Information for Patients

When you choose The Heart Institute at ARMC for your heart surgery, you’re choosing wisely. Our skilled surgical team can boast high volumes, advanced training, and outcomes that outshine even big-name, big-city heart programs. Whether you need valve repair or replacement or coronary bypass, our physicians and surgical team put their experience to work for you, answer your questions and do their best to put your mind – and heart – at ease.

Learn more about the surgical services offered at the Heart Institute at ARMC by clicking a link below.

• Coronary Artery Disease (CAD) and Treatment
• Valvular Disease and Treatment
• Aortic Disease and Treatment
• What to Expect Before and After Surgery

Coronary Artery Disease

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Coronary artery disease (CAD) is the most common kind of heart disease in the Western world. How would you know if you had CAD? The first symptom is often chest pain, or angina pectoris. An angina attack usually occurs when the heart muscle is required to perform extra work, that is, with exertion, stress or after a heavy meal. The heart can’t get the blood flow it needs because an artery or arteries are blocked. When the pain of angina can’t be controlled, coronary artery bypass surgery is considered

Risk Factors
Some risk factors for CAD cannot be controlled: age, family history and gender. As you age, your chances of developing CAD increase. If you have relatives with CAD, your chances of developing it increase. Males, more than females, develop this disease before age 50. But the number of women with CAD is on the rise -- so is the rate of death from Heart attack (myocardial infarction). Risk factors you can change include smoking, lack of exercise, poor nutrition and stress. People with diabetes or high blood pressure should always follow their doctor's recommendations for prevention and treatment of CAD.

How CAD Develops
Atherosclerosis, or hardening of the arteries, can occur in the coronary arteries when they become clogged with deposits of plaque. These deposits narrow the arteries, so less blood can flow through them. As the blood supply decreases, the heart muscle receives less oxygen and is unable to pump efficiently.

A myocardial infarction or heart attack occurs when heart muscle is permanently damaged because it cannot get oxygenated blood. A heart attack may be very serious, even fatal, or it may be unnoticed by the patient, depending on the amount of heart muscle affected. You might experience a massive attack with mild or no symptoms, or you could have terribly severe symptoms without sustaining a great deal of heart damage. You should know that men and women [link to men/women heart attack symptoms] experience heart attack symptoms differently, and may even have different symptoms.

About Heart Surgery
Coronary artery bypass surgery has been performed for many, many years. Over 300,000 of theses procedures are performed annually in the United States. Patients who are not candidates for medical treatment or angioplasty are generally referred for bypass surgery. At ARMC, we frequently see patients with many critical medical conditions co-existing with complex coronary artery disease. Eighty percent of our surgical patients have just been admitted to the hospital with an acute cardiac event. Our patients range in age from the 30s all the way up into the 90s. Despite the complexity of our surgical patients we have established a tradition of excellent clinical outcomes.

A recent advance in coronary artery bypass surgery is off-pump (“OPCAB”) surgery – also called “beating heart” bypass. In this surgery, patients are not hooked up to a cardio-pulmonary bypass machine -- a machine that keeps your organs functioning during surgery. There are certain subsets of patients who we believe clearly benefit from this technique. Because we offer both the standard and the OPCAB techniques, we can ensure surgery meets each patient’s individual needs. Tailoring treatment to each patient, we try to ensure the best outcome.

During coronary artery bypass, a patient will donate a blood vessel from another part of his or her body. This donated blood vessel is used to “bypass” the clogged artery or arteries leading to or from the heart. The most commonly used arteries are the mammary artery, radial artery or the greater sphenoid vein from the leg. For many years, removing this particular vein meant creating a series of long incisions up and down one or both legs. Unfortunately, these incisions were often a source of postoperative pain or even infection. In our efforts to improve recovery we initiated our Endoscopic Vein Harvesting Program. This minimally invasive approach allows us to remove the vein through a small two to three cm incision. The great benefits of this technique include a better cosmetic result, less pain, earlier ambulation and a dramatic reduction in the incidence of infection. Although some patients are not candidates for this procedure, we have been able to take this approach in over 90% of patients.

Clinical Outcomes
Over the years ARMC has established a tradition of excellent clinical outcomes in coronary artery bypass surgery. ARMC carefully tracks and records morbidity and mortality results. Since our inception in 2001, cardiac surgical mortality statistics have been superior. In fact, ARMC Has been recognized by the New Jersey Department of Health and Senior Services as having the lowest mortality rate in the state for our first full year of operation in 2002.

Each patient who has bypass surgery is different. The Society of Thoracic Surgeons (STS) has identified certain risk factors that can make bypass surgery more difficult for some subsets of patients. The STS , based on careful analysis of clinical data, has established expected mortality rates for patients undergoing bypass surgery. These expected rates take into account age, the presence of such complicating factors as obesity or diabetes, and other factors. The actual (or observed) mortality rate for ARMC has consistently been less than the calculated (or expected) mortality rate. This indicates that our patients have done much better than would be expected based on a careful analysis of the condition going into surgery. ARMC mortality statistics surpass the STS averages as well as those of several nearby centers in New Jersey and Philadelphia.

