Heart Surgery & Procedures: How Techniques Have Advanced Over the Decades

With a drastic shift in lifestyles in terms of diet and physical activity, Cardiovascular diseases (CVDs) have become prominent health conditions contributing to 32% of deaths worldwide. Though it can’t be claimed that people were not suffering from CVD earlier, the dramatic elevation in CVD cases in recent times can’t be overlooked.

Thanks to advancing technology, various treatment measures are available to combat the heart conditions. Let’s explore different heart surgery procedures to understand the advancements in cardiac care.

Open heart surgery 

Open heart surgery is the most common type of heart surgery in which the chest wall of the patient is opened via an incision to access the heart directly. This allows cardiac surgeons to make necessary medical interventions.

A significant breakthrough came in the field of open heart surgery in the 1950s when Dr. John Gibbon developed a heart-lung machine referred to as cardiopulmonary bypass. This device allowed surgeons to temporarily stop the heart and lungs, providing a safe environment to perform delicate procedures.

When this cardiopulmonary machine is used, the surgery is referred to as on-pump surgery. With time and expertise, cardiac surgeons now perform off-pump surgery, where cardiac surgeons directly perform surgery on the beating heart.

Once considered a complicated and risky procedure, open heart surgery has evolved into a relatively more common and successful operation.Some of the common heart procedures include:

Coronary Artery Bypass Grafting (CABG)

CABG aims to improve the blood flow to the heart. This procedure involves bypassing blocked arteries utilising a healthy blood vessel usually from leg or arm. It is often employed to treat severe coronary artery disease.

Angioplasty and Stenting

Often considered as a less invasive alternative to CABG, angioplasty is a procedure where a small balloon is inserted via a catheter into a blocked artery to widen it. This is done to restore proper blood flow. 

Further, to prevent the artery from narrowing again due to deposition of plaques, a stent (a small mesh tube) is inserted so that the widened artery remains intact. 

Valve Repair or Replacement

Heart valves are responsible for controlling the flow of blood through the heart and also prevent backflow so that there is an intermixing of oxygenated and deoxygenated blood. Now, imagine what happens when any of these valves get damaged or diseased. Obviously, it’ll hamper the way the heart functions. 

Valve repair or replacement surgery corrects problems by either repairing the diseased valve if possible or, in case of severe damage, replacing the damaged valve with a prosthetic valve.

Pacemaker Implantation

For patients with arrhythmias, i.e., irregular heart rhythms, a pacemaker implant can be a possible solution to regulate the heart rate. This small device is placed under the skin and sends signals to different chambers of the heart, where the sinoatrial node or SA node (the natural pacemaker of the human heart), atrioventricular node, and HIS-Purkinje system are not functioning efficiently.

Transcatheter Aortic Valve Replacement (TAVR)

TAVR, a minimally invasive procedure is performed to treat aortic stenosis. It is the condition where the aortic valve becomes too narrow which restricts the blood flow. In this, an Interventional Cardiologist inserts a catheter into the heart via which the damaged aortic valve is replaced with a prosthetic valve.

If this procedure is performed for replacing the mitral valve, the process is known as transcatheter mitral valve replacement (TMVR).

Heart Transplant

In some critical heart conditions, the heart stops functioning, and other treatment procedures are no longer effective. A heart transplant becomes the only option in this case. This complex procedure involves replacing the diseased heart with a healthy donor heart to improve the quality of life for patients suffering from end-stage heart disease.

The surgical procedures to treat heart conditions have undergone many developments both technically and clinically. Improvements in intraoperative technique and perioperative care have diverted patients’ interest and surgeon’s preferences in techniques which are less invasive but equally effective.

Over the decades, cardiac surgeons have pushed the boundaries of what is possible, saving countless lives and improving the quality of life for millions.This led to opt for minimally invasive approaches.

Arrival of Minimal Invasive Heart Surgeries

Although open heart surgeries showed high success rates in improving heart conditions, issues arise when managing bleeding and infection becomes difficult. Moreover, open heart surgery resulted in wounds which took months to heal.

It was in the 1990s that minimally invasive heart surgery emerged as a game-changer. With this approach, the size of incisions for heart surgery could be greatly reduced, and instead of cutting the ribs and separating them to access the heart, small incisions allowed them to access the heart and perform necessary interventions.

This not only led to less blood loss and a lower risk of infection but also ensured faster recovery times, which was especially beneficial for heart patients who were travelling. 

The cost of heart surgery in India and other prominent countries such as Turkey , Thailand and Germany is highly impacted if the cardiac surgeon is utilising a minimally invasive approach for performing cardiac procedures.

Now, a preferred approach, minimally invasive heart surgery, easily bypasses the limitations of open heart surgery, and hence, it has been adopted by cardiac surgeons wherever possible.

Patients experienced shorter hospital stays and were able to resume normal activities much sooner, making it a preferred option for many with heart conditions.

Robotic Surgery: A Breakthrough in Heart Surgery

Minimally invasive techniques, being the central focus of heart surgeries, paved the way for robotic surgeries or, to be precise, robot-assisted surgery.

The robotic surgical system is equipped with several tools to assist surgeons in controlling the surgical procedure. Major components of the robotic system include:

Robotic arms 

These are the core components of the robotic surgical system, controlled by the surgeon from the console. It is designed to hold and operate surgical tools, enabling the surgeon to execute complex movements with enhanced accuracy. 

Surgical Console

The surgical console is the cabinet area from where the surgeon controls the entire robotic system to carry out the surgical procedure.

The surgical console involves joysticks or handles equipped with arm control and foot pedals. They mimic the surgeon’s hand movements into precise actions by the robotic arms. 

3D Visualisation System

Composed of advanced cameras and imaging technology, the 3D visualisation system captures visuals of the internal organs in detail and projects them onto screens present on the surgical console. 

By offering a high-definition, three-dimensional view of the surgical area, it enables surgeons to easily navigate the patient’s anatomy in depth.

With the advent of robotic surgery, unmatchable precision and control have been achieved in cardiac procedures.

Conclusion

In a world where innovation meets experience, the advancements in open-heart surgery over the decades have transformed to a great extent. What was once feared has now become safer, with a more precise approach offering advanced outcomes to the patients.

We all are together in witnessing the evolutions of these methods that stand as a testament to medical innovation, paving the way for even advanced breakthroughs in the future of cardiac care.