In this article

Drug treatments Heart surgery

Heart transplant Rest and recovery

Sometimes medication can't control all the symptoms of heart disease. Surgery may be needed to open or replace the blocked arteries, repair damaged valves or simply keep the patient alive.

Common operations for heart disease include:

Coronary angioplasty

Coronary angioplasty, or percutaneous transluminal coronary angioplasty (PTCA) to give it its full technical name, is used to treat coronary heart disease.

It involves passing a long, thin, hollow tube or catheter up into the coronary arteries, under x-ray guidance, from an artery in the groin or arm (under local anaesthetic.) A device on the tube is then used to unblock the artery, and stretch the artery walls so that more blood and oxygen can flow to the heart muscle.

Angioplasty may be recommended if angina cannot be controlled with drugs, if angina is limiting a person's life, or when a person gets angina just sitting in a chair at rest.

PCTA may be performed as an emergency when someone is having a heart attack. If carried out soon enough it can open the blocked coronary artery before permanent damage is done to the heart muscle. But it can only be performed in a specialist hospital, so it's not an option for most people having a heart attack.

Types of angioplasty

Balloon angioplasty, often known simply as balloon treatment, was the first type of angioplasty. On the end of the tube or catheter is a small, sausage-shaped balloon. The balloon is inflated in the blocked artery, compressing the fatty build-up (atheroma) against the artery walls. The surgeon then deflates the balloon and removes it.

Another common type of angioplasty involves inserting a short stainless steel mesh tube, called a stent, at the same time as the balloon. As the balloon is deflated, the expanded stent is left in place to help keep the artery open.

This method helps to prevent the problem of reblockage (restenosis), which affects around a third of people following conventional balloon treatment.

Recently, doctors have begun to use stents that incorporate drugs to help prevent reblockage.

Doctors are also trying a number of newer ways to perform angioplasty. They're using devices to cut or drill out fatty deposits, vaporise them with a laser, or blast them with ultrasound.

But, as yet, these techniques haven't been proven to be better than the standard balloon or stent method. While they're being tested and developed in some centres in the UK, they're not routinely available.

Coronary bypass surgery

Coronary bypass surgery, medically known as coronary artery bypass graft or CABG (pronounced 'cabbage'), is an operation in which a blood vessel from another part of the body is grafted between the aorta (the main artery leading from the heart) and the coronary artery, or arteries, to bypass blockages and restore blood flow to the heart muscle.

A bypass can be done on each of the four coronary arteries if necessary, hence the terms single, double, triple or even quadruple graft, depending on how many arteries are bypassed. The operation can be done using conventional surgical techniques or by keyhole surgery (microsurgery).

While many people find this sort of surgery hugely improves their health, it's not without considerable risks.

CHD can frequently be controlled with drugs alone, but if the blood vessels have become severely narrowed, or if drug treatment is unable to control symptoms, surgery may be needed to open up or replace the blocked arteries.

Valve replacement

Diseased heart valves can be repaired or replaced with either mechanical valves or biological valves (made from human or animal tissue). Mechanical valves may last longer but usually require a person to take anticoagulant medicines because there is an increased risk of clots forming.

Cardiac pacemakers

When the electrical system of the heart becomes damaged or faulty, it may be necessary to put in an artificial pacemaker to make the heart beat regularly.

This involves on operation to put a wire into the heart, attached to an external device and battery, to deliver electrical signals to the heart.

The first experiments for pacemakers were almost 120 years ago. Some of the most recent pacemakers can deliver tiny electrical shocks to stop dangerous heart rhythms and restart the heart.

Another new type of pacemaker, known as a biventricular pacemaker (or CRT, cardiac resynchronisation therapy) paces both the main chambers, or ventricles, of the heart in synchrony. The effect is to make the heart a more efficient pump. This type of pacemaker is proving effective in treating severe heart failure.

When the heart is beyond repair, damaged by heart attacks, infection or other disease, the only answer may be to replace it with a heart from a person who has donated theirs on death.

A heart transplant may be offered for a number of reasons, when certain provisos are met:

• the heart muscle has become weakened (cardiomyopathy)
• the heart's blood vessels are blocked and the heart muscle is damaged
• apart from heart problems, the individual is in good health
• other treatments have been tried or excluded
• the individual is under 60 (in most cases)
• the individual is able and willing to stick to lifestyle changes necessary after the transplant

In the past, heart transplants sometimes failed because the person's immune system rejected the transplanted heart. But as techniques have improved and new immunosuppressive drugs have been introduced to prevent rejection, so heart transplants have become more successful. The majority of people who have a heart transplant can now expect to live for five years or more.

Even so, transplant remains an 'end-of-the-line' treatment when all else has failed and the patient is likely to die or have a poor quality of life unless it's done. Unfortunately, a shortage of donors means that a significant number of people who are waiting for a heart transplant die before one is found.

After a transplant, the individual will need to take immunosuppressive drugs for the rest of their life, to stop their body rejecting the transplant, as well as other drugs to help their body fight infections. The new heart will be monitored at regular intervals for any signs of rejection.

Despite huge advances in heart surgery techniques, recovery can be slow and, in a significant number of cases, a variety of complications ranging from infection to stroke cause long-term problems.

The length of time it takes to recover after any of the above procedures depends on the type of surgery, the type of anaesthetic administered, and the age and overall state of health of the patient. It's extremely common to be easily upset and tired for the first three to six months after surgery, so it's important to get plenty of rest.

Likewise, it's extremely important to attend a cardiac rehabilitation programme to attain your optimum level of health and to learn how to modify your lifestyle to minimise the chance of future heart problems.

For a small number of patients, depression is a persistent problem.

Forgetfulness is also common, but normal memory will usually return after about six months. In some cases, people find they have more persistent problems with aspects of intellectual function, including memory. This may be related to the use of the bypass pump used to circulate blood around the body while the heart is being operated on, which can cause tiny clots that block small arteries in the brain.

After any kind of heart surgery it's extremely important to pay attention to your lifestyle, watch your diet and become more active, both to promote recovery and to help improve the health of the heart and blood vessels.

A GP or cardiac nurse will be able to advise you. Driving should be avoided for at least a month after bypass surgery. Contact the Driver and Vehicle Licensing Agency (DVLA) for details.

This article was last medically reviewed by Dr Trisha Macnair in March 2007.
First published in June 2001.