Heart disease remains the leading cause of death in the United States. If you joined our recent webinar, you likely have questions about what comes next, whether you need surgery, what your options are, and what to expect.

If you are feeling unsure or overwhelmed, you are not alone. These are some of the most common and important questions patients ask when facing heart surgery.

In our recent Q&A panel, several cardiovascular experts from The Christ Hospital Health Network shared how they determine when surgery is needed and how they work together to deliver the best possible outcomes.

The discussion featured leaders from our Heart and Vascular Institute including Thomas O’Brien, MD, Heart and Vascular Institute President and Service Line Medical Director; Jarrod Frizzell, MD, Director of the Complex Coronary Therapeutics Program; Dean Kereiakes, MD, Heart and Vascular Institute Chair; and J. Michel Smith, MD​, Castellini Foundation Endowed Chair in Cardiothoracic Surgery.

Together, they answered the questions patients ask most when facing heart surgery. As one of the nation’s Top 50 heart hospitals, The Christ Hospital Health Network is a leader in cardiac surgery outcomes, experience, and innovation. Here is what our team of experts wants you to know about heart surgery.

When do you need heart surgery?

Your doctor does not base the decision to recommend heart surgery on your symptoms alone. Some heart disease symptoms, like chest pain, are easy to identify. Others, such as increasing fatigue or shortness of breath, are more subtle. That is why providers at The Christ Hospital Health Network consider other factors before recommending surgery.

In some cases, patients are surprised to learn they may need treatment even if they feel fine.

“It’s not unusual that we may recommend a procedure for a patient who has no symptoms or minimal ones,” Dr. Smith says. “We follow the current guidelines on when a patient should consider an interventional or more invasive procedure. And that guidance is clear.”

Doctors also rely on factors beyond symptoms when deciding on surgery. These can include:

• Disease severity, such as aneurysm size or location

• Exercise stress test results

• Imaging and diagnostic results, such as a calcium score​ that measures plaque buildup in your arteries

• Patient-specific risk factors, including age, personal medical history, and overall health

Together, these factors help determine not only if you need surgery, but the right time to move forward.

“One of the clearest signs about whether you need surgery is if you cannot do as much as you once were. Maybe you haven’t noticed you have scaled back within the last year or two,” Dr. Frizzell says. “Reflecting on that slow onset of symptoms can make a difference in what you decide to do about surgery.”

Should you seek a second opinion?

If your provider thinks you may need heart surgery, getting a second opinion can help you better understand your options.

“You’re going to make very few decisions that will potentially impact the length and quality of your life more than your healthcare choices,” Dr. Kereiakes says. “It’s your essential right as a patient to get a second opinion.”

Many of the patients we see come to us after being told there are no other options or that they need to travel out of state for care. Frequently, we are able to offer additional treatments or less invasive approaches right here in Cincinnati.

You can seek a second opinion even if you have already been referred elsewhere. You do not need a referral to explore your options.

Commonly, talking with another doctor may reveal additional treatment options, including less invasive approaches that can improve outcomes. You may also learn about newer techniques or clinical trials that are not widely available. And if a second opinion confirms surgery is your best option, you can move forward with confidence.

As a clinical cardiovascular research facility ranked in the top 3 percent nationally, The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital is at the forefront of innovative treatment options.

Center investigators have introduced more than 45 novel cardiovascular medications and devices to the United States and more than 25 to the world. Researchers are actively studying advancements in heart valves, gene therapies, and medications designed to improve results for patients with complex heart conditions. This means you may have access to treatments and technologies years before they are widely available.

“The Lindner Center at The Christ Hospital gives you options you might otherwise have to wait three to five years for,” Dr. Kereiakes says. “Depending on what your problem is, three to five years can actually be the difference between life and death.”

What are your treatment options?

To deliver the best outcome, our cardiovascular team offers a full range of nonsurgical and surgical treatment options. Not every hospital provides the same level of expertise or access to advanced therapies, and that difference can impact your care.

Based on your unique condition, your care team will recommend the approach that is safest and most effective for you.

Nonsurgical treatment

In many cases, you may not need surgery to treat your heart condition, Dr. Frizzell says. Instead, a catheter-based procedure can be an effective option.

These procedures are typically performed through a small incision in the wrist or groin and often allow for a shorter recovery time.

Our providers offer:

• Angioplasty and stents: This procedure opens a blockage in one of your blood vessels. By making a small incision in your wrist or groin, your care team guides a balloon to the blocked artery, inflates it to restore blood flow, and places a stent to help keep the artery open.

• Transcatheter aortic valve replacement (TAVR): This procedure replaces one or more of your heart valves using a minimally invasive approach. A new valve is placed inside your existing valve, allowing it to open and close properly and improve blood flow.

Surgical treatment

If your heart condition is more complex or you have advanced heart failure, your provider may recommend surgery.

Advanced heart failure occurs when you no longer respond to medications or guideline-directed therapies. At this stage, care from a specialized, high-volume center becomes especially important. Your care team works together to determine the safest and most effective surgical approach based on your condition, risk factors, and overall health.

We offer:

• Left ventricular assist device (LVAD): If you have advanced heart failure and are waiting for a heart transplant or are not a transplant candidate, this device helps pump blood throughout your body.
  
  “This device is implanted except for a small power cord that comes out of your abdominal area,” Dr. O’Brien says. “It’s your lifeline and it must remain connected to power. There is ongoing work to make these devices wireless, and the expectation is that future patients may be able to charge them externally.”

