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Heart disease intervention

Heart conditions can often be controlled by medication, diet, and lifestyle changes, but intervention, including possible surgical procedures is sometimes necessary. The heart care specialists at Tyler Heart Institute can help you choose the best plan.

Here are some of the most common types of interventional procedures.

Angioplasty

Coronary (heart) angioplasty opens narrow or blocked coronary arteries and restores blood flow to the heart muscle. Almost always a stent is inserted to keep the artery open. A stent is a small, thin metallic tube inserted into the artery. During the procedure, a thin, flexible catheter (tube) with a balloon at its tip is threaded through a blood vessel to the affected artery. Once in place, the balloon is inflated to compress the plaque against the artery wall and restore blood flow. Doctors may use angioplasty to improve symptoms of heart disease, such as chest pain. The procedure also can reduce heart muscle damage caused by a heart attack.

What to expect

If angioplasty isn't performed as an emergency treatment, you'll meet with your cardiologist beforehand. Angioplasty takes 1–2 hours, but you'll likely need to stay in the hospital overnight. Your doctor may advise you to not drive for a certain amount of time.

Recovery

You will probably go home the day after the procedure. Your doctor will provide  instructions to follow at home and prescribe medicine to help prevent blood clots from forming.

Most people recover from angioplasty and return to work within a week of leaving the hospital.

Your doctor will want to check your progress after you leave the hospital. During the follow-up visit, your doctor will examine you, make changes to your medicines (if needed), do any necessary tests, and check your overall recovery.

For more on angioplasty, visit the National Heart, Lung, and Blood Institute.

Electrophysiology procedures: pacemaker, Implantable Cardiac Defibrillator (ICD), and ablation

In the case of arrhythmia (a problem with your heart rate), your doctor may opt for a procedure to stabilize your heartbeat. These are referred to as electrophysiology (EP) procedures.

Pacemaker

A pacemaker is a small device that helps the heart keep its rhythm. In this minimally invasive surgery, an incision is made near the collarbone, and a pocket is created from the tissue overlaying the muscle. The pacemaker is placed into the pocket, and tiny wires are inserted through a vein to the heart. The pacemaker emits a tiny electrical impulse that causes the heart to beat at the rate needed for your activity at that moment.

Implantable Cardiac Defibrillator (ICD)

If you are diagnosed with a life-threatening arrhythmia, your doctor may recommend an EP procedure to implant an ICD. The device is similar to a large pacemaker, yet it can deliver stronger electrical stimulation to correct dangerous defibrillation. It works by shocking the heart when necessary to restore a normal heartbeat.

Ablation

Small, localized areas of the heart sometimes pulse out of rhythm with the rest of the heart. If an area of irregular heartbeat is located during an EP procedure, it can often be corrected by EP ablation. A special wire carrying radiofrequency energy is used to heat and destroy the specific cells causing the irregularity.

What to expect

EP procedures take place in the cardiac catheterization lab. You will wear a hospital gown. During the procedure, you will lie on a special exam table with a large camera and several television monitors overhead.

Before the exam begins, a nurse will insert an IV into your arm for medications and fluids. You will be given a sedative to keep you comfortable, yet still awake. You may not remember the procedure.

Electrodes will be placed on your chest. The electrodes are painless and they will essentially feel like sticky patches with lightweight wires attached. The electrodes are attached to an electrocardiogram (EKG) machine that will chart your heart's electrical activity.

The nurse will let you know if the catheter will be inserted at your arm or your groin, then your skin will be cleansed with a special soap, and possibly shaved, at the site where the catheter will be inserted. A local anesthetic will be used to numb the catheter insertion site. Sterile drapes will be used to cover the insertion site during the procedure. A small cut is made in the skin, then the catheter is inserted. You may feel pressure as the catheter is inserted, but you should not feel any pain.

The procedure generally takes about 1 hour for a diagnostic EP study, but it will take longer if ablation is needed.

