Surgical Treatment

Adventist Heart Institute surgeons are experienced in performing the full range of heart operations—from minimally invasive surgical approaches to coronary artery bypass surgery.

Aortic disease surgery

Our cardiac surgeons are dedicated to comprehensive, multispecialty care for all types of aortic diseases, including thoracic aortic aneurysms, congenital aortic disease, and aortic root and valve disease.

Adventist Heart Institute consists of a multidisciplinary team of cardiac and vascular surgeons, endovascular specialists, cardiovascular anesthesiologists, cardiologists, vascular radiologists, nurse practitioners and social works. We offer state of the art diagnostic imaging and cutting edge intervention with compassionate care for the following aortic conditions:

  • Ascending, arch and descending thoracic aneurysms
  • Thoraco-abdominal aneurysms
  • Abdominal aortic aneurysms
  • Acute and chronic type A and B aortic dissection
  • Aortic root and valve disease
  • Native aortic and prosthetic graft infections
  • Thoracic/aortoiliac occlusive and thrombo-embolic disease
  • Congenital aortic disease
  • Aortic, essenteric and renal aneurysmal and occlusive disease

Atrial fibrillation surgery

This innovative surgery uses radiofrequency energy to help restore a normal electrical pathway through the heart. At the Adventist Heart Institute, atrial fibrillation surgery is frequently performed through small incisions.

Beating-heart “off pump” coronary artery bypass surgery

Surgery on a beating heart helps preserve heart function, and reduces the risk for complications.

When an open-chest approach is required, it's preferable to perform the surgery on a beating heart, without the use of the heart-lung bypass machine. Adventist Heart Institute surgeons have performed beating-heart bypass surgery for several years, and frequently on patients considered high-risk for certain complications, such as stroke and organ failure.

Our surgeons perform beating-heart surgeries because they have observed that heart function is better preserved if the heart is not stopped during an operation. This is especially true with high-risk cases, in which the heart is less able to bounce back after surgery.

What is beating-heart coronary artery bypass surgery? How is it performed?

In an open-chest, beating-heart bypass procedure, surgeons make an incision through the breastbone to gain access to the heart. In many cases, surgeons do a partial sternotomy--which is a shorter incision through the breastbone than a full sternotomy. Unlike traditional bypass surgery, the heart is not stopped during a beating-heart bypass procedure. This approach uses special devices to stabilize the part of the heart the surgeon is operating on.

At the Adventist Heart Institute, beating-heart bypass is typically performed without the use of a heart-lung bypass machine, though it may be performed with the support of the machine in select cases.

What are the benefits of beating-heart bypass surgery?

In comparison to traditional bypass surgery, the benefits of beating-heart bypass surgery include:

  • Quicker recovery
  • Reduced hospital stay
  • Reduced risk of neurological injury, including stroke and damage to the memory function
  • Better preservation of heart function
  • Less chance for heart rhythm, kidney, or liver complications
  • Better survival rate, especially among high-risk patients

Who is a candidate for the beating-heart approach?

Most people who require coronary artery bypass graft surgery are candidates for the beating-heart approach. Surgeons weigh several factors, such as the location of blocked arteries, a patient's history of past thoracic surgeries, and the presence of co-existing diseases. Patients with very poor heart function, cases that require reoperation involving the side of the heart, and hearts that are unable to tolerate manipulation may not be appropriate for this approach.

Is beating-heart bypass surgery widely available? What's different about beating-heart bypass surgery performed by physicians from the Adventist Heart Institute?

Most of coronary bypass surgeries performed at the Adventist Heart Institute are done on a beating heart. No other hospital in the Northern California area performs such a high percentage of beating-heart bypass procedures. Although beating-heart bypass is not an option for all patients requiring bypass surgery, our experienced surgeons are frequently able to offer it safely to many patients refused for beating-heart bypass by other hospitals.

For high-risk patients, such as the elderly or those who have had multiple open-heart procedures, our surgeons can offer sternal plating, a method that secures the breastbone after open-heart surgery to help it heal properly. Rather than securing the breastbone with wires after the procedure, surgeons use small titanium plates to rejoin it. This approach has dramatically decreased the number of patients who develop post-operative infections or pain caused by separation of the bone.

Congenital heart disease surgery in adults

Our surgeons have many years of experience treating adults with repaired or unrepaired congenital heart defects.

Coronary artery Bypass Surgery

Our team provides a range of bypass surgery options, from surgeries on a beating heart achieved through small incisions without cutting through the breastbone, to traditional, open-chest procedures.

