Cardiac catheterization is usually performed while you are awake but sedated. Your doctor will first numb the area where the catheter will be inserted, usually the groin, neck, or arm. After the area has been numbed, a needle will be used to make a small hole into the blood vessel.
Next, your doctor will insert a tapered tube called a sheath. After inserting the sheath, your doctor will insert a thin, flexible guide wire through the sheath and into your blood vessel, and then thread the wire through your blood vessel to your heart.
Once the wire reaches your heart, your doctor will use it to put the catheter in place. From that point, there are several different diagnostic and therapeutic actions your doctor can take.
If your doctor is checking for blockages, a dye can be injected into the catheter. The injected dye can be detected using X-ray imaging. This procedure is called a coronary angiogram.
If your doctor needs to collect a tissue sample (biopsy), a jaw-like tip can be attached to the end of the catheter to remove the sample.
Coronary artery bypass grafting requires general anesthesia and is usually done through a long incision on the chest. After the chest is opened, the heart is temporarily stopped and a heart-lung machine takes over to circulate blood to the body.
The surgeon then takes a section of a healthy blood vessel harvested from the chest or lower leg, and attaches the ends of the section above and below the blocked artery, thereby “bypassing” the blockage.
In some cases, the surgeon may be able to perform the procedure by merely stabilizing the heart but not stopping it entirely. In other cases, the surgeon may be able to take a minimally invasive approach and enter the chest through a smaller incision with the assistance of robotics or video imaging.
Heart valve surgery has traditionally been an open-heart procedure. However, newer, less invasive techniques have been developed, which may be performed through one or more small incisions, and may be robotic-assisted. Minimally invasive heart surgery typically involves less post-operative pain, shorter hospital stays, and faster recoveries.
A valve repair is generally preferable to a replacement, as it preserves existing tissue and function. In valve repair, the surgeon may:
- patch holes
- reconnect flaps
- remove excess tissue
- sever flaps that have fused
- tighten the ring around the outer edge of valve
If a valve cannot be repaired, the surgeon may replace it with either a mechanical valve or one made from cow, pig, or human heart tissue.
Both types of replacement have upsides and downsides. Biological valves degenerate and may eventually need to be replaced. Mechanical valves require that you take blood-thinning medications for the rest of your life to avoid blood clots from forming.