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Valvular Disease and Treatment

When valves aren’t working as they should, surgical options include repair and replacement. The heart has four valves: mitral, aortic, tricuspid and pulmonary. These valves normally function like little doors: they open wide to allow blood to flow easily through to the next chamber, and close tight to prevent blood in the heart from traveling in the wrong direction. People may be born with a malformed valve; sometimes they develop rheumatic fever as a child with the same result; and sometimes, for unknown reasons, a valve malfunctions. The two conditions of a malfunctioning valve are stenosis and insufficiency.

Stenosis refers to the narrowing of a heart valve because of a build-up of calcium (and other substances normally found in blood). Calcium and other debris build up on the door-opening parts of the valve, or leaflets. These deposits keep the leaflets from opening as widely as they should and once could. The hole the blood must pass through when the leaflets are open becomes progressively smaller. The problem is that the heart still must pump the same amount of blood through a smaller and smaller opening.

Normally, when valve leaflets close, they stay shut. This ensures that blood flows through the heart in one direction only. When a valve does not close tightly, it is called valvular insufficiency, or leakage. This leakage may allow blood to travel the wrong way.

More than one valve can be affected by stenosis or leakage. Sometimes one valve might be affected by stenosis while another experiences leakage. Very often, valves can be repaired and function very well after surgery. When a valve can’t be repaired, it is removed and replaced with a prosthetic (artificial) valve made of metal or plastic. These are also called mechanical valves. New options in valve replacement include bioprostheses, or natural tissue valves taken from animals.

The decision to replace a valve with a mechanical or tissue valve depends on a patient’s ability to take a blood thinner called Coumadin (warfarin). This blood thinner keeps clots from developing around the valve.

Valve Surgery
Minimally invasive valve surgery is now available at ARMC. Through our affiliation with New York University Medical Center, patients in South Jersey have access to the most advanced and innovative techniques. The Department of Cardiac Surgery at New York University Medical Center – which ARMC’s heart surgeons are members of – has pioneered minimally invasive valve repair and replacement.

There are three ways to replace valves that leak or are narrowed. At the Heart Institute at ARMC, we offer the most effective and advanced valve repair and replacement techniques.

Repair
Whenever possible, surgeons prefer to repair a valve rather than replace it. The most common kind of repair involves sewing a ring around the entrance to a valve to improve its size or shape. Another involves cutting tissue to let leaflets open or close better. When repair isn’t possible, the valve will be replaced.

Replacement with a Mechanical Valve
Mechanical valves are made of metal or carbon. There are many designs. They can last for decades. But blood tends to stick to them, forming clots. So if you receive a mechanical valve, you have to take blood thinner or anticoagulant medication for life to prevent blood clots.

Replacement with a Tissue Valve
A tissue valve usually comes from a pig or a cow. Blood usually does not clot on tissue valves. So most patients getting tissue valves need to take blood thinners for only a few weeks or months. However, because tissue valves may wear out faster than mechanical valves, they may have to be replaced sooner.

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Aortic Diseases and Treatment

The aorta is the largest artery in the body. Blood leaves the heart and enters the aorta to start its course through the body. In some people, the aorta can be the source of serious life-threatening medical conditions. The aorta can become abnormally enlarged, which weakens the blood vessel’s walls. This condition is called aortic aneurysm. The main danger of an aneurysm is the risk of rupture resulting in sudden death. Aneurysms may develop in any part of the aorta. If and when an aneurysm grows to a certain size, surgery is needed. In this procedure, the aorta is replaced with a permanent, artificial Dacron graft.

More information about Aortic Aneurysm is available in our Health Library »

Another life threatening condition of the aorta is called an aortic dissection. An aortic dissection is a tear in the lining of the aorta. This tear allows blood to flow through the walls of the aorta. The two major types of aortic dissection, type A and type B, are defined by the location of the tear. Type B dissections are initially treated with strict blood pressure control and careful monitoring. If complications develop, surgical intervention is often necessary. Type A dissections almost always require emergency surgery.

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What to Expect Before and After Surgery

Before Surgery

Before surgery, you will meet with your surgeon to discuss the findings of your cardiac catheterization and the planned surgical procedure(s) and to have some diagnostic testing done. During this period, you will also view a video on the planned procedure that will help you and your family to better understand your condition. Please feel free to ask questions. If you will be coming into the hospital from home on the day of your surgery, we have provided a printable pre-surgical checklist of things to bring to the hospital on the day of your operation.

After Surgery

Here is a printable summary of what to expect immediately after surgery, including postoperative instructions checklist for when you are discharged from the hospital.

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For more information:

Information about Cardiac Surgery at the Heart Institute
609-748-7089

General Information about the Heart Institute at ARMC
1-888-569-1000

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