What is Heart Surgery – Type & Average Treatment Cost in India

Heart surgery is performed on people with heart conditions. Coronary Artery Bypass Grafting (CABG) and heart valve repair or replacement are the most common types of heart surgeries. Such surgeries are carried out during times of emergencies like heart attack, or are recommended by doctors in the event of any malfunction.

Cardiac or cardiovascular surgery involves your heart or the blood vessels connected to it. Surgeries can be conducted to rectify issues you were born with (congenital heart disease), as well as issues that develop later in life. The type of heart surgery depends on the underlying problem or combination of problems.

Heart surgery is prescribed by doctors to treat the following problems –

• Coronary artery disease (CAD) - It is a condition in which an accumulation of plaque narrows or blocks the arteries that supply blood to your heart muscle.
• Heart valve disease – It is a problem involving the valves which control the blood flow in your heart.
• Arrhythmia – It is a medical condition that causes irregular, fast or slow heartbeat. It can be caused by issues with the electrical signals that control your heartbeat.
• Heart failure - It is a condition in which the heart is not able to pump enough oxygen-rich blood to meet the body's needs.
• Heart aneurysm - A heart aneurysm is a bulge in the artery wall. If this bulge bursts or tears, it can lead to life-threatening damage to other organs.
• Angina – It is a problem where the patient has chest pain caused by coronary artery disease.
• Congenital heart defects - These are defects of the heart, often present at birth. They can include holes in the heart, an abnormal-sized or shaped heart and problems with blood flow to the body.

1. Coronary Artery Bypass Grafting (CABG)

Coronary artery bypass grafting (CABG) is a procedure done by cardiothoracic surgeons to restore blood flow to the heart. It can be done to treat a number of conditions, including peripheral vascular disease, angina pectoris, and certain forms of heart failure. The procedure involves removing one large vein from a leg and then connecting it to an artery in order to restore blood flow through the blocked arteries.

• Benefits
  • Increases the flow of blood in the otherwise blocked artery.
  • Decreases angina (chest pain).
  • Increases ability to perform physical activities that were restricted by ischemia or angina.
  • It can help prevent stroke as it can widen the brain and neck arteries.
• Survival Rate After Surgery 
  • 5 years: 92%
  • 10 years: 77%
  • 15 years: 57%
  • 20 years: 40%
• Cost of Surgery
  • Approximately ₹ 95,000 to ₹ 4,50,000

2. Transmyocardial Laser Revascularization (TMR)

A transmyocardial laser revascularization is a form of heart surgery that uses laser technology to create a channel through the heart muscle, as well as on the left side of the heart's chamber (ventricle). The surgeon performs this type of surgery with the assistance of a heart-lung machine, which is not used when performing transmyocardial resection because it does not operate during times when blood is present in the body.

• Benefits –
  • Increases flow of blood through the otherwise blocked arteries.
  • It can relieve severe chest pain (angina) in patients who aren't candidates for bypass surgery or angioplasty.
• Survival Rate After Surgery
  • TMR patients: 84% to 95%
  • Patients under medical therapy: 79% to 96%
• Cost of Surgery
  • Approximately ₹ 1,14,000 to ₹ 2,61,250

3. Heart Valve Repair or Replacement

The heart has two sets of valves that help blood flow in one direction. If the heart's valves become damaged, they might stop working altogether or begin to leak blood backwards. This can cause a heart attack or other serious problems. In some cases, doctors may recommend replacing your valves with mechanical devices called "valve replacement." These devices are made from metal, plastic or porcine tissue and are usually permanent once implanted.

• Benefits –
  • Restores the normal function of valves inside the heart.
• Survival Rate After Surgery
  • 5 years: 64% to 94%
  • 10 years: 37% to 93%
• Cost of Surgery
  • Approximately ₹ 70,000 to ₹ 8,50,000

4. Arrhythmia Treatment

Arrhythmia is a condition in which the heartbeat is irregular. Treatment typically involves placing a pacemaker under the collarbone or in the abdomen, which controls the irregular heartbeat. The procedure for implanting a pacemaker involves making a small incision in the patient's chest or abdomen during general anaesthesia.

• Benefits –
  • Increases flow of blood by eliminating the plaque buildup in the otherwise blocked artery.
  • It can also be used to prevent the risk of stroke. 
• Survival Rate After Surgery
  • 15 years: 92%
  • 30 years: 68%
• Cost of Surgery
  • Approximately ₹ 2,25,000 to ₹ 3,00,000

5. Aneurysm Repair

Aneurysm surgery is performed to repair an artery that has ruptured or otherwise become weakened. In this procedure, a large incision is made in the abdomen so that the aorta can be seen. A surgeon then uses a length of tubing called a graft to patch together the weakened part of the artery with healthy tissue from elsewhere in the body.

