Thanks to recent advances in heart surgery, quality of life usually improves quickly and dramatically with reduced pain and increased vitality.

It's great if you can keep your heart healthy — not smoking, eating a healthful diet and getting regular physical activity can do wonders. But in the event you or a loved one needs heart surgery, what should you know about it now?

For one thing, trust you'll be in good hands.

"We reassure patients they're being treated by highly trained, caring individuals who are absolutely devoted to getting them to full recovery with the least amount of risk to their well-being and independence," says Joseph S. Coselli, M.D., chief of cardiothoracic surgery at Baylor College of Medicine and chief of adult cardiac surgery at the Texas Heart Institute, both in Houston.

Further, Coselli adds, the prospect for recovery is probably better than you think. "For a coronary artery bypass operation, if you're otherwise in reason ably good condition, the risk for mortality is only about 1 to 2 percent," he says. "A few decades ago, the risk would have been in the 5 to 10 percent range."

What Surgery Involves
Coronary artery bypass is just one form of heart surgery. Others include heart valve repair or replacement; arrhythmia surgery, which helps restore regularity of the heart's natural rhythm; and aneurysm repair to replace weakened sections of a blood vessel or the heart with a graft.

Bypass surgery is the most common. When coronary arteries are clogged as a result of a buildup of fats, cholesterol or other substances, a surgeon can attach a new section of blood vessel that goes around, or bypasses, the clogged arteries to restore a healthy fl ow of blood.

Patients are asleep during bypass surgery, which in standard surgery may take from three to six hours. They awaken afterward in the hospital's intensive care unit (ICU). After the ICU, patients are transferred to hospital rooms.

Recent Advances
New technologies have reduced surgery and recovery times and make heart surgery an option for even some of the sickest patients.

After being in use for nearly 30 years, for example, coronary artery bypass surgery is now the most frequently performed major surgery in the United States, with more than 500,000 procedures done each year. Advances also have reduced recovery time and heart-surgery-related risks for stroke and spinal cord injury.

Reduced recovery time is particularly important to older patients because a few months can take a big chunk out of their remaining years of life. So is the reduced risk for stroke or other major complications.

"People often wonder if this operation will cause them to lose their independence," says Coselli. "Most likely the answer is no, due to the progress we've made in providing curative therapies, reducing recovery time and reducing the loss of independence."

Some of the more notable advances include:

• Minimally invasive surgery. With this option, the rib cage doesn't have to be opened to access the heart area.

  "Perhaps 40 to 60 percent of patients may be eligible for minimally invasive surgery, but it's still a novel technology," says Coselli. "It's mostly done only in larger hospitals." Robots are used for performing minimally invasive surgery, which reduces the size of the incision, the recovery time and risk to the patient.

  For example, traditional surgery for an aortic aneurysm commonly can take up to six hours and require two to four days in the intensive care unit, a week to 10 days in the hospital, and two to four months of recovery at home.

  Minimally invasive surgery takes about an hour; it's done with a small incision in the groin only a few inches long through which a stented device is placed into the artery. The patient may spend one night in the recovery room, only two to three days in the hospital and be effectively fully recovered.

• Better heart valves. Today's artifi cial valves, used to replace the fl aplike "doors" in the heart that help transport blood with each heartbeat, are far superior to the ones used a few decades ago, both in terms of durability and how well they work inside the heart, notes Coselli.
• Reduced post-surgery discomfort. One of the patients' biggest complaints after surgery traditionally has been the long scar in the leg where a vein is removed for use as a bypass artery. New procedures have reduced both the size of the scar and the discomfort.

Nearly all patients do feel better, not worse, after surgery, Coselli stresses. "Many patients going into surgery are short of breath or have chest pain," he says. "The treatment addresses these issues — people are more vigorous afterward, they have reduced chest pain and they feel relieved. Their quality of life usually improves dramatically."

For the Best Surgery Experience
Some helpful advice when facing heart surgery:

• CHOOSE A "CENTER OF EXCELLENCE," IF POSSIBLE. "There's absolutely no question that the results of heart surgery tend to be better in institutions that have a special focus on these procedures and carry them out in higher volumes," says Joseph S. Coselli, M.D., of the Texas Heart Institute. Coselli notes that in his 22 years of performing heart surgeries, he has opened patients' chests "many, many thousands of times," whereas a surgeon at the usual community hospital "would probably have done so only a few dozen times."
• TRY TO HAVE A POSITIVE ATTITUDE. "Understand there are risks to heart surgery," Coselli says. "At the same time, you can be optimistic: in the overwhelming number of cases, there's an excellent result in both the short and long term. the light at the end of the tunnel is bright. full recovery is something nearly all patients can look forward to."
• PLAN AHEAD FOR AFTER SURGERY. "Heart surgery isn't just a three-hour operation," he says. "And it's more than the actual management and treatment of heart disease. It's your time in the intensive care unit and the recovery room, it's your hospital stay, it's your recovery at home, and it's your transition back to full activity. Uncertainty about any part of this process, and about having all the support you'll need, will get in the way of your positive attitude."

Polly Turner spoke with Joseph S. Coselli, M.D., chief of cardiothoracic surgery at Baylor College of Medicine and chief of Adult Cardiac Surgery for the Texas Heart Institute in Houston. For more information about heart surgery, visit www.texasheart.org/HIC/Topics/Proced.

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