Heart surgery

Sometimes your doctor will recommend surgery to help control your symptoms and/or reduce the chance of a sudden heart event in the future. Heart surgery can be planned in advance or performed as part of emergency treatment.

Heart surgery can help to maintain and prolong life by:

• restoring blood supply to the heart by opening - or replacing - blocked coronary arteries
• stretching, repairing or replacing a damaged heart valve
• correcting or regulating an abnormal heart rhythm

Apart from emergency situations, it’s important you’re prepared for surgery and know what it involves as well as what the risks are. If you have to wait for your surgery, try to use the time positively and prepare yourself - for example, by making any necessary changes to your lifestyle that will reduce your risk of future heart disease. 

Further information on reducing the risks.

Open heart surgery

This term refers to surgery in which the chest is opened and surgery is performed on the heart. The term ‘open’ refers to the chest, not to the heart itself - the heart may or may not be opened, depending on the particular type of surgery. The term generally relates to the sternum being opened and corrective surgery being performed.

Coronary angioplasty and stenting

Coronary angioplasty and stenting is used to open up narrowed or blocked arteries which supply your heart muscle. This treatment is done to provide relief from symptoms of angina.

During angioplasty and stenting, the narrowed artery is stretched open with a balloon (angioplasty), and a metal strut known as a stent is implanted into the coronary artery. This keeps the narrowing open and allows your blood to flow more freely through it.

Angioplasy is also known as Percutaneous Coronary Intervention (PCI).

Heart bypass

Heart bypass is also known as coronary artery bypass grafting (CABG). It’s a surgical procedure used to treat narrowed or blocked arteries supplying your heart muscle. This is a major heart operation which is used routinely for the treatment of patients with coronary artery disease and angina.

A blood vessel will be taken from another part of your body and attached to the coronary artery above and below the narrowed area or blockage. This is known as a graft. The graft adds to the flow of blood around the part of the coronary artery that is narrowed or blocked.

Valve surgery

Sometimes your doctor may recommend heart valve surgery to treat a damaged heart valve. Valves can sometimes be:

• stretched
• repaired
• replaced

Balloon valve surgery 

A narrowed valve can sometimes be stretched with balloon valve surgery. This is most often performed for treating mitral valve stenosis and is called mitral valvuloplasty.

A small, plastic tube (a catheter) is inserted into a major artery (usually in your groin) and then guided up to your heart. A wire, with a tiny inflatable balloon, is passed through the catheter. When it reaches the damaged valve, the balloon is inflated to stretch the valve. The balloon is then deflated and the catheter and balloon are removed.

Balloon aortic valvuloplasty involves the same procedure to open up a narrowed aortic valve.

This type of treatment does not involve open heart surgery and can sometimes be as effective as replacement surgery.

Valve repair 

If possible, surgeons will try to repair a damaged valve, as it’s a less invasive procedure than valve replacement. Valve repair surgery is most commonly performed for treating mitral valve regurgitation.

Valve replacement 

If the valve can’t be repaired, it may be replaced. Replacement valves can be either artificial mechanical valves made of metal, or natural tissue valves from pigs (porcine) or cows (bovine), specially treated for the use of humans. Not everyone will be suitable for this type of surgery.

TAVI (Transcatheter Aortic Valve Implantation) 

For some people, valve repair or replacement options may not be suitable, as they may have had previous surgery or, when assessed, they’re not well enough to have these operations.

This procedure may be offered instead:

• You will be given a general or local anaesthetic.
• A catheter (hollow tube) with a balloon at its tip is inserted into an artery in your groin, under your collarbone or through a small cut on your chest.
• The catheter goes into your heart, within the opening of the aortic valve.
• The balloon is gently inflated to make room for the new tissue valve, which is put in position.
• The new valve either expands by itself or is expanded using the balloon, depending on which type of valve is used.
• The balloon is deflated, and then removed with the catheter.
• The new valve will now be sitting inside your own valve.

Find out more from British Heart Foundation on the TAVI procedure.

Interventions for arrhythmias

Different therapies are required to treat arrhythmias, which are abnormal heart rhythm.

Electrophysiologists and cardiology specialists are usually involved in these treatments, which are done in clinical and surgical environments.