Recovery

  • You will be given specific wound-care instructions before you leave.
  • You may experience some soreness at the catheter entry site as the numbness wears off.
  • Do not drive for at least 12 hours after the procedure.

After an invasive procedure, your heart-care team may recommend a follow-up program to assist in your recovery.

Coronary Artery Bypass Graft

Coronary artery bypass grafting (CABG) improves blood flow to the heart. During the procedure, a healthy artery or vein from the body is connected, or grafted, to the blocked coronary artery. The grafted artery or vein bypasses the blocked portion of the coronary artery, creating a new path for oxygen-rich blood to flow to the heart muscle.

Surgeons can bypass multiple coronary arteries during one surgery.

The results of CABG usually are excellent, improving or completely relieving angina symptoms in most patients. Although symptoms can recur, many people remain symptom-free for 10 to 15 years. CABG also may lower your risk of having a heart attack.

What to expect

Coronary artery bypass grafting (CABG) requires a team of experts. A cardiothoracic surgeon will do the surgery with support from an anesthesiologist, perfusionist (heart-lung bypass machine specialist), other surgeons, and nurses. Traditional CABG usually lasts 3–6 hours, depending on the number of arteries being bypassed. You’ll be under general anesthesia during the surgery.

Recovery

Your stay will start off in the Intensive Care Unit (ICU). Your health care team will check your heart rate, blood pressure, and oxygen levels regularly during this time. After you leave the ICU, you'll be moved to less-intensive level of care in a nursing unit elsewhere in the hospital before going home.

Recovery at home may take 6–12 weeks or more, and your doctor will give you instructions. Your doctor may also refer you to cardiac rehabilitation.

For more on CABG, visit the National Heart, Lung, and Blood Institute.

Heart valve repair

Heart valve repair or replacement surgery is a treatment option for valvular disease and heart failure. During valve surgery, the surgeon will adjust your own heart valve to make it work better. In valve replacement surgery, the doctor will replace the diseased valve with a new one. The new valve may be mechanical or biological.

What to expect

  • You will be awake upon entering the operating room, where an anesthesiologist will place an IV in your arm and give you medicine that will put you to sleep for the surgery.
  • Your surgery will last approximately 3 hours, but you may be in the operating room for up to 5 hours. Your family should wait in the South Pavilion reception area, outside the SSU on the main floor. A nurse will update your family during your surgery, and your surgeon will talk to your family after the procedure.
  • Once you are in the operating room, the staff will apply devices to monitor your vital signs at all times. The monitoring devices will accompany you to the Intensive Care Unit/Critical Care Unit (ICU/CCU), where you will be taken immediately after surgery.

Recovery

Your stay will start off in the Intensive Care Unit (ICU). Your health care team will check your heart rate, blood pressure, and oxygen levels regularly during this time. After you leave the ICU, you'll be moved to less-intensive level of care in a nursing unit elsewhere in the hospital before going home.

  • This is where your transition home begins. You will be encouraged to become more independent. Nurses and nurses' aides will monitor your progress and assist you with your routine. Your family is encouraged to assist in your care as well.
  • It is important to take your pain medication routinely while in the hospital to ensure that you do not become too uncomfortable. Your nurse will provide pain medication as needed. It is also a good idea to take pain medication prior to activity.
  • Activity/exercise is the single most important thing you can do to speed your recovery. Getting out of bed to a chair for every meal is encouraged. Try to increase the length of your walk each day.
  • The second most important activity in the hospital is deep breathing and coughing. This keeps your lungs clear. Coughing and deep-breathing exercises will be taught and should be performed every hour while you are awake during your hospital stay.

Going home

After you are released from the hospital, your heart-care team will continue to be involved in your recovery. You will be scheduled for follow-up visits, and participation in our outpatient cardiac rehabilitation program may be recommended. Learn more.

How to make an appointment

To see a doctor at the Tyler Heart Institute, you will first need to be referred by a cardiac specialist.

Visit your family doctor, who can refer you to a cardiologist if needed.

Our cardiologists