Types of Cardiac Surgery

The Heart and Vascular Center offers the most advanced surgical procedures available for all types of heart problems. Procedures include:

Coronary artery bypass grafting
Valve surgery
Aortic surgery
Arrhythmia (atrial fibrillation) surgery
Heart failure and transplant surgery
Minimally invasive heart surgery
Surgery for adults with congenital heart disease

Coronary Artery Bypass Grafting

Cardiac surgeons perform all forms of coronary bypass graft surgery (CABG), removing healthy arteries and/or veins from one part of the body and attaching them to the coronary artery to restore blood flow to the heart.

Traditional CABG — involves cutting through the sternum (breastbone). During the procedure, the heart is stopped, and a heart-lung machine keeps blood moving throughout the body.
Off-pump (“beating heart”) CABG — involves cutting through the sternum. This procedure is done without stopping the heart or using a heart-lung machine. Instead, the part of the heart where a bypass is needed is steadied with a special device. The heart continues to pump blood to the body during surgery.
Minimally invasive/robotic CABG — minimally invasive direct coronary artery bypass (MIDCAB) may be done when only one or two artery bypasses is needed. A 2- to 3-inch incision is made in the chest, without splitting the sternum. This surgery, performed without using a heart-lung machine, may be done with or without robotic assistance.
Redo CABG — over time (10+ years), 10 percent to 15 percent of people who had CABG surgery need to have another bypass procedure. This may be caused by narrowing of the grafted arteries or worsening of the person’s coronary artery disease.
Transmyocardial LASER revascularization (TMR) — a procedure for patients with inoperable coronary artery disease and angina (chest pain). TMR is aimed at improving blood flow to areas of the heart that cannot be treated by angioplasty or surgery. A special laser is used to create small channels in the heart muscle to improve blood flow. The procedure is performed through a small incision on the left side of the chest or through the sternum. TMR may be performed with coronary artery bypass surgery or independently.

Valve Surgery

The Heart and Vascular Center offers all surgical options for valve repair and replacement. Procedures on the mitral, aortic and tricuspid valves can be done using either traditional (open) surgery or a minimally invasive approach. The less invasive approach requires only two small incisions — a 2- to 3-inch incision on the right side of the chest and a 1.5- to 2-inch incision in the groin (for the heart-lung machine).

When less invasive valve surgery is possible, patients generally experience less pain, fewer complications, shorter hospital stays and reduced recovery times compared to traditional valve surgery. Each case is evaluated to ensure the best possible outcome for the patient.

Traditional valve surgery — involves making a long incision through the sternum to reach the valves in the heart. Depending on the problem, a heart valve may be repaired or replaced.
Minimally invasive aortic valve surgery — the Heart and Vascular Center excels in performing minimally invasive surgery to repair and replace the aortic valve. Most people with isolated aortic valve problems are able to have the less invasive approach.
Minimally invasive/robotic mitral valve repair/replacement — the mitral valve in the heart can often be repaired or replaced in a minimally invasive procedure, through a small incision in the chest.

Aortic Surgery

A tear or aneurysm (abnormal bulge) in the aorta, the large artery leaving the heart, can be life-threatening. Medical College of Wisconsin cardiac surgeons are highly skilled in repairing the aorta.

Traditional surgery — to repair an aortic aneurysm involves making a large incision through the sternum. A surgeon clamps off the aorta, removes the diseased or injured part of the aorta, and sews in a synthetic graft to act as a bridge for the blood to flow.
Valve sparing aortic root surgery — when an aneurysm occurs at the aortic root (the section of the aorta attached to the heart), it can cause the aorta to dilate and the aortic valve to leak. Often times, the leaky valve needs to be replaced along with the aorta. Medical College of Wisconsin surgeons are experienced in valve-sparing aortic root replacement, in which the aneurysm is repaired but the patient’s native aortic valve is preserved. If the aortic valve is diseased or cannot be used during surgery, a donor tissue valve can be used.
Thoracic aortic endografting — in 2006, the Heart and Vascular Center was the first in the region to perform thoracic endovascular artery repair (TEVAR) to repair a thoracic aortic aneurysm (TAA) from inside the aorta. In this minimally invasive procedure, a catheter is guided to the aneurysm in the lower part of the thoracic aorta. Through the catheter, a synthetic graft is deployed from inside the aorta. It stops direct pressure from being exerted on the weak aortic wall. In cases of a torn aorta, such as after a motor vehicle accident, this procedure can be life-saving by covering the torn aortic wall and stopping further leakage.

TEVAR, performed by a team that includes cardiac surgeons, vascular surgeons, and vascular interventional radiologists, prevents the need to cut through the chest to repair the aorta. In certain cases, the stent graft can also be used to treat traumatic injuries and tears of the thoracic aorta.

