Skilled cardiac surgeons at GW Hospital perform a comprehensive range of cardiovascular procedures — including innovative coronary artery bypass surgery, other revascularization procedures and valve repairs and replacements — to help patients with advanced heart disease.
 
Coronary Bypass Surgery
Many patients with heart disease have serious blockages in the arteries that supply blood to the heart. When minimally invasive techniques, such as angioplasty, can’t be used to improve their conditions, patients may benefit from coronary artery bypass surgery.

Surgeons at GW Hospital use advanced strategies and techniques to perform bypass surgery, including conventional procedures using the heart-lung machine and newer “off-pump” techniques.
 
Coronary Artery Bypass Surgery Using the da Vinci Robot
 
Traditional Bypass Surgery
When performing traditional bypass surgery, surgeons make an incision down the center of the chest and separate the breastbone to reach the heart. The patient’s heart must be stopped during the procedure, so a heart-lung machine is used to pump blood throughout the body.

Surgeons then graft a section of a healthy blood vessel — usually from the leg — onto the affected vessel to reroute blood flow around the blockage. This procedure can restore blood flow to or “revascularize” the heart. It also may reduce chest pain and lower the risk of heart attack.

Off-Pump Bypass Surgery
Surgeons at GW Hospital also employ newer procedures that allow them to perform bypass surgery without stopping the heart.

They can immobilize a section of the heart with specially designed stabilizers. The rest of the heart continues beating normally so a heart-lung machine isn’t used during the bypass procedure.

Patients who undergo off-pump procedures may have a reduced risk of developing some of the complications, such as swelling, clotting and neurological problems, that may be associated with the heart-lung machine.

Minimally Invasive Bypass Surgery
Surgeons often can perform minimally invasive heart surgery when the patient needs a bypass for only one or two arteries.

Instead of making a large incision in the chest and dividing the breastbone, surgeons make a small incision directly over the artery to be bypassed. Next, they detach an artery from inside the chest and attach it to the clogged artery to bypass the blockage.

Hybrid Revascularization
Some patients who have blockages in multiple vessels benefit from different treatment approaches. For example, some vessels may be suitable for angioplasty, a procedure that involves threading a catheter through the body to the blockage and widening the artery with a tiny balloon or stent. Other blockages, however, may need bypass surgery.

During a hybrid procedure, surgeons perform bypass surgery and angioplasty during the same operation. This procedure usually is performed without a heart-lung machine. Conventional and minimally invasive approaches can be used to reach the heart.

Laser Transmyocardial Revascularization
Heart disease can’t always be controlled with traditional medical or surgical treatment. Some patients, for example, don’t improve with medical therapy and risk reduction strategies, and they aren’t candidates for angioplasty or bypass surgery because they have extensive narrowing throughout their vessels rather than localized blockages.

In the past, there was little to offer patients with refractory or difficult-to-treat heart disease. Now surgeons at GW Hospital perform a procedure called laser transmyocardial revascularization that can help some of these patients. Surgeons use a laser to burn small holes onto the surface of the heart. These holes stimulate the growth of new blood vessels.

Some patients are born with defective heart valves that affect blood flow through the heart. In addition, infection, rheumatic fever and the aging process can damage healthy heart valves.

Surgeons at GW Hospital are recognized nationally for their expertise in valvular surgery. They perform innovative valve repair and replacement procedures using advanced surgical techniques, valve devices and prostheses.

Valve Repairs or Replacements
Whenever possible, surgeons try to repair valves by resecting the defective valve and using flexible rings to support the valve.

Repaired valves have a more natural shape, so patients have more normal or even improved heart function. Patients with repaired valves also have less risk of infection, and in most cases, they don’t need to take anticoagulants for an extended period.

When valves can’t be repaired, surgeons replace patients’ defective valves with mechanical or biologic (pig) valves.

Minimally Invasive Valve Procedures
Surgeons at GW Hospital use an innovative minimally invasive technique — called port access — to repair or replace valves.

Like traditional bypass surgery, conventional valve surgery requires a major incision in the chest and separation of the breastbone. During a port-access procedure, however, surgeons leave the breastbone intact and access the heart through a small incision under the breast.

This approach can’t be used in all patients, but those who undergo minimally invasive surgery usually have shorter hospital stays, quicker recoveries and less scarring.

Port-access techniques also can be used to treat a patient who has both a valve defect and a tumor in the heart or a hole in the wall that divides the heart.

A variety of procedures are available to support patients with serious impairment in their heart functions. These include a range of operations, including bypass surgery, valve repair and removal of non-functioning parts of the heart. In addition, a range of implantable devices can be used to assist the pumping action of the heart, for both acute and long-term heart failure.

Using a combination of approaches, including minimally invasive techniques, GW surgeons can reduce or eliminate the very common electrical irregularity of the heart known as atrial fibrillation. This can be done as a primary treatment for this problem, or in association with valve or bypass surgery.

GW is a regional leader in aneurysm surgery performing complex reconstruction in patients with aortic dissections as well as those with ascending, arch and descending aneurysms. Deep hypothermic circulatory arrest as well as perfusion-assisted techniques are performed. At times, the surgeon may be able to perform the procedure without the use of the heart lung machine.