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Heart Health Q&As


Q.

Am I too old for heart surgery?

A.

This is a commonly asked question. In the 1990's, 80 years old was widely considered the upper limit of age for patients to undergo open heart surgical procedures such as coronary artery bypass grafting and valve repair or replacement. Today, however, improved healthcare has allowed people to not only live longer, but to be far more active and functional in their 80's and even mid 90's. So the focus on surgical eligibility has shifted from looking only at chronologic age, to looking at functional age. Many people in their mid 90's are active and highly functional, and can tolerate heart surgery well, particularly as the procedures and care techniques have advanced. Today, a 90 year old can undergo aortic valve replacement through a minimally invasive approach: a small 2-3 inch incision strategically placed to minimize pain, and optimize both recovery and cosmetics, leaving the hospital on the 3rd or 4th postoperative day and early return to full activity.

˜Dr. Robert Helm, Cardio Thoracic Surgeon at the Heart & Vascular Institute


Q.

Besides Coronary Artery Bypass Grafting (CABG), what other treatment options are available to a patient with narrowed or blocked arteries?

A.

A severely narrowed coronary artery may need treatment to deflect the risk of a heart attack. Coronary bypass surgery is one form of treatment, but there are others: Angioplasty, which opens narrowed arteries, is performed by interventional cardiologists. They use a small balloon-tipped catheter that they inflate at the blockage site to flatten the plaque against the artery wall. A stent procedure is used in conjunction with balloon angioplasty. It involves implanting a mesh-like metal device into an artery at a site narrowed by plaque. The opened stent keeps the vessel open and stops the artery from collapsing. Atherectomy may be an option for certain patients who cannot have balloon angioplasty. A high-speed drill on the tip of a catheter is used to shave plaque from artery walls. Laser ablation uses a catheter that has a metal or fiber optic probe on the tip. The laser uses a light to “burn” away plaque and open the vessel enough so that a balloon can further widen the opening.

˜ Dr. Mark Jacobs, Cardiologist at the Heart & Vascular Institute


Q.

I have been told that I have an Abdominal Aortic Aneurysm (AAA), what does that mean?

A.

An AAA has a genetic predisposition of 15-25%. Other risk factors include male, over 65 years of age and smoking. Fortunately the U.S. Congress added a Medicare benefit for free, one-time AAA screening with ultrasound for men who have smoked and for both men and women with a family history of AAA.

Dr. Victor Kim Cardiovascular Surgeon at the Heart & Vascular Institute


Q.

How long does it take to recover from heart surgery?

A.

Specific recovery time frames for heart or cardiac surgery vary from person to person, depending on their procedure and their overall physical health. Generally, most patients leave the hospital 4-5 days following surgery. Most patients will continue to need the help of family, friends, and/or home nursing care during their first couple of weeks back at home. It usually takes 4-6 weeks for the breast bone and chest muscles to heal, and patients gradually return to their usual daily routine.

Dr. Donato Sisto, Cardio Thoracic Surgeon at the Heart & Vascular Institute


Q.

What are the advantages of performing cardiac catheterization using access through the wrist compared with access through the groin?

A.

Over the last few years performing cardiac catheterization and stenting using a wrist access through the radial artery has gained significant popularity among Interventional Cardiologists as well as patients. From the Cardiologist’s standpoint it has less risk of serious bleeding. From a patient’s standpoint, there is no longer the need to lie flat for a few hours which can often be uncomfortable and when the radial artery is used, patients can return home soon after the procedure.

Dr. Salman Ghiasuddin, Cardiologist at the Heart & Vascular Institute


Q.

Why do I need Coumadin for Atrial Fibrillation (AFib)?

A.

Atrial fibrillation is a major cause of stroke. The stroke risk is based on the presence of AFib as well other risk factors that may increase the likelihood for stroke. These other risk factors include: age over 65, the presence of hypertension or diabetes, congestive heart failure, vascular disease, and female sex. The presence of atrial fibrillation without any of these risk factors confers a less than 1% annual risk of stroke and would not indicate the need for oral anticoagulation. However as the number of risk factors increase the stroke risk increases significantly and Coumadin or one of the novel oral anticoagulants (Pradaxa, Eliquis or Xarelto) are recommended which can reduce the risk of stroke by almost 80%.

- Dr. Peter Dourdoufis, Cardiologist at the Heart & Vascular Institute


Q.

My doctor told me I have coronary artery disease and blockages that should be fixed. I've heard that there are different ways of doing this surgery. How do I choose what's best?

A.

Restoring blood flow to the heart is a critical step to ensure health in individuals with coronary artery disease. Your cardiologist may recommend a specific way to accomplish this, based on research and data that has been published. In some cases, the decision is complex and is best addressed by a team of physicians including the cardiologists who place stents and the surgeons who perform bypass surgery. In these cases, receiving care at a hospital that provides all levels of care can help ensure that the best decisions are made.

Dr. Jeff Colnes, Cardiologist at the Heart & Vascular Institute


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