• Abdominal Aortic Aneurysm Repair (AAA Repair)

    Why is the doctor performing this surgery?

    To repair a weakened portion of the aorta located in the abdomen. The aorta is the largest artery in the body. It carries oxygen-rich blood from the heart to the rest of the body, including the abdomen. The weakened aorta can balloon out, becoming thin, large, and fragile. This ballooning is called an aneurysm. As it progresses, there is risk of rupture, with massive internal bleeding.

    What is the surgery?

    Traditional AAA Repair is an open-abdomen (or open-chest) surgery. The bulging aneurysm part of the aorta is removed, an artificial graft is put in its place, and the remaining aortic end-pieces are reattached to the graft. Alternatively, a less invasive surgery involves placing a stent graft to cover the aneurysm. Blood flows thru the stent, entirely bypassing the aneurysm, thus preventing rupture, and excludes the aneurysm from the circulation. This less invasive procedure can decrease length of stay and recovery time significantly.

    Where is the surgery performed?

    In the Operating Room (OR), under general anesthesia.

    How long does this surgery take?

    AAA Repair usually takes 3-5 hours.


    Peripheral Bypass Surgery

    What does "bypass surgery" mean?

    Bypass surgery is a surgically constructed new route around an area of blockage or narrowing and can be performed on any artery in the body, but most often is performed on the femoral arteries in the groin, or the popliteal arteries behind the knee. During bypass surgery, a graft vein or artery is taken from a healthy blood vessel in the body (sometimes an artificial graft is used). The graft is then surgically attached above and below an obstructed or poorly functioning artery. After surgery, the blood will flow thru the graft vessel, avoid or "bypass" the blocked vessel, and provide oxygen and nutrients necessary for survival to the area of tissue beyond the blockage.

    Why is the doctor performing this surgery?

    To bypass, or go around, the obstruction caused by an artery filled with a clot or with plaque (atherosclerosis). In the groin and/or legs, decreased blood flow (therefore, decreased oxygen and nutrients) causes painful muscle cramping and spasms, known as claudication. Claudication can progress to constant pain, cold legs and feet, sores, and even gangrene. If the condition is not treated adequately with medications, exercise, and quitting smoking, surgery is necessary.

    What is the surgery?

    Two common vascular bypass surgeries performed include:

    • Femoral-Popliteal Bypass - The femoral arteries in the groin, and the popliteal arteries behind the knees, can both be areas of atherosclerotic plaque build-up. A healthy graft vessel is taken from elsewhere in the body (often the saphenous vein in the leg) and is attached to the femoral artery above the narrowing. The other end is attached to the popliteal artery behind the knee below the narrowed area. The blood will then flow easily thru this new vessel, and avoid the plaque obstruction in the groin.
    • Aorto-Bifemoral Bypass - If the plaque build-up is higher up in the femoral arteries or in the iliac arteries, a different surgical bypass is necessary. This bypass requires an artificial graft that is shaped like an upside-down Y. The top part is attached to the aorta, and the bottom two pieces are attached to the femoral or iliac arteries, beyond the plaque obstruction. The blood will then flow from the aorta, into the graft, branch into two graft conduits, then back into the patient's own femoral or iliac arteries, and continue down the arteries of the legs.

    Where is the surgery performed?

    In the Operating Room (OR), under general anesthesia.

    How long does this surgery take?

    Femoral-Popliteal Bypass and Aorto-Bifemoral Bypass each take 2-4 hours.


    Coronary Artery Bypass Surgery (CABG)

    What does "bypass surgery" mean?

    Bypass surgery can be performed on any artery in the body, but most often involves the coronary arteries (the arteries that supply blood to the heart muscle itself). During bypass surgery, a graft vein or artery is taken from a healthy blood vessel in the body. The graft is then surgically attached above and below an obstructed or poorly functioning artery. After surgery, the blood will flow thru the graft vessel, avoid or "bypass" the blocked vessel, and provide oxygen and nutrients necessary for survival to the area of tissue beyond the blockage.

    Why is the doctor performing this surgery?

    To bypass, or go around, the obstruction caused by a coronary (heart) artery filled with a clot or with plaque (atherosclerosis). If the obstruction is not bypassed, the heart muscle beyond the obstruction is denied oxygen and nutrients leading to heart damage (heart attack or chest pain).

    What is the surgery?

    There are two types of Coronary Artery Bypass Surgeries (CABGs) routinely performed:

    • On Pump - On Pump CABG is also known as "Traditional Bypass Surgery". The pumping and oxygenation function of the heart is taken over by a heart-lung machine during the surgery, and medications are given that briefly paralyze the heart (cardioplegia). This way, the heart is completely at rest while the surgeon performs the bypass surgery.
    • Off Pump/Beating Heart - Off Pump CABG is also known as "Beating Heart Bypass Surgery" and is another method of bypass surgery. A heart-lung machine is not used, and the heart is not stopped with medications. Instead, the heart continues to perform its pumping and oxygenation functions while the surgeon works. The surgeon stabilizes just the portion of the heart where the bypass is needed, while the remainder of the heart continues to function normally. According to the Journal of the American Heart Association, off-pump bypass, in the appropriate patients, is as safe and effective as standard on-pump coronary bypass surgery, and many healthcare professionals, including our surgeons believe it may reduce the risk of stroke, bleeding and renal failure. Off-pump bypass is not for everyone, and there is no long-term data available about outcomes…yet. However, it is a highly effective surgical option which you can discuss with your doctor.

