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Surgical and Other Invasive Procedures for Heart Attack

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Surgery can be done to restore or improve blood flow to the heart muscle. This helps the heart work better. When heart attacks are severe, surgery may be done right away.

Surgery to Relieve a Heart Attack

Coronary Artery Bypass Grafting (CABG)

During CABG, a healthy blood vessel is taken from somewhere in the body. The healthy blood vessel is attached to an artery in the heart just above and below the blockage. The new blood vessel lets blood move around the blockage. Bypass can be done for each blocked artery in the heart. CABG can be done as:

  • On-pump—Done while the heart is stopped. A machine moves blood and oxygen around the body for the heart and lungs. Once the arteries are fixed, the heart is restarted.
  • Off-pump—No machine is needed. The arteries are fixed while the heart is beating.
  • Minimally invasive direct—Small cuts are made along the left side of the chest and between the ribs to get to the blood vessels.

Angioplasty

A catheter is threaded through an artery in the groin and passed to the problem artery. Imaging tracks the catheter and watches blood flow.

Types of angioplasty are:

  • Balloon—The catheter is placed in the near-blocked artery. A small balloon is quickly inflated and deflated. This lets the balloon press the plaque on the walls of the artery to open reopen it. The catheter is taken out when blood flow returns to normal.
  • Stent—A mesh stent may be placed in the artery to keep it open. The stent may be coated with medicine to keep it from narrowing again.
  • Laser—A laser beam vaporizes the plaque to open the artery.
  • Atherectomy—A shaver on the tip of the guided catheter slices the plaque away.

Although these procedures may ease symptoms, it does not cure heart disease. Other steps such as keeping a healthy weight, eating right, and quitting smoking will need to be taken.

Surgery to Treat Damage from a Heart Attack

Heart attacks can cause permanent heart damage. This can change the heart's structure and how it works. Surgery is used to move blood around damaged tissue or to fix heart rhythm problems. They are not a cure, but they do improve quality of life. These are:

  • Intra-aortic balloon counterpulsation (IABP)—A small balloon is threaded into the aorta, the body's largest artery. It moves with your heart rhythm, bringing the heart muscle more blood.
  • Transmyocardial laser revascularization (TMR)—TMR is mainly used in people who have severe angina. A laser is placed through small cuts on the left side of the chest. These make small channels the parts of the heart that need them.
  • Implantable cardioverter defibrillator (ICD)—An ICD is placed in the chest. People having a heart attack are more prone to heart rhythm problems. ICDs help keep the heart rhythm normal.
  • Coronary artery radiation—Radiation is sometimes used to reopen arteries in the heart that have narrowed after a stent was placed.
REFERENCES:

Acute coronary syndromes. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T116779/Acute-coronary-syndromes. Updated March 15, 2019. Accessed March 27, 2019.

Cardiac procedures and surgeries. American Heart Association website. Available at: https://www.heart.org/en/health-topics/heart-attack/treatment-of-a-heart-attack/cardiac-procedures-and-surgeries. Accessed March 27, 2019.

Coronary artery bypass graft (CABG) surgery. EBSCO DynaMed Plus website. Available at:https://www.dynamed.com/topics/dmp~AN~T113960/Coronary-artery-bypass-graft-CABG-surgery. Updated February 20, 2019. Accessed March 27, 2019.

Coronary artery bypass grafting. National Heart, Lung, and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health-topics/coronary-artery-bypass-grafting. Updated February 23, 2012. Accessed March 27, 2019.

Percutaneous coronary intervention (PCI) procedure. EBSCO DynaMed Plus website. Available at:https://www.dynamed.com/topics/dmp~AN~T915838/Percutaneous-coronary-intervention-PCI-procedure. Updated January 18, 2019. Accessed March 27, 2019.

ST-elevation myocardial infarction (STEMI). EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T115392/ST-elevation-myocardial-infarction-STEMI. Updated July 10, 2018. Accessed March 27, 2019.

Ventricular assist devices. Texas Heart Institute website. Available at: https://www.texasheart.org/heart-health/heart-information-center/topics/ventricular-assist-devices. Accessed March 27, 2019.

Last reviewed March 2019 by EBSCO Medical Review Board Michael J. Fucci, DO, FACC  Last Updated: 3/27/2019