• Benefits –
  • It removes any surrounding scar tissue, and the aneurysm
  • Reduces symptoms of angina and allows the heart to pump blood better.
• Survival Rate After Surgery
  • 28 days: 3.3% to 27.1% in men and 3.8% to 54.3% in women
  • 5 years: 12.9% to 78.1% in men and 24.3% to 91.3% in women
• Cost of Surgery
  • Approximately ₹ 6,71,100 to ₹ 8,68,500

6. Heart Transplant

A heart transplant is an operation that replaces a patient's diseased heart with a healthy one. The procedure can be performed on patients in the early stages of heart failure or coronary artery disease so that they can live longer, healthier lives. In order for such a procedure to be successful, the patient's body must be prepared for the surgery by using medications and life-support measures.

If a patient does not have enough time left to live with their diseased heart functioning properly before undergoing a transplant, then the risk of developing serious complications resulting from rejection of their organs by the patient's immune system is much higher if they undergo a heart transplant without any intervention from medical professionals beforehand.

• Benefits –
  • Recognized as a proven method to restore a healthy heart in selected patients.
• Rate After Surgery
  • 1 year: 85% to 90%
  • 3 years: 75%
• Cost of Surgery
  • Approximately ₹ 22,90,000 to ₹ 35,50,000

7. Pacemaker or Implantable Cardioverter Defibrillator

Arrhythmia is a condition which causes your heart to beat irregularly. It can be treated by medication. However, if that does not work, surgeons might choose to implant a pacemaker under the skin of your chest or abdomen. It is a machine that includes wires, connecting to the heart chambers. It uses electrical pulses to control the heart rhythm. Once it detects acute arrhythmia, it sends electrical control to your heart’s rhythm.

• Benefits
  • It helps to cure acute arrhythmia by restoring a regular heart rate. 
  • It helps patients to avoid shortness of breath due to heart conditions.
• Survival Rate After Surgery
  • 5 years: 57%
  • 10 years: 36.8% 
• Cost of Surgery
  • Approximately ₹ 40,000 to ₹ 50,000

8. Maze Surgery

In this surgery, the surgeon tries to create a pattern of scar tissue within the upper chambers of your heart. This helps them to send electrical signals to your lower heart chamber along a controlled path. This is mainly used in case of atrial fibrillation, which is caused by stray electrical signals. The surgery helps to block these signals. 

• Benefits
  • This surgery helps to avoid arrhythmia by blocking stray electrical signals. 
  • It helps to treat atrial fibrillation and irregular heartbeat. 
• Survival Rate After Surgery: The success rate of this surgery is 80%-90%. Majority of the patients survive after the surgery. 
• Cost of Surgery
  • Approximately ₹ 2,40,000 to ₹ 4,00,000

9. VAD and TAH Implants

A ventricular assist device (VAD) or total artificial heart (TAH) can be inserted in your heart for improving heart health. It is used when your heart fails to perform effectively. VAD is a mechanical pump, which assists the heart with blood flow and other functions. A TAH, on the other hand, replaces two lower chambers of the heart when they fail to perform.

• Benefits
  • These machines help your heart to function efficiently with mechanical support. 
  • They can help avoid the difficulties of poor heart functioning. 
• Survival Rate After Surgery
  • 30 days: 86%
  • 1 year: 56%
  • 2 years: 30.9%
• Cost of Surgery
  • Approximately ₹ 30,00,000 to ₹ 50,00,000

As the heart is a vital organ, its surgery is likely to be complicated. Therefore, you should be prepared for an open heart surgery, following the recommendations of your doctor or surgeon. These recommendations are likely to be in the following areas.

Medication: You need to stop taking certain medicines from a week or two before the surgery. In Particular, you should avoid nonsteroidal anti-inflammatory drugs and blood thinning medicines. These come with bleeding risks.

Food and drinks: The surgeon is likely to ask you to eat or drink right before the surgery. Fasting will be safer before a serious surgery. Anaesthesia is also safer in an empty stomach.

Alcohol and tobacco: You might have to avoid smoking and drinking alcohol right before the surgery. These can increase complications during the surgery, and slow down post surgical healing.

