dr. Todd Rosengart, professor and chair of the Michael E. DeBakey Department of Surgery, DeBakey-Bard Chair in Surgery at Baylor College of Medicine

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