Cardiac (Heart) Surgery

ECMO serves as life support for patients whose heart or lungs can’t perform their normal functions. This technology provides a bridge to recovery for patients with reversible heart and lung failure. The goal is to stabilize patients long enough to fix the problem that caused their illness and minimize trauma to heart or lung tissue so that they can recover. Billings Clinic was the first ECMO provider in Montana, Wyoming and the western Dakotas, and has the largest ECMO experience in the region.

Billings Clinic was the first hospital in Montana and Wyoming to perform Thoracic Endovascular Aortic Repair (TEVAR) in 2014.

In addition, Billings Clinic became the state’s first Certified Thoracic Branched Endograft (TBE) center, which is a specialized minimally invasive technique that allows for more complex transcatheter aortic repairs without the need for open surgery. 

TEVAR involves the use of a Thoracic Stent Graft to repair conditions such as aortic aneurysms or traumatic injury to the descending thoracic aorta. Historically these conditions have resulted in the need for major surgery which requires a several day stay in the hospital and many activity restrictions for patients as they recover from surgery.

The TEVAR procedure is completed in the Cardiac Catheterization Lab using a multi-disciplinary team of cardiologist, cardiac surgeons, anesthesia, cath lab, and OR personnel. During this procedure, a fabric graft supported by a metal framework is placed within the affected area of the aorta. The procedure takes approximately 1-3 hours to complete and patient’s stay in the hospital is approximately 2-3 days. Within 2 weeks of the procedure, patients should be back to their normal, active lifestyle with no restrictions.

The most common heart surgery procedures performed at Billings Clinic include coronary artery bypass grafting surgery and heart valve repair or replacement surgery.

Heart Surgery (coronary artery bypass grafting) is an operation in which the surgeon creates a bypass or detour around blockages within the coronary arteries. The bypass or detour restores normal blood flow to the heart. The surgeon uses the patient’s own blood vessels (arteries and veins) to create the bypass grafts. The most commonly used blood vessels are the internal mammary artery (which supplies blood to the inside of the chest) or saphenous veins (which return blood to the heart from the legs).

The goal of bypass surgery is to relieve symptoms of coronary artery disease, lower risk of a heart attack, and enable patients to resume a normal lifestyle.

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Cardiac surgeons at the Billings Clinic are the only surgeons in Montana and Wyoming that currently offer aortic valve repair using a bio-stable ring, a procedure that is on the forefront of cardiac surgery techniques.

We are the only surgical team in MT and WY that currently offers minimally invasive valve surgery.

We are the only team that offers “university level” comprehensive approach and ability to deal with highly complex conditions.

As noted previously, the heart has 4 chambers. Blood is pumped through the chambers of the heart, aided by 4 heart valves. The perfect valve would be one which minimizes any obstruction and allows blood to flow freely in one direction through the heart. The four heart valves include:

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

Each valve has a set of flaps (also called leaflets or cusps). When working properly, the heart valves open and close fully and blood flows through the valve in a smooth and even manner. Heart valves don’t always work as they should. There are several factors which can cause heart valves to work improperly. A person can be born with an abnormal heart valve (a congenital heart defect) or a valve can become damaged by infections, rheumatic fever, or changes in valve structure as a person ages. Diagnosis of valvular heart disease is made by a Cardiologist usually with an echocardiogram (ultrasound of the heart).

There are two common conditions that can occur when a natural heart valve becomes defective or fails to fully open or close. These conditions can occur in just one valve or in more than one valve.

• Stenosis occurs when the valve cannot open completely or becomes narrow, so blood is pumped through a smaller than normal opening.
• Regurgitation occurs when the valve is not able to close completely, so blood leaks back through the valve when the valve should be closed.

Generally, even though the initial damage to a valve may happen early in life, the early effects are mild and defect progresses slowly. When the stenosis or regurgitation rate attains a significant level, clinical problems may become noticeable and symptoms of heart failure are felt by the patient.

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Heart Valve Repair and Replacement Options

Diseased heart valves can be treated in several ways. These include 1) treatment with medication; 2) surgical repair; or 3) surgical replacement.

Heart valve repairs are generally completed using a ring to repair the valve.

If the surgeon chooses to replace a natural heart valve, the first step is to remove the diseased natural valve (excise the valve) and then implant a prosthetic heart valve in its place. Prosthetic valves used to replace the heart’s diseased natural valves come in different sizes to fit the patient and are made from a variety of materials. If the surgeon chooses to replace the natural heart valve, there are two broad categories of heart valves that he will choose from.

• bioprosthetic or tissue valves made primarily from animal tissue [i.e., a pig’s aortic valve, a cow’s pericardium (sac surrounding its heart) or human valves from cadavers]. Patient’s will be on blood thinners for a short period of time with this type of replacement valve.
• mechanical valves constructed from synthetic material. Patient’s will be required to take blood thinners for the rest of their lives with this type of valve replacement.