Arrhythmia (atrial fibrillation) Surgery

Atrial fibrillation is the most common arrhythmia which accounts for up to one-third of strokes seen in older adults. Surgery to correct an arrhythmia, or irregular heart rhythm, involves a high level of skill and experience.

Minimally invasive CryoMaze procedure — a highly successful procedure for curing atrial fibrillation, the Maze procedure was traditionally performed on the atrial chambers of the heart through an incision in the chest bone. Medical College of Wisconsin surgeons perform the full CryoMaze procedure using a small incision in the right chest without cutting bones. This procedure is highly effective and much less traumatic than the traditional Maze procedure.

Heart Failure and Transplant Surgery

Cardiac surgeons perform special surgeries to help people with heart failure.

Ventricular assist device — a device implanted in a person with severe heart failure most often as a “bridge” while awaiting a heart transplant. The device serves as an artificial heart, allowing a patient to return home while waiting for a donor heart. Our success rate with this device is significantly higher than the national average. This is also used in some patients who have temporary severe dysfunction of the heart. In these cases, once the heart recovers function, the device can be removed.
Heart transplantation — patients with end-stage heart disease with severe heart failure may be candidates for a heart transplant. The Heart Transplant Program provides every aspect of care patients need during evaluation, transplant and follow-up care. Froedtert & The Medical College have performed heart transplants since 1985.
Surgical ventricular restoration (ventricular remodeling) — a procedure designed to restore the left ventricle to its normal shape and size in patients with areas of dead heart tissue. The procedure is usually done with coronary bypass surgery, with the aim of preventing the progression of heart failure.
Minimally invasive mitral valve repair for cardiomyopathy — a procedure to treat a leaky or narrowed mitral valve in the heart, using a small incision in the chest.
Minimally invasive epicardial lead placement for a biventricular pacemaker (cardiac resynchronization therapy) — used to treat the delay in heart ventricle contractions that occur in some people with advanced heart failure. A pacemaker is implanted to synchronize the ventricles’ contractions and to prevent arrhythmias.

Minimally Invasive Heart Surgery

Traditionally, heart surgery has been performed using a long incision through the sternum (breastbone) to reach the heart. Today, minimally invasive cardiac surgery is possible for many types of heart surgery, such as repairing a valve or closing a hole in the heart. In minimally invasive heart surgery, surgeons use small incisions, thin instruments, tiny cameras and robotic instruments. This approach offers many benefits over traditional heart surgery. These include:

Smaller incisions with little scarring
Less pain
Minimal blood loss and less need for transfusion
Greatly reduced risk for infection
Faster return to normal activities
Shorter hospital stay

Heart surgeries that may be done using minimally invasive techniques include:

Coronary bypass surgery — possible when only one or two bypass grafts is needed
ASD/PFO closure — a technique to close a hole in the septum (wall) between the atria, the two upper chambers of the heart. The hole — an atrial septal defect (ASD) or a patent foramen ovale (PFO) — is a congenital defect.
Atrial fibrillation (arrhythmia) ablation — to correct an abnormal heart rhythm
Mitral valve surgery — to repair or replace the mitral valve
Aortic valve surgery — to repair or replace the aortic valve

Surgery for Adults with Congenital Heart Disease

About one in 100 people are born with a heart defect (congenital heart disease or CHD), and many of them have corrective surgery during childhood. Because of possible long-term implications, most adults who had heart surgery as a child need regular evaluations throughout life.

To meet the unique needs of adults with CHD, Children’s Hospital of Wisconsin, in conjunction with Froedtert & The Medical College of Wisconsin, runs the Adult Congenital Heart Disease Program — the only program of its kind in Wisconsin — to provide ongoing care for adults with CHD. The clinic offers testing and diagnosis, medication management, interventional procedures and surgery.

Physicians with training and experience in adult CHD see patients in clinic, based at Children’s Hospital. Clinic physicians collaborate with adult cardiology specialists at Froedtert & The Medical College of Wisconsin to treat specific heart problems.

Collaboration with Marfan Syndrome Clinic — Marfan syndrome, a genetic condition, affects connective tissue in the body, including the heart and blood vessels. Children and adults with Marfan syndrome receive coordinated care through the Marfan Syndrome Clinic at Children’s Hospital of Wisconsin. For adults, the Marfan Syndrome Clinic works with the Adult Congenital Heart Disease Program to coordinate care for heart and blood vessels problems.

Author: Marla Fraunfelder

Last Review Date: Aug. 16, 2011

Online Editor(s): Kathryn Adam