See Chest Heart & Stroke Scotland for more on arrhythmias

Ablation therapy

Ablation - also known as catheter ablation - is a treatment that aims to control or correct certain types of abnormally fast heart rhythms.

Catheter ablation is a surgical procedure where any areas producing electrical signals which interfere with the natural pacemaker are destroyed using a laser.

Cardioversion

Cardioversion uses a controlled electric shock to the heart, from a machine called a defibrillator, to restore the normal heart rhythm. Cardioversion allows the conduction system of the heart to reset. It can be performed under a general anaesthetic or with sedation. Cardioversion can be repeated if necessary.

Pacemakers

A pacemaker is an electrical device that is used to correct and regulate an abnormal heart rhythm. When necessary, a pacemaker will send out electrical signals to stimulate the heart’s chambers to contract and relax in a regular way.

In effect, pacemakers artificially take over the role of the heart’s natural pacemaker. They can be set to work only if needed (on demand) or all the time (fixed rate). 

There are different types of pacemakers and settings that the electrophysiologist or cardiologist will use when the pacemaker is implanted, depending on the heart rhythm problem they’re hoping to correct.

The reasons why people require pacemakers vary:

• When your heart’s electrical activity doesn’t join up, it can’t deliver an adequate rhythm (called heart block).
• When your heart’s periodically running too fast, it may be necessary to take medicines that will slow your heart down. However, during the times when it’s not going too fast, the medicines will still have this effect resulting in too slow a heart rate. A pacemaker would ensure that this low rate was corrected.
• If your old heart rhythm is wiped out altogether for whatever reason - for example, in ablation therapy (used for some arrhythmias) - a pacemaker would replace the rhythm and ensure a regular heart rate is restored.

Pacemakers are usually implanted in a cardiology unit or department as a planned procedure or following a heart event which has caused the above issues to happen.

More about having a pacemaker fitted

Implantable Cardioverter Defibrillators

Implantable Cardioverter Defibrillators (ICDs) are life-saving devices, similar to pacemakers. They’re programmed to pick up and stop specific life-threatening arrhythmias (abnormal heart rhythms) and restore your heart to its normal rhythm.

ICDs can be used:

• if you’re at risk of specific life-threatening arrhythmias - known as "primary prevention"
• if you’ve survived a specific life-threatening arrhythmia - known as "secondary prevention"

Cardiac Resynchronisation Therapy (CRT-P) and Cardiac Resynchronisation Therapy Defibrillator device (CRT-D)

If you have heart failure, you may need a special type of device called cardiac resynchronisation therapy device. As well as treating heart arrhythmias, this device also synchronises your heart’s chambers to contract and relax in a regular way, which improves the pumping action of your heart.

There is also a type of CRT that can be used as above and in addition can deliver a "shock" to treat dangerous heart arrhythmias and then synchronise your heart’s chambers to normal rhythm once more. This is CRT-D (D for defibrillation).

Left Ventricular Assist Device (VAD or LVAD)

A VAD - also known as an LVAD for Left Ventricular Assist Device - is a circulatory support device. It takes blood from the left ventricle (a lower chamber of your heart) and pumps it into the aorta (the main artery), helping the heart in pumping blood round the body.

It was originally designed to support the work of the heart while someone was waiting for a heart transplant. However, it’s now also used as a long-term support therapy for people who are not candidates for transplant and have end-stage heart failure.

Learn more about left ventricular assist devices through the British Heart Foundation.

Heart transplant

A heart transplant is an operation in which a failing, diseased heart is replaced with a healthier, donor heart. Heart transplant is a treatment that’s usually reserved for people who have tried medications or other surgeries but whose conditions haven’t improved sufficiently.

Heart transplant is not suitable for everybody and carries risks during the pre- and post-operative stages as well as during recovery.

While a heart transplant is a major operation, your chance of survival is good, with appropriate follow-up care.

When faced with a decision about having a heart transplant, you should find out what to expect of the heart transplant process, the surgery itself, potential risks and follow-up care.

In Scotland, heart transplant only occurs within the Golden Jubilee Hospital in Clydebank.

Find out more:

• British Heart Foundation: Heart transplant