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Cardiac Surgery


  1. CABG – Coronary Artery Bypass Graft
  2. REDO-CABG – Redo-Coronary Artery Bypass Graft
  3. OPCAB-OFF PUMP Coronary Artery Bypass Graft
  4. Valve Repair / Replacement Surgery
  5. Carotid Endarterectomy Surgery
  6. Thoracic Aortic Aneurysm Surgery
  7. Abdominal Aortic Aneurysm (AAA) Surgery
  8. Femoral Bypass
  9. Thoracotomy Surgery
  10. MAZE/Atricure Set
  11. ASD (Atrial Septal Defect) Repair
  12. VSD (Ventricular Septal Defect) Repair
  13. PDA (Patent Doctus Arteriosus) Repair
  14. Modified MAZE Procedure
  15. SVR (Surgical Ventricular Restoration)
  16. Mitral Valve Repair

1.  CABG – Coronary Artery Bypass Graft

Coronary arteries are those small blood vessels that supply our heart muscle with oxygen and nutrients. These arteries can gradually become clogged with fats and cholesterol which can accumulate inside them. This buildup of fat and cholesterol plaque is called >atherosclerosis. When one or more of these coronary arteries becomes blocked, whether partially or totally, the heart does not get enough blood supply. This is called ischemic heart disease or coronary artery disease (CAD) which can cause chest pain (angina).

Sometimes CAD does not cause pain until the blood supply to the heart becomes really low, and the muscle begins to die. In this case, the first symptom of CAD may be a potentially deadly heart attack.


Heart bypass surgery creates an alternative route or "bypass" around the blocked part of a coronary artery to restore the blood supply to the heart muscle. The surgery is commonly called Coronary Artery Bypass Graft, or CABG.

Once the patient is anesthetized, the heart surgeon makes an incision in the middle of the chest and separates the breastbone.  Through this incision, the surgeon can see the heart and aorta.  After surgery, the breastbone will be rejoined and the incision will be sewn closed.

In the traditional surgery, the patient is connected to a heart-lung machine, or bypass pump, which adds oxygen to the blood and circulates blood to other parts of the body during the surgery. This is necessary because before the graft can be done, the heart muscle must be stopped.

One end of the graft is stitched to an opening below the blockage in the coronary artery if the grafted vessel is the saphenous vein or the radial artery.  Its other end is stitched to an opening made in the aorta. If the grafted vessel is the mammary artery, its other end is already connected to the aorta.

The entire surgery can take 4-6 hours.  The patient is taken to the Intensive Care Unit after the surgery.  The patient is connected to monitors and tubes for a few days after the surgery.


The saphenous vein is the vein that is responsible for circulating blood from the leg to the heart and normally only does 10% of the work.  It can therefore be taken out with harming the patient or the leg.  If it is to be used for bypass, the vein is removed by making an incision in the leg, from the ankle to the groin.

It is common for the leg to swell a little during recovery from surgery, but this is temporary and is treated by elevating the leg.

The internal mammary artery (IMA) can also be used as the graft. This has the advantage of staying open for many more years than the vein grafts, but there are some situations in which it cannot be used.

Other arteries are also now being used in bypass surgery. The most common of these is the radial artery. This is one of the two arteries that supply the hand with blood. It can usually be removed from the arm without any impairment of blood supply to the hand.


There are possible risks in having CABG.  Some of them are:

  • Heart attack, which occurs in 5% of these surgeries
  • Stroke, which occurs in 5% of these surgeries (the risk is greatest in those over 70)
  • Blood clots
  • Death, which occurs in 1 - 2% of those who have the surgery (that means 95 - 98% have no serious complications)
  • Sternal wound infection, which occurs in 1 - 4% of these surgeries (this complication is most often associated with obesity, diabetes, or having had previous CABG)

The incision in the chest or the graft site (if the graft was from the leg or arm) can be itchy, sore, numb, or bruised.  Some report loss of mental clarity or "fuzzy thinking" and memory loss after having undergone CABG.

Like with all surgeries, there is a risk for heavy bleeding. In case a transfusion is needed during or after surgery arrangements may be made for an "autologous" pre-operative blood donation (banking your own blood for surgery). 

After Surgery   

CABG will improve blood flow to the heart.  It, however, does not prevent the  recurrence of coronary blockage if lifestyle changes are not made, such as, not smoking, improved diet, regular exercise, and treating high blood pressure and high cholesterol.

The patient will spend about a week in the hospital after the procedure, with the first 2 hours in an intensive-care unit (ICU) where the heart function is monitored continuously.

Patients may need a breathing tube for a few hours after surgery. Two to three tubes in the chest drain fluid from around the heart and are usually removed one to three days after surgery.

A urinary catheter in the bladder drains urine until the patient is able to void on his own. Intravenous lines (IV) provide fluids and medications.

Usually within 12 – 24 hours, when constant monitoring is no longer needed, the patient is moved to a regular or a transitional care unit.  He may gradually resume activity and may begin a cardiac rehabilitation program within a few days.