    There are four sources used during bypass surgery for the healthy graft blood vessel:

    • Endoscopic Vein Harvesting - The saphenous vein in the leg is the most common vein used as a bypass graft. Traditionally, the saphenous vein was obtained via a long incision in the leg, from groin to ankle. Contrary to popular perception, this usually presents the highest degree of post-procedural pain. This new endoscopic technique requires only two or three 1-inch long incisions in the leg. An endoscope connected to a video camera is then inserted into the smaller incisions and the saphenous vein is removed with far less scarring and trauma. This technique is only available in select centers throughout the US.
    • Arterial Bypass - There are several arteries that can be used as grafts for bypass surgery, but the most common is the left internal mammary artery (LIMA). The right internal mammary artery (RIMA) may also be used as a graft. These arteries are accessed thru the same chest incision used to access the heart. Occasionally, the radial (in the arm) or the gastroepiploic (near the stomach) arteries may be used, each accessed thru separate incisions.
    • Donor Saphenous Vein: This is a vein that has been cryopreserved and stored in a tissue bank. It is blood type specific for the patient.

    Where is the surgery performed?

    Both On-Pump and Off-Pump/Beating Heart surgeries are performed in the Operating Room (OR), and under general anesthesia.

    How long does this surgery take?

    The length of time surgery takes will vary based on the number of vessels being bypassed, the graft location, On-Pump vs. Off-Pump/Beating Heart procedure, the patient's associated medical problems, etc, but usually an On-Pump or Off-Pump/Beating Heart surgery will take between 3-6 hours.


    Carotid Endarterectomy (CEA)

    Why is the doctor performing this surgery?

    To remove plaque buildup (atherosclerosis) in the carotid arteries, which supply the brain with vital oxygen and nutrients. Removing this plaque can ultimately prevent a Stroke.

    What is the surgery?

    CEA is neck surgery to strip the inner lining of a carotid artery of obstructive plaque. The surgeon first makes an incision in the neck to access the narrowed carotid artery. Then the artery is opened and the plaque is removed. Finally, the artery is sutured back together. Once the plaque is removed, the artery diameter is wider, and blood can flow to brain tissue freely.

    Where is the surgery performed?

    In the Operating Room (OR), under general anesthesia.

    How long does this surgery take?

    Carotid Endarterectomy usually takes 1-2 hours.


    Valve Repair Surgery

    Why is the doctor performing this surgery?

    To repair a poorly functioning heart valve. Properly functioning heart valves are essential to direct the flow of the blood thru the heart, and to maintain a normal workload for the heart. The most common heart valve surgically repaired is the mitral valve. The tricuspid and aortic valves may also be repaired.

    What is the surgery?

    Valve Repair Surgery is an open-heart procedure to fix a poorly functioning heart valve, often without the need for mechanical or biologic parts. Fused valve leaflets may be separated (called a Commissurotomy); calcium deposits hindering valve function may be removed; pieces of floppy/weak valve leaflets may be removed (called a resection); and holes or tears in valve leaflets may be patched.

    Sometimes a mechanical (synthetic/man-made) ring may be necessary to reshape and tighten the valve opening.

    Where is the surgery performed?

    In the Operating Room (OR), under general anesthesia.

    How long does this surgery take?

    The length of time surgery takes will depend on the valve being repaired, the repair that must be done, the patient's underlying medical condition, etc, but a good estimate is 2-3 hours.


    Valve Replacement Surgery

    Why is the doctor performing this surgery?

    To replace a poorly functioning heart valve. The valve can be narrowed and obstruct blood flow (called stenosis), or it can be floppy/leaky (called insufficiency). Properly functioning heart valves are essential to direct the flow of blood thru the heart, and to maintain a normal workload for the heart. The most common heart valves surgically replaced are the mitral valve and the aortic valve.

    What is the surgery?

    This surgery is an open-heart procedure to remove the poorly functioning (either stenotic or insufficient) valve, and replace it with either a mechanical (synthetic/man-made) or a tissue (biologic/from another organism) valve. The pumping and oxygenation function of the heart is taken over by a heart-lung machine during the surgery, and medications are given that briefly paralyze the heart (cardioplegia). This way, the heart is completely at rest while the surgeon performs the replacement surgery.

    Please note: Patients receiving a mechanical valve replacement will be required to take a blood-thinning medication called Coumadin (an anticoagulant) daily for life to prevent blood clots from forming on the prosthetic valve.

    Where is the surgery performed?

    In the Operating Room (OR), under general anesthesia.

    How long does this surgery take?

    The surgery length of time will vary based on which valve is replaced, the type of replacement valve, the patient's underlying medical condition, etc, but a good estimate for Valve Replacement Surgery is 3-6 hours.