• Cardiothoracic Surgery

  • Heart & Vascular Surgeries Performed at St. Anthony Hospital

    Should your physician recommend heart or vascular surgery, St. Anthony Hospital is ready with the comprehensive care you need and deserve. Our Heart and Vascular program brings together highly skilled specialists, award-winning services, the advanced technology of our state-of-the-art facility and a dedicated cardiovascular ICU. We are also innovators in new procedures and approaches to care that assure optimal outcomes.  The information provided here is for educational purposes only. Your health care provider will provide information specific to your condition.

  • Coronary Artery Bypass Surgery (CABG)

    What is a coronary artery bypass surgery?

    While bypass surgery can be performed on any artery, the coronary arteries—those supplying blood to the heart muscle—are the most common site. The surgery involves removing a healthy vein or artery from another area of the body and then surgically grafting it below or above the artery that is not functioning correctly. This allows the blood to “bypass” the blocked vessel.

    The two types of coronary artery bypass surgeries (CABGs) are:

    • On Pump – Known as "traditional bypass surgery,” this type employs a heart-lung machine during the surgery to replace the natural pumping and oxygenation function of the heart. Medications are given, as well, so the heart can be completely at rest during the surgery.
    • Off-Pump/Beating Heart – Also known as "beating heart bypass surgery," this approach does not use a heart-lung and the heart is not stopped with medications. Instead, the surgeon stabilizes only the area of the heart where the bypass is required. The Journal of the American Heart Association reports that off-pump bypass, in the carefully selected patients, is as effective and safe as the on-pump option. Additionally, many experts believe this approach can reduce the risk of bleeding, renal failure and stroke.

    Both types of coronary bypass surgery are performed in the operating room under general anesthesia. Surgical times vary by individual, but generally are from two to six hours.

    What types of graft sources are used in a bypass surgery?

    The most common vein used in a bypass graft is the saphenous vein from the leg. This can be harvested endoscopically with small incisions for less scarring and pain. Other options include either the left or right mammary artery, the radial artery from the arm, and the gastroepiploic artery near the stomach. In some instances, a surgeon will use a donor saphenous vein from a tissue bank or a sutureless anastomic device. Such devices are inserted through a small hole in the patient’s aorta, then deployed to release a tiny wire web that serves as a rivet in the repair process.

    Why is heart valve replacement surgery important?

    When heart valves function poorly—either due to narrowing (called stenosis) or leakage (called insufficiency), blood flow is compromised and the heart has to work harder.  Replacing the problem valve can resolve this. The aortic valve is the heart valve most commonly replaced. The mitral valve can be replaced, but usually requires only repair.

    During valve replacement surgery, a heart-lung machine replaces the natural pumping and oxygenation function of the heart. Medications are given, as well, so the heart can be completely at rest during the surgery.

    • Aortic Valve Replacement

    The aortic valve can fail to function properly because of a congenital abnormality (abnormal from birth) or due to an acquired disease or aging.  In the normal heart,

    This valve opens during systole (when the ventricle squeezes blood out into the aorta to flow to the rest of the body). Narrowing or obstruction makes the ventricle work harder and, over a period of time, require extra blood flow to the heart, itself. When blood flow is insufficient, fatigue, shortness of breath and chest pain (angina) can occur. Also, if the heart can’t keep up with the requirements, fluid will begin to collect in the lungs, leading to congestive heart failure.

    A similar problem arises when the aortic valve leaks. While the heart generally can compensate for this extra workload for some time, eventually it will begin to fail. Shortness of breath and fatigue are signs this is happening.

    The valve used for replacement in such cases is called a prosthetic valve. Two types may be considered, depending upon the individual’s medical needs:

    • Mechanical valves are crafted from very durable man-made materials. Because clots tend to form on mechanical valves, blood thinners (anticoagulants) are generally required for the rest of the individual’s life.
    • Bioprosthetic valves are tissue taken from pig, cow or human donors.

    These generally do not last as long (10-15 years, on average), but anticoagulants are usually not needed. For most patients age 65 and older, a bioprosthetic valve is recommended.

    Why is heart valve repair surgery important?

    A heart valve that functions poorly compromises the flow of blood through the heart and increases the heart’s normal workload. While all three types of heart valve—the mitral, aortic and tricuspid—can be repaired, the mitral valve is the one most commonly corrected in this way. In most cases, no mechanical or biologic parts are required. Instead, surgeons use the procedure to:

    • Separate fused valve leaflets (commissurotomy)
    • Remove calcium deposits that hinder valve function
    • Remove pieces of valve leaflets that are floppy or weak
    • Patch or repair holes or tears in valve leaflets

    In some cases, the surgeon uses a synthetic ring to tighten or reshape the valve opening.

    Until recently, heart valve repairs required an open-chest procedure. Now, minimally invasive surgery is an option for many patients. Minimally invasive mitral heart valve repair surgery is being performed at St. Anthony Hospital.

    Several heart procedures that once required open surgery can now be performed with minimally invasive techniques at St. Anthony Hospital. Our cardiothoracic surgeons regularly perform minimally invasive heart valve repair and replacement surgeries using specialized instruments and without dividing the breastbone.  Instead, a two-inch keyhole incision is made in the patient's chest and the procedure is performed laparoscopically.

    Minimally invasive surgery is often an option for the individual requiring repair or replacement of only one valve.

    What is the TAVR procedure?

    A transcatheter aortic valve replacement (TAVR) procedure is a minimally invasive option. Instead of removing the damaged heart valve, surgeons use small catheters to deliver a replacement valve to the site. Once in place, the new valve is expanded to wedge into the old aortic valve’s position. This works something like a stent, pushing the old valve leaflets aside and allowing the new valve to regulate blood flow.

    When a thoracic aortic aneurysm becomes large, causes symptoms or appears to be expanding rapidly, repair is needed to reduce the risk of a life-threatening rupture. During the procedure, the surgeon repairs the weakened area using a man-made graft.

    Depending on the size and location of the aneurysm, the repair may be made by open surgery or a less-invasive method called endovascular repair. 

  • Cardiac & Thoracic Surgery Associates

    Schedule: 1-800-204-9896
    Website: ctsurgery.com

    Cardiothoracic Surgeons

    Jason Fitzgerald, MD
    Jason Fitzgerald, MD, FACS
    Board-Certified: Thoracic Surgery
    Full Bio

    John Mehall, MD
    John Mehall, MD, FACS
    Board-Certified: Thoracic Surgery
    Full Bio  

    Patrick Rudersdorf
    Patrick Rudersdorf, MD
    Board-Certified: Thoracic Surgery & General Surgery
    Full Bio

    Nurse Practitioners & Physician Assistants:
    • Christine Birchem, PA-C
    • David Cookish, PA-C
    • Joshua Cross, PA-C
    • Jonathan Degner, PA-C

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