Surgeons at the Adventist Heart Institute take an uncommon approach to coronary artery bypass surgery, a common heart procedure performed to detour blood flow around blocked arteries. Rather than cutting the breastbone (sternum) to access the heart, our surgeons regularly perform minimally invasive bypass surgery through small incisions at the side of the chest.

People who have minimally invasive coronary bypass surgery recover faster, have significantly less pain, and experience fewer post-surgical complications than those who undergo traditional open-heart coronary bypass surgery.

About coronary artery bypass surgery

Coronary artery bypass graft surgery is a time-tested procedure used to detour blood flow around blocked arteries. All forms of bypass surgery involve removing a "clean" vessel (graft) and attaching it to the areas around the blocked artery in order to restore blood flow. The goal of the surgery is to improve blood flow and alleviate chest pain and other symptoms.

Our physicians are highly skilled in determining the best approach for each patient's bypass surgery, taking into account the number and location of blocked vessels, the patient's prior history of heart surgery, and other factors such as age and co-existing conditions. In most cases, our experts can offer minimally invasive options that spare the breastbone, and don't require stopping the heart and using a heart-lung bypass machine.

Surgeons here also prefer using arterial grafts rather than vein grafts because arterial grafts better withstand blood pressure over time, and they are less likely to develop blockages than vein grafts. The use of arterial grafts reduces the need for re-operation significantly.

Adventist Heart Institute cardiac surgeons frequently perform bypass surgery on people considered high risk and on those who have been turned down for surgery at other hospitals.

Types of coronary artery bypass surgery

Traditional, open-chest coronary artery bypass surgery

Traditional open-chest coronary bypass surgery has been performed for decades. This technique involves making an incision through the breastbone (sternotomy) to gain access to the heart. The heart is stopped and a heart-lung bypass machine is used to oxygenate and circulate blood during surgery.

Traditional bypass surgery involves an incision through the breastbone and the use of a heart-lung bypass machine. In this procedure, the heart is stopped and a heart-lung machine is used to pump blood and perform the functions normally achieved by lungs. The surgeon performs the bypass operation on the stopped heart, and then revives the heart later during the procedure.

All types of bypass surgeries performed by the physicians from the Adventist Heart Institute typically use arterial grafts, instead of vein grafts because arterial grafts better withstand blood pressure over time.

Over the years, our cardiac surgeons have refined their approach to coronary artery bypass surgery, so this open-chest, stopped-heart technique is performed here less often than in the past. We can usually offer minimally invasive approaches or beating-heart options that provide benefits over traditional bypass surgery. Our surgeons have a long track record of success performing coronary bypass surgery, and are experts in determining the best approach to reduce chest pain and improve blood flow to the heart.

The heart-lung bypass machine

Surgery with the heart-lung bypass machine has been associated with a slight increase in the risk for complications such as stroke and memory problems. Yet it's important to note that heart-lung bypass machines have been in use for many years, with several improvements in technology making the machines better than ever. If your surgery requires the bypass machine, be assured that our surgeons and perfusionists are experts is using this life-saving equipment.

Sternal plating for high-risk cases

For high-risk patients, such as the elderly or those who have had multiple open-heart procedures, our surgeons can offer sternal plating, a method that secures the breastbone after open-chest surgery to help it heal properly. Rather than securing the breastbone with wires after the procedure, surgeons use small titanium plates to rejoin it. This approach has dramatically decreased the number of patients who develop post-operative infections.

Heart failure surgery

Adventist Heart Institute surgeons take on even the most complex cases of heart failure, and can offer surgical solutions not widely available at other hospitals.

Heart valve disease and treatment

Our surgeons have pioneered many of the latest surgical treatments for heart valve disease, including minimally invasive approaches performed through small incisions. Here, surgeons aim to repair valves before replacing them.

What are heart valves?

The heart consists of four chambers, two atria (upper chambers) and two ventricles (lower chambers). There is a valve through which blood passes before leaving each chamber of the heart. The valves prevent the backward flow of blood. These valves are actual flaps (also called leaflets) that are located on each end of the two ventricles (lower chambers of the heart). They act as one-way inlets of blood on one side of a ventricle and one-way outlets of blood on the other side of a ventricle. Normal valves have three flaps (leaflets), except the mitral valve, which has two flaps (leaflets). The four heart valves include the following:

  • Tricuspid valve - located between the right atrium and the right ventricle
  • Pulmonary valve - located between the right ventricle and the pulmonary artery
  • Mitral valve - located between the left atrium and the left ventricle
  • Aortic valve - located between the left ventricle and the aorta

How do the heart valves function?

