SU26.1 | Surgery for Heart Disease — Summary & Reflection

KEY TAKEAWAYS

Surgery treats three groups of heart disease. Ischaemic (coronary) disease is revascularised by coronary artery bypass grafting (CABG) — using the internal mammary artery, vein or radial artery — preferred over angioplasty for left main and triple-vessel disease. Valvular disease is treated by repair (favoured where feasible, especially mitral) or replacement with a mechanical valve (very durable but needs lifelong warfarin, target INR ~2.5-3.5) or a bioprosthetic/tissue valve (no long-term anticoagulation but less durable); the choice depends on age, anticoagulation ability and pregnancy plans. Congenital disease is divided into acyanotic left-to-right shunts (PDA, ASD, VSD), which are closed before they reverse into Eisenmenger syndrome, and cyanotic lesions such as Tetralogy of Fallot (VSD, pulmonary stenosis, overriding aorta, right ventricular hypertrophy), corrected by closing the VSD and relieving the outflow obstruction. Most open procedures use cardiopulmonary bypass — an oxygenator and pump that take over the heart and lungs — with cardioplegia arresting the heart for a still operative field. Key investigations: coronary angiography (coronary), echocardiography (valvular and congenital).

REFLECT

Think of a patient you have seen with chest pain, breathlessness or a heart murmur, or imagine clerking one. Could you decide which of the three surgical pathways — coronary, valvular or congenital — their story points toward, and name the investigation you would request first? Now consider counselling: if your patient needed a valve replacement, could you explain in plain language the trade-off between a mechanical valve (durable but lifelong warfarin) and a tissue valve (no warfarin but wears out), and how their age and circumstances would shape the choice? Reflect on how understanding cardiopulmonary bypass changes the way you would reassure a frightened patient about how the surgeon safely stops and repairs the heart.