• Open heart surgery: This procedure involves making an incision in the chest to directly access the heart. It is typically used for the most complex conditions where a full view of the heart is necessary.

• Robotic surgery: In this approach, your surgeon uses robotic tools to perform the procedure with greater precision and smaller incisions. For many patients, this can mean less pain and a faster recovery. However, open heart surgery may still be recommended for more complex cases or certain heart conditions.

• Ross procedure: This surgery replaces a damaged aortic valve with your own pulmonary valve, which is then replaced with a donor valve.

• Heart transplant: For patients with advanced heart failure, this procedure replaces a failing heart with a healthy donor heart.

Risks from Surgery

According to Dr. Smith, the risks associated with heart surgery in the United States are low. The chances of a heart attack, stroke, or death after a stent or open-heart procedure are typically less than 1 percent. However, as with any procedure, the risk of complications still exists.

At The Christ Hospital Health Network, surgeons carefully evaluate each patient’s risk before moving forward with surgery.

Surgeons across specialties routinely review cases and use a tool from the Society of Thoracic Surgeons to assess risk on a patient by patient basis. By entering details such as the patient’s age, gender, and medical history, the team can identify potential complications and plan accordingly.

To help reduce risks, our surgeons can collaborate to perform hybrid procedures when appropriate, combining different techniques to improve safety and outcomes. “We don’t let a high-risk operation keep us from offering care to a patient. With a hybrid approach, we can use a robotic technique with some vessels while others are treated with stents,” Dr. O’Brien says.

What can you expect during heart surgery?

According to Dr. Smith, cardiovascular providers at The Christ Hospital Health Network take a team-based approach to your procedure. Every step is carefully coordinated to keep you safe and support the best possible result.

Before surgery

A large, highly specialized team is involved in your care. Your procedure team will include your surgeon, anesthesiologist, certified registered nurse anesthetists, nurses, perfusionists, and advanced practice providers.

Once you are asleep – and before your surgery begins – your team performs a final safety check. They review all your existing images and capture new ones in the operating room to identify any changes that may affect your procedure. This step is critical, as it allows your team to confirm your plan in real time and make any necessary adjustments before surgery begins.

They then walk through a detailed checklist to ensure all equipment, tools, and team members are fully prepared and aligned. This process helps ensure your procedure is as safe, precise, and well-coordinated as possible.

After surgery

When your procedure is complete, your surgeon will close and bandage your incision or catheter site. You will then be moved to the intensive care unit (ICU), where a dedicated team of doctors, nurses, and advanced practice providers will monitor you closely around the clock.

This team watches for any changes, manages your recovery, and ensures you are stable and progressing as expected.

What will recovery and post-surgery life be like?

Your recovery will depend on the type of procedure you have, but most patients begin to feel stronger over time with the right support and care.

If you have a catheter-based procedure, you will likely go home the same day. However, you will still need to rest and avoid heavy lifting for several days.

After surgery, most people stay in the hospital for four to five days. Once your vital signs are stable and you can walk and move independently, your care team will discharge you to continue your recovery at home. Your recovery plan and instructions will be tailored to your specific procedure and overall health.

Stents

Recovery after a stent procedure is typically easier for your body, Dr. Frizzell says. Still, you will have some temporary restrictions.

“Even though a stent procedure may only last an hour or two, it takes more out of you than you think,” he says. “Most people are not really in the mood for doing much extra until a few days have passed.”

In most cases, the wrist or groin is used as the access point for the procedure. It is important to take care of that area as you heal.

Dr. Frizzell recommends:

• Avoid heavy lifting over ten pounds for four to five days

• Avoid driving or traveling for a few days

• Stand up and walk every few hours to prevent blood clots

LVAD and Transplant

These procedures are more complex and require a longer recovery period, but the same general precautions apply.

You should:

• Avoid driving for two to three weeks

• Limit heavy lifting over ten pounds for four to six weeks

According to Dr. O’Brien, these procedures also require additional recovery time, education, and support.

If you have an LVAD procedure, your care team will teach you how to manage the pump that circulates your blood before you leave the hospital. You will have time to practice, and a direct number to call if you need help once you are home.

For a transplant, your providers will help you adjust to new anti-rejection medications before discharge. You will also have frequent follow-up appointments to closely monitor your recovery.

Cardiac Rehabilitation

A full recovery can take three to six months, and rebuilding your strength is an important part of that process. This is done by starting cardiac rehabilitation within the first month after surgery.

“Cardiac rehab is the single most important thing you can do after surgery to support your recovery,” Dr. Smith says. “It will help get you back to the life you want to have.”

Most cardiac rehabilitation programs last for about three months and include multiple sessions a week. Before starting formal rehabilitation, it's important that you begin building strength at home. Many patients are sent home with a personalized walking plan that gradually increases activity over several weeks.

“Our cardiac rehabilitation specialists want you to have some endurance built up before you start cardiac rehab,” Dr. Smith says. “So, we send you home with a walking program that recommends you walk a certain number of times a day for a particular number of minutes. This way, you’re in a better position to start and maximize your cardiac rehab.”

How can you prevent heart disease?

Taking steps to prevent heart disease can help you avoid more serious procedures in the future, Dr. Kereiakes says. Prevention and early detection play a critical role in protecting your long-term heart health.

He recommends practicing these healthy lifestyle behaviors:

• Eat a balanced, heart healthy diet