After surgery, it takes 4 - 6 weeks to start feeling better. It usually takes 3 - 6 months after surgery to determine the full benefits of the surgery. Sexual activities may be resumed 4 weeks after surgery. Those activities that do not cause fatigue are allowed.

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2.  REDO-CABG - Redo-Coronary Artery Bypass Graft

This is essentially a repeat coronary artery bypass grafting  for patients who have a recurrence of angina due to progression of native coronary artery disease or graft blockage.Please refer to Coronary Artery Bypass Graft.

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3.  OPCAB - OFF PUMP Coronary Artery Bypass Graft

This is another surgical technique to create a  bypass wherein the the use of the heart-lung machine is avoided.  This is called off-pump coronary artery bypass or OPCAB. This operation allows the creation of the bypass while the heart is still beating.

When the heart-lung machine is used, there is a possibility that it may lead to  some loss of memory and mental clarity.  However, with OPCAB, that risk is reduced because the heart is not stopped, and the blood is not oxygenated outside.

There is another surgical technique called the Minimally Invasive Direct Coronary Artery Bypass or MIDCAB where the use of smaller incisions is used instead of  splitting the breastbone.

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4.  Valve Repair / Replacement Surgery

There are four valves in the heart that control the direction of blood flow through the heart, namely the aortic valve, mitral valve, tricuspid valve and pulmonary valve.  Heart valve surgery is used to repair or replace diseased heart valves.

Valves may be repaired or replaced. Replacement heart valves are either natural or artificial.  Natural valves are from human deceased donors (cadavers). Modified natural valves come from animal donors. (Porcine valves are from pigs, bovine are from cows.) These are placed in synthetic rings.  Artificial valves, on the other hand, are made of metal.

Once an artificial valve is used, life-long medication needs to be taken to prevent blood clots. Natural valves rarely require life-long medication.

The surgery is an open-heart surgery done while under general anesthesia. A cut is made through the breast bone (sternum). Blood is routed away from your heart to a heart-lung bypass machine which keeps the blood circulating while the heart is being operated on.


As with any surgery, there are certain risks, such as bleeding and infection.  The risks for anesthesia include reactions to medications and problems with breathing.  The risks for cardiac surgery include death, stroke, heart attack, arrhythmia and kidney failure.

It is very important to prevent valve infections. Therefore, antibiotics are needed indefinitely, or before invasive procedures.

After Surgery   

The first 2 or 3 days are spent in the intensive care unit following the operation. Heart functions will be monitored constantly. The average hospital stay is 1-2 weeks. It would take a few weeks to several months for complete recovery to be felt and all depending on the health before surgery.

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5.  Carotid Endarterectomy Surgery

Carotid endarterectomy is an operation wherein the surgeon removes the inner lining of the carotid artery if it has become thickened or damaged. This procedure  can restore blood flow by eliminating a substance called plaque from the artery.

As one ages, plaque can build up in the walls of the arteries. Cholesterol, calcium, and fibrous tissue make up this plaque. The arteries narrow and stiffen as more plaque builds up leading to atherosclerosis, or hardening of the arteries. As more plaque builds up, it eventually reduces blood flow through the carotid arteries, or causes irregularities in the normally smooth inner walls of the arteries.

The carotid arteries are located on each side of the neck and extend from the aorta in the chest to the base of the skull. These important arteries supply blood to the brain.

Carotid artery disease is very serious issue as clots can form on the plaque. These, in turn, can also break loose and travel to the brain. If a clot or plaque blocks the blood flow to the brain sufficiently, it can cause an ischemic stroke, which can cause permanent brain damage, or death.  If it blocks only a tiny artery in the brain, it may cause a transient ischemic attack (TIA), or a mini-stroke.  A TIA is like a warning sign that a stroke may occur anytime soon, and it should push one to seek treatment before a stroke occurs. 

Carotid endarterectomy is one of the most commonly performed vascular operations to remove plaque in the carotid arteries, and is a safe and long-lasting treatment.


The surgeon will shave the skin on your neck where he or she is going to make an incision, to help prevent infections. He then makes the incision on one side of your neck to expose the blocked carotid artery. He will then temporarily clamp the blocked artery to stop blood from flowing through it. Next, the surgeon peels out the plaque deposit by removing the inner lining of the diseased section of your artery which has the plaque. After the plaque is removed, the artery is stitched, the clamp is removed and any bleeding stopped.  He then closes the neck incision.  The procedure takes about 2 hours to perform but may seem slightly longer depending upon the anesthetic and preparation time. .

After Surgery
After surgery, you may stay in the hospital for 1 to 2 days. Your progress will be  monitored during this time.  Also, during recovery, fluid and nutrients are given through a small, thin tube called an intravenous (IV) catheter. Because the neck incision is so small, you may not feel significant pain.

You can usually begin normal activities again several weeks after the operation.


As with any surgical procedure, there are complications. A stroke is one possible complication, though it is very low. Another unusual complication is the re-blockage of the carotid artery, called restenosis, that may occur later, especially if you continue to smoke cigarettes.  Another uncommon complication is temporary nerve injury, leading to hoarseness, difficulty with swallowing, or numbness in your face or tongue. This usually clears up in less than 1 month and usually doesn't require any treatment.

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