Even though heart surgery can have excellent outcomes, it is still an invasive procedure with a number of risks. The risks may include:

• Bleeding
• Damage to the lungs, kidneys, heart and liver
• Swelling, Infection and fever 
• Stroke
• Problem due to anaesthesia
• Arrhythmia

People who have undergone heart surgery tend to be at greater risk if the surgery is performed on them in an emergency or during another medical condition, including:

• Peripheral artery disease (PAD)
• Kidney diseases
• Diabetes
• Lung diseases

Preparation for your surgery can take weeks or months. Before your heart surgery is scheduled, your medical care team will evaluate your condition. Your care team will likely include your primary care doctor and cardiologist. You’ll also consult with a cardiothoracic surgeon (a cardiac surgeon who operates on organs and tissues in the chest). Your care team will give you a medical evaluation. This includes:

• Electrocardiogram (ECG/EKG).
• Cardiac computed tomography scan (cardiac CT).
• Echocardiogram (echo).
• Cardiac magnetic resonance imaging (heart MRI).
• Stress test.
• Chest X-ray.
• Coronary angiography.

The day before surgery, if you’re admitted to the hospital, you might experience some discomfort due to the procedure. Your care team will spend time getting you settled and talking with you about what to expect during the procedure. Further tests will be conducted to check that your body is ready for surgery.

Various methods are used by surgeons to operate on the heart. Further, the care team will provide input on the method that is recommended by the surgeon. The methods used by surgeons to operate are as follows –

• Open-heart surgery - Open heart surgery is performed to repair or replace a damaged or diseased heart. The surgeon first cuts the chest open to reach the heart and then uses medicines to stop its beating. A heart-lung bypass machine keeps oxygen-rich blood pumping through the body during this time.
• Off-pump heart surgery - Off-pump heart surgery is the use of a beating heart without using a heart-lung bypass machine. The surgeon holds the heart steady with a device, which allows surgeons to do coronary artery bypass grafts (CABG) but only in certain cases.
• Minimally invasive heart surgery - Minimally invasive heart surgery uses cuts along the chest to expose the heart. The surgeon inserts tools into the chest through these cuts, which can be as small as two to three inches. The tool used depends on the type of surgery being performed. This type of surgery is generally performed without a heart-lung bypass machine.
• Robotic-assisted surgery - Robotic-assisted surgery is similar to minimally invasive surgery. Here, a computer-controlled arm on the robot allows the surgeon to perform complex operations with great ease and precision.

After your heart surgery, you'll be moved to the intensive care unit (ICU). You'll recover in the ICU for at least one day and then be moved to a general care room for further rest and care. Your recovery time depends on how long you were in the operating room and how well your body responded to the surgery. Each person has a different recovery period, but you should feel better every day as long as you are eating well and getting enough rest. Your hospital team will watch over you closely and make sure that you are healing as expected.

Recovery takes time and depends on the type of surgery and overall health. Some people require at least six to 12 weeks or even more than that. Follow the care team’s guidelines on when you can go back to work, lift heavy objects, drive, or perform other activities. Further, it is advisable to slow down and provide time for the body to heal.

A heart attack can come without a notice. Therefore, it is essential to notice the symptom and take precautions. you must call the doctor if you experience the following issues.

• Chest pain
• Other heart rate abnormalities
• Nausea and vomiting
• Fever
• Shortness of breath
• Signs of infection like oozing and redness
• Slurred speech
• Other signs of stroke

If you have reservations regarding a complicated heart surgery, you can now find its alternatives, thanks to medical science. However, it depends on your medical condition. The following methods are often used as substitutes for open-heart surgeries.

Video-assisted thoracic surgery (VATS): The surgeon inserts a tiny video camera called thoracoscope and other surgical instruments in small chest incisions. It can be used to place a pacemaker, cure arrhythmia and repair heart valves.

Catheter-based method: This method uses a catheter, which is a thin and hollow tube. After placing the catheter, the surgeon inserts surgical instruments, balloons, or stents through the catheter while performing a procedure.

Robotically-assisted method: This is a minimally invasive approach, and a replacement for a large surgery. People suffering from conditions like cardiac tumours, valvular heart disease, atrial fibrillation and septal defects can choose this method.

Following heart surgery, people can live for many years or decades. Many factors affect how long a person lives after he has been treated for heart disease, including his overall health and risk factors. Heart surgery can make you healthier and stronger. But it’s important to keep doing whatever you can to lower your risks for future problems.