As the heart muscle contracts and relaxes, the valves open and close, letting blood flow into the ventricles and out to the body at alternate times. The following is a step-by-step illustration of how the valves function normally in the left ventricle:

After the left ventricle contracts, the aortic valve closes and the mitral valve opens, to allow blood to flow from the left atrium into the left ventricle. The left atrium contracts and more blood flows into the left ventricle.

When the left ventricle contracts, the mitral valve closes and the aortic valve opens, so blood flows into the aorta and the systemic circulation.

What is heart valve disease?

Heart valves can have one or both of the two malfunctions:

Regurgitation (or leakage of the valve)

The valve(s) does not close completely, causing the blood to flow backward through the valve. The heart is forced to pump more blood on the next beat, making it work harder.

Stenosis (or narrowing of the valve)

The valve(s) opening becomes narrowed, limiting the flow of blood out of the ventricles or atria. The heart is forced to pump blood with increased force in order to move blood through the narrowed or stiff (stenotic) valve(s).

Heart valves can have both malfunctions at the same time (regurgitation and stenosis). Also, more than one heart valve can be affected at the same time. When heart valves fail to open and close properly, the implications for the heart can be serious, possibly hampering the heart's ability to pump blood adequately through the body. Heart valve problems are one cause of heart failure.

What are the symptoms of heart valve disease?

Mild heart valve disease may not cause any symptoms. The following are the most common symptoms of heart valve disease. However, each individual may experience symptoms differently. Symptoms may vary depending on the type of heart valve disease present and may include:

  • chest pain
  • palpitations caused by irregular heartbeats
  • migraine headaches
  • fatigue
  • dizziness
  • low or high blood pressure, depending on which valve disease is present
  • shortness of breath
  • abdominal pain due to an enlarged liver (if there is tricuspid valve malfunction)

What causes heart valve damage?

The causes of heart valve damage vary depending on the type of disease present, and may include the following:

  • A history of rheumatic fever (now a rare disease in north America due to effective antibiotic treatment) - a condition characterized by painful fever, inflammation, and swelling of the joints.
  • Damage resulting from a heart attack
  • Damage resulting from an infection
  • Changes in the heart valve structure due to the aging process
  • Congenital birth defect
  • Syphilis (now a rare sexually transmitted disease in North American due to effective treatment) - a disease characterized by progressive symptoms if not treated. Symptoms may include small, painless sores that disappear, followed by a skin rash, enlarged lymph nodes, headache, aching bones, appetite loss, fever, and fatigue.
  • Myxomatous degeneration - an inherited connective tissue disorder that weakens the heart valve tissue.

The mitral and aortic valves are most often affected by heart valve disease. Some of the more common heart valve diseases include:

Bicuspid aortic valve

This congenital birth defect is characterized by an aortic valve that only has two flaps (a normal aortic valve has three flaps). If the valve becomes narrowed, it is more difficult for the blood to flow through, and often the blood leaks backward. Symptoms usually do not develop during childhood, but are often detected during the adult years.

Mitral valve prolapse (also known as click-murmur syndrome, barlow's syndrome, balloon mitral valve or floppy valve syndrome)

This disease is characterized by the bulging of one or both of the mitral valve flaps during the contraction of the heart. One or both of the flaps may not close properly, allowing the blood to leak backward. This may result in a mitral regurgitation murmur.

Mitral valve stenosis

Often caused by a past history of rheumatic fever, this condition is characterized by a narrowing of the mitral valve opening, increasing resistance to blood flow from the left atrium to the left ventricle.

Aortic valve stenosis

This type of valve disease mainly occurs in the elderly and is characterized by a narrowing of the aortic valve opening, increasing resistance to blood flow from the left ventricle to the aorta.

Pulmonary stenosis

This condition is characterized by a pulmonary valve that does not open sufficiently, causing the right ventricle to pump harder and enlarge.

How is heart valve disease diagnosed?

Heart valve disease may be suspected if the heart sounds heard through a stethoscope are abnormal. This is usually the first step in diagnosing a heart valve disease. A characteristic heart murmur (abnormal sounds in the heart due to turbulent blood flow across the valve) can often indicate valve regurgitation or stenosis. To further define the type of valve disease and extent of the valve damage, physicians may use any of the following diagnostic procedures:

Electrocardiogram (ECG or EKG)

A test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle damage.

Echocardiogram (Echo)

A noninvasive test that uses sound waves to produce a study of the motion of the heart's chambers and valves. The echo sound waves create an image on the monitor as an ultrasound transducer is passed over the heart.

