Heart surgery: bypass, valve operations, TAVI and what recovery involves

Heart surgery is carried out by consultant cardiac surgeons, who are specialists in cardiothoracic surgery. They work in a team with cardiologists, cardiac anaesthetists, perfusionists who run the heart-lung machine, intensive care staff, specialist nurses and physiotherapists. The Society for Cardiothoracic Surgery (SCTS) provides patient information on individual procedures and a glossary for people who have been referred.

Operations are usually performed in specialist cardiac centres, often within large NHS hospitals or private hospitals with cardiac theatres and intensive care. The decision to operate is normally made jointly by a team, including the cardiologist who has been caring for you, rather than by one person.

Coronary heart disease occurs when fatty deposits narrow the arteries that supply the heart muscle. The NHS describes treatment as lifestyle changes, medicines and, in some cases, procedures such as angioplasty with a stent, or coronary artery bypass grafting when arteries are narrowed or blocked and symptoms are not controlled by medicines.

Heart valve disease is when one or more valves are narrowed or leak. The NHS says symptoms can include breathlessness, tiredness, dizziness, palpitations, swollen ankles and chest pain, although some people have none and the problem is found when a doctor hears a murmur. Mild disease may only need regular check-ups. Severe disease may need surgery or a catheter-based valve procedure.

Other conditions treated surgically include some rhythm problems, aneurysms of the aorta, congenital heart defects in adults, and severe heart failure, where a heart transplant is occasionally considered. The NHS describes transplant as an option when the heart is severely damaged and medicines are not effective.

The assessment usually starts with an echocardiogram, which is an ultrasound scan of the heart, an electrocardiogram (ECG) and a chest X-ray. A coronary angiogram, a type of X-ray used to check blood vessels, determines whether bypass or angioplasty is suitable. Further tests such as CT coronary angiography, cardiac MRI or stress testing may be used depending on the question being asked, along with blood tests and checks of lung and kidney function.

In coronary artery bypass grafting (CABG), healthy blood vessels, usually taken from the leg or chest, are attached so that blood can flow around the narrowed part of the artery. The NHS says it usually takes 3 to 6 hours, is done under general anaesthetic, and may need up to 4 grafts. It is usually done through a cut in the middle of the chest, though keyhole surgery is sometimes suitable. Some bypass operations are done without stopping the heart, which is called off-pump surgery.

In valve surgery, a damaged valve is repaired or replaced. The NHS describes two main types of replacement valve: mechanical valves made from carbon and metal, which are usually recommended for younger people because they last a long time but require lifelong anticoagulant medicine, and tissue valves from human or animal tissue, which usually last 15 to 20 years and are usually recommended for older people or those who cannot take anticoagulants.

Transcatheter aortic valve implantation (TAVI) is used for a narrowed aortic valve when open surgery is unsuitable or too high risk. You are awake with sedation and local anaesthetic, a catheter is passed through a blood vessel, and a new valve is fixed on top of the damaged one. It usually takes 1 to 2 hours and does not need the heart to be stopped.

After open surgery you are usually looked after in intensive care at first, with tubes draining fluid from the chest that are removed after 1 or 2 days. You will have a wound in the chest and sometimes in the leg, may feel tired for the first few weeks, and will start to move with help from physiotherapists the day after.

The NHS advises not driving for at least 4 weeks (3 months for a bus, coach or lorry licence), avoiding heavy lifting for 3 months, and telling the DVLA if you hold a bus, coach or lorry licence. Metal wires used to close the breastbone are usually left in permanently. If you have a mechanical valve, you will need anticoagulants such as warfarin for life, an alert card, and good dental care to reduce the risk of infection of the heart.

On the NHS, heart surgery follows a referral from a GP to a cardiologist, investigations and a discussion at a team meeting. Waiting times depend on urgency and local capacity, and more urgent cases are operated on sooner.

Privately, a cardiologist or cardiac surgeon sees you, arranges the tests and, if surgery is suggested, gives you a written plan and an itemised estimate. Costs depend on the operation, the type of valve or devices used, the length of intensive care and hospital stay, and follow-up. Ask what is included, what happens if you need unplanned intensive care, and who will be responsible for your care if there is a complication.

• Ask whether surgery, a stent or a catheter valve is best for your situation, and what the alternatives are.

• Ask how many operations of your type the surgical team performs and what its outcomes are, using national audit data where available.

• Ask about valve type, anticoagulants, driving, work and when you can resume exercise.

• Ask about cardiac rehabilitation and who to call if you are worried after discharge.

• Call 999 for sudden chest pain that spreads to your arms, back, neck or jaw or lasts more than 15 minutes, or chest pain with breathlessness or palpitations. Do not drive yourself to A&E.