High-Risk Cardiac Surgery/Redo Cardiac Surgery

Like all procedures, most cardiac surgeries are major and carry potential risks. However, the risk is significantly higher in patients with other diseases or conditions, such as diabetes, kidney disease, lung disease or peripheral artery disease. Risks vary depending on the heart problem, types of surgery and the patient's overall health.

What Is a High-Risk Cardiac Procedure?

Surgeons perform cardiac surgery to address various heart conditions when lifestyle changes, medications or other treatments are no longer effective in treating symptoms. Over two million people of all ages worldwide undergo open-heart surgery to treat different heart problems.

The type of surgery depends on the specific heart issue, ranging from minimally invasive procedures to open-heart surgeries, which might require a more extended recovery period. Candidates for cardiac surgery undergo tests to help surgeons determine the most suitable type of procedure to address a condition. Through cardiac surgery, surgeons can:

Repair or replace heart valves that regulate blood flow through the heart
Fix abnormal or damaged structures within the heart
Implant medical devices to help control the heartbeat or support heart function and blood flow
Replace a damaged heart with a healthy donor heart

Cardiac surgery has evolved and improved over the years, reducing symptoms and improving quality of life and chances of survival. However, as with any heart surgery, there are some risks. The potential for complications is generally significant in high-risk cardiac surgery and redo-cardiac surgery, which remain some of the most challenging procedures in the field.

High-risk cardiac surgery refers to procedures and interventions performed on patients with a significant risk of complications due to the complexity of the procedure or the patient's underlying conditions. Some examples of high-risk cardiac surgery include:

Aortic Surgery: There are two ways to treat an aortic aneurysm surgically. Open aortic surgical repair is the most common type of surgery for aneurysms. It involves making a large incision in the abdomen or chest to remove the aneurysm and replace it with a graft, usually a leak-proof polyester tube. Endovascular aneurysm repair is a less invasive alternative, which involves making a smaller incision, often in the groin, to guide a stent graft to the aneurysm site to prevent blood from entering. This procedure is performed via cardiac catheterization. Aortic surgery is a high-risk cardiac surgery due to the potential for significant blood loss and complications.

Peripheral Vascular Surgery: Revascularization is a procedure used to restore blood flow through the arteries in the legs. Two types of revascularization are used to treat peripheral vascular disease (also called peripheral arterial disease). Angioplasty involves widening a blocked or narrowed artery by inflating a tiny balloon inside the blood vessel. In contrast, an artery bypass graft uses blood vessels from another part of the body to bypass a blockage in an artery. Procedures to repair or bypass blocked arteries outside of the heart, such as in the legs, can be high-risk, especially in patients with other health issues.

Redo cardiac surgery involves performing a second or subsequent cardiac procedure on a patient who has previously undergone heart surgery. Cardiac reoperations are more challenging than initial surgeries due to scar tissue and adhesions, which increase the risk of injuring nearby vital structures. Additionally, patients needing reoperations have more severe heart conditions and other health issues, making them less resilient than those undergoing their first surgery.

These procedures, along with prolonged surgeries with significant blood loss and emergency surgeries, are high-risk heart procedures that require careful preoperative cardiac assessment and planning to minimize risks and ensure the best possible outcomes.

Who Is at High Risk for Heart Disease?

A person's risk for heart disease depends on various factors; some are reversible, while others are not. Risk factors are traits and lifestyle habits that increase the likelihood of developing a disease and can vary from one person to another. Preventing heart disease begins with understanding a person's risk factors and taking steps to reduce them.

Risk factors for heart disease include:

High blood pressure
High blood cholesterol
Overweight or obesity
Prediabetes or diabetes
Smoking
Physical inactivity
Family history of early heart disease
History of preeclampsia (a sudden rise in blood pressure and too much protein in the urine during pregnancy) or early menopause
Unhealthy eating behaviors
Women age 55 or older
Men age 45 or older

The more of these risks a person has, the higher the risk of developing heart disease.

What Tests Are Done for Cardiac Clearance?

Cardiac clearance, often part of a preoperative evaluation before noncardiac surgery, involves a physical exam, blood tests, X-rays and an electrocardiogram (ECG) to assess heart health. These evaluations help determine the risk of heart-related issues during surgery. A cardiac clearance cannot guarantee a complication-free operation, but it allows surgeons to prepare for potential heart-related risks and have contingency plans.

Find a Cardiovascular and Thoracic Surgeon in San Antonio

Heart care is a journey better taken together. When it comes to your heart health, finding the right partner in care is crucial. The cardiovascular and thoracic team at Cardiovascular and Thoracic Surgical Institute of Texas, a member of Baptist Medical Network in San Antonio, combines experience and compassionate care to help you understand your risk or explore solutions to treat or manage symptoms if you already have a cardiovascular condition.

Whether you need heart surgery, lung procedures, or vascular interventions, Let us help you navigate your journey to better health. To connect with our patient navigator, call 210-798-4311 or find a cardiovascular and thoracic surgeon here. Please don't delay care.

Takeaways

Although high-risk and redo cardiac surgeries are some of the most challenging procedures in cardiac care, advanced technology and careful patient selection and planning may help improve the quality of life of patients at the most risk of heart-related complications.