Diagnosis and treatment

Routine procedures carried out by the unit include:

• Coronary artery bypass grafting
• Coronary angioplasty
• Aortic valve surgery

Specialised procedures carried out by the unit, on patients who are suitable for treatment, include:

• Aortic surgery
• Off-pump surgery
• Heart failure surgery

Coronary artery bypass grafting

This is an operation to bypass a narrowed section or sections or coronary arteries and improve the blood supply to the heart.

The surgeon does this by grafting a blood vessel between the aorta (the main blood vessel leaving the heart) and a point in the coronary artery beyond the narrowed or blocked area.

Doctors can carrying out a bypass graft for each of the main coronary arteries affected – so most people might have three, four or sometimes more grafts.

In most cases at least one of the blood vessels used for the graft is made using an artery from inside the chest. Blood vessels from other parts of the body might also be used – usually from the leg or an artery in the arm.

Normally, the surgery will used a heart-lung bypass machine to circulate blood around the body while the operation is taking place. Your heart will temporarily be stopped - and will be started again once the blood supply is restored.

According to a Healthcare Commission survey up to 2005, patients who have this type of surgery at the Wessex Cardiac Unit have a 'better than expected' survival rate – just over 99 per cent.

Coronary angioplasty

This is a technique for treating coronary artery disease first used in 1977. About 45,000 angioplasties are done every year in the UK.

Coronary angioplasty squashes the fatty tissue in the narrowed artery, allowing the blood to flow more easily. Sometimes it is done as a planned procedure, sometimes it has to be an emergency operation.

During the operation, a catheter (a find, flexible, hollow tube) with a small inflatable balloon on the end is passed into an artery either in your groin or your arm.

The operator then used an x-ray to direct the catheter to a coronary artery until its tip reaches the narrowed or blocked section. The balloon is then gently inflated to that it squashes the fatty tissue responsible for the narrowing.

The catheter contains a 'stent' – a short tube of stainless steel mesh. As the balloon is inflated, the stent expands so that it holds open the narrowed blood vessel. The balloon is then let down and removed, leaving the stent in place.

Aortic valve surgery

If your heart valves are severely affected by disease, you may be advised to have valve surgery. This can get rid of, or greatly improve your symptoms.

There are two types of valve surgery:

• Valve replacement is when the diseased heart valve is replaced with another valve. The most common types of replacement are manufactured valves or animal valves. In some cases, a preserved human valve may be used.
• Valve repair is most often used for valves which leak but which are not seriously damaged.

During the operation, the heart is stopped and the blood circulation is kept going by a heart-lung bypass machine. The surgeon then opens up a heart chamber to reach the affected valve.

According to a Healthcare Commission survey, patients who have this type of surgery at the Wessex Cardiac Unit had a 'better than expected' survival rate between 2002 and 2005 – at just over 98 per cent. Between 2004 and 2005 there was an 'as expected' survival rate of just over 97 per cent.

Off-pump surgery

This is sometimes also known as beating heart surgery. It is when the doctor performs surgery without stopping the heart and linking you up to a heart-lung bypass machine.

Surgery is carried out on the beating heart through a wound along the chest bone. The doctor may use drugs to slow the heart down and will probably use specialised equipment to prop the heart in a position that will allow them to work on it.

Heart failure surgery

This is surgery on patients who have an inadequate pumping action in their hearts.

Heart failure surgery involves removing pieces of damaged heart muscle that do not move properly when the heart beats. This 'downsizes' the heart back to a more normal size and shape.