Chest x-ray

A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. An x-ray can show enlargement in any area of the heart.

Cardiac catheterization

This diagnostic procedure involves a tiny, hollow tube (catheter) being inserted into an artery leading to the heart in order to image the heart and blood vessels. This procedure is helpful in determining the type and extent of valve blockage.

Magnetic resonance imaging (MRI)

A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

Heart valve disease and surgical procedures

A person with heart valve disease will often need to take antibiotics before undergoing dental or other surgical procedures that cause bleeding. Antibiotics are also recommended by physicians and dentists before routine professional teeth cleaning and other procedures involving the gum or soft tissues of the mouth. Bacteria released during these and other procedures may enter the bloodstream and lodge in the heart on the vulnerable, diseased heart valve. The antibiotics help prevent against a potentially fatal infection called endocarditis, an infection of the heart's lining. In addition, inform your dentist and other physicians if you are taking any anticoagulant medication (to prevent blood clots), because this medication can cause excessive bleeding during surgery. Always inform your dentist and other physician(s) if you have heart valve disease.

Treatment for heart valve disease

In some cases, the only treatment for heart valve disease may be careful medical supervision. However, other treatment options may include medication, surgery to repair the valve or surgery to replace the valve. Specific treatment will be determined by your physician based on: your age, overall health, and medical history extent of the disease the location of the valve your signs and symptoms your tolerance for specific medications, procedures, or therapies expectations for the course of the disease your opinion or preference.

Treatment varies, depending on the type of heart valve disease, and may include one, or a combination, of the following:

Medication treatment options

Medications are not a cure for heart valve disease but in many cases are successful in the treatment of symptoms caused by heart valve disease. These medications may include:

Medications such as beta-blockers, digoxin, and calcium channel blockers reduce symptoms of heart valve disease by controlling the heart rate and atrial fibrillation.

Medications to control blood pressure, such as diuretics (medications that remove excess water from the body by increasing urine output) or vasodilators (medications which relax the blood vessels, decreasing the force against which the heart must pump) ease the work of the heart.

Surgery treatment options

Surgery may be necessary to repair or replace the malfunctioning valve(s). Surgery may include:

Valve repair and replacement surgery

Adventist Heart Institute heart surgeons have expertise in all types of heart valve surgeries, including complex valve repair and replacement and minimally invasive valve surgery. Our cardiac surgeons are pioneers in this field, and can often offer surgical solutions that are not available at most hospitals. Heart valve problems that benefit from surgery include congenital valve disorders, leaky valves that don't close properly (regurgitation), infected valves and narrowed valves that don’t open correctly (stenosis).

Our cardiac surgeons aim to repair malfunctioning heart valves before opting for total valve replacement. Valve repair may involve sewing damaged valve flaps or strengthening the "ring" that holds the valve in place. If valve repair is not a viable option, University of Chicago cardiac surgeons can replace the faulty heart valves with artificial or biological valves taken from human or animal valve tissue. Our surgeons carefully assess which type of heart valve is best for each patient. These same specialists are currently investigating new and better methods to repair valves, and have access to the most advanced artificial valves.

Here, our cardiac surgeons regularly take on challenging cases, such as those that involve the repair or replacement of more than one heart valve at a time, or "redo" operations to correct unsuccessful valve surgeries. Many of our patients are considered high risk, including people who have had several prior heart surgeries, those with co-existing medical conditions, elderly and overweight individuals, and people who have been turned down for heart surgery at other hospitals. While we routinely care for high-risk patients, our team welcomes any patient with a heart valve problem that can benefit from surgery.

Minimally invasive valve surgery

Minimally invasive valve surgery is a breakthrough approach to treating heart valve disease. Rather than making a large incision through the breastbone (sternum) to gain access to the heart, this method uses sophisticated instruments to perform the surgery through a smaller incision at the side of the chest.

Adventist Heart Institute cardiac surgeons are leaders in the field of minimally invasive valvular heart surgery, and have performed more of these procedures than surgeons at any other hospital in the region. Minimally invasive valve surgery is a highly advanced technique that requires special expertise and equipment. Only select hospitals offer this approach.

Minimally invasive valve surgeries performed here include:

  • Aortic valve repair or replacement
  • Mitral valve repair and replacement
  • Tricuspid valve repair or replacement

Benefits of the minimally invasive approach

  • Faster recovery and a quicker return to normal activities
  • Less time spent in the hospital
  • Small incisions that result in little to no scarring. Depending upon the procedure, incisions may be four to five dime-size slits or a 3- to 5-inch incision at the side of the chest.
  • Quicker resolution of pain, with many patients able to control pain after discharge with Tylenol or other over-the-counter pain medicines
  • Because the breastbone (sternum) remains intact, patients avoid the risk for infection and other complications associated with cutting it (sternotomy) that may occur with traditional open-chest procedures.

Types of valve surgery procedures

Our surgeons perform the complete range of valve repair and replacement procedures, including:

  • Aortic Valve
  • Mitral Valve
  • Pulmonary Valve
  • Tricuspid Valve

Minimally invasive surgery

Surgery performed through very small incisions reduces scarring and pain, and helps patients return to normal activities faster. Our team provides the full range of minimally invasive procedures, including coronary artery bypass surgery, valve repair, atrial fibrillation treatment and more.

Adventist Heart Institute surgeons are operating on the hearts of adults through tiny openings in the chest, eliminating the need for sternotomy--a large incision through the breastbone (sternum). This method of surgery, called minimally invasive cardiac surgery, offers many benefits compared to traditional, open-chest procedures. Surgeons use sophisticated thin instruments, miniature cameras, robotic devices, and hybrid techniques with coronary stenting to perform the operations.

Minimally invasive surgeries are performed at St. Helena Hospital. The surgical suites feature sophisticated diagnostics, leading-edge medical technologies and state of the art imaging capabilities.

Benefits of minimally invasive heart surgery

Minimally invasive heart surgery offers several advantages compared to open-chest procedures, including:

Faster return to normal activities.

Rather than waiting several weeks to heal, patients can return to work or other activities much more quickly--usually within three weeks.

Shorter hospital stay.

Time spent in the hospital can sometimes be reduced by as much at 50 percent, compared to open procedures.

No splitting of the breastbone.

Keeping the breastbone (sternum) intact reduces the chance for post-surgical complications and infection.

Smaller incisions.

Depending upon the case, the operation may be performed through four to five dime-size incisions, or through a 2- to 5-inch incision at the side of the chest. Traditional open-heart procedures require a longer incision down the center of the chest.

Quicker resolution of pain.

Decreased damage to tissue and muscle results in pain that does not last as long as after a sternal incision. Tylenol or aspirin are often enough to manage pain after hospital discharge.

Elimination of the heart-lung bypass machine,

in most cases. Avoiding the bypass machine decreases the risks for neurological complications and stroke.

Minimal blood loss and less need for transfusion.

Little scarring.

Instead of a long chest scar, only a few tiny scars or a short, 2- to 5-inch scar remains.

We're one of a handful of hospitals in the world that offers a wide range of minimally invasive procedures for heart conditions. Every member of our cardiac surgery team has specialized expertise in minimally invasive cardiac surgery.

Some of the minimally invasive procedures regularly performed by surgeons include the following:

  • Single and multiple vessel coronary artery bypass surgery, to improve blood flow to the heart and to reduce chest pain
  • Valve repair and replacement to restore proper valve function
  • Surgery to correct atrial fibrillation, a common type of arrhythmia
  • Implantation of ventricular heart devices to boost the pumping action of the heart in heart failure patients
  • Procedures to treat congenital heart conditions, such as atrial septal defect
  • Sternal Plating for High-Risk Cases (Links to section below for more information)

Sternal plating – a procedure that significantly reduces the likelihood of post-operative infection

Adventist Heart Institute surgeons utilize a novel device and technique to secure the breastbone after open-heart surgery. This approach reduces the likelihood of post-operative infection.

It's necessary to cut the sternum (breastbone) to perform an open-heart operation. After the surgery is complete, surgeons typically rejoin the sternum by sewing it shut with wires. This closure technique works well for most patients, but for some patients--such as those who have had multiple open-heart procedures, the elderly, or other high-risk cases--the wire closure technique may not be effective. If the sternum does not heal correctly, patients become susceptible to serious infections.

Since adopting this technique to close the sternum in high-risk patients, our surgeons have observed a dramatic decrease in the number of patients who develop post-operative infections. Other benefits of sternal plating include less pain after surgery, easier breathing, and less time spent in the hospital.

Start living. Heart healthy.

Request More Information

Call (888) 529-9018 to speak with a Patient Service Advisor, or fill out the form and we’ll contact you soon.

The Adventist Heart Institute values your privacy and handles your personal information with care. Your email address and information is secure, confidential and will not be sold to any third party sources.

AHI Rebrand

To talk with someone immediately, call (888) 529-9018

The Adventist Heart Institute values your privacy and handles your personal information with care. Your email address and information is secure, confidential and will not be sold to any third party sources.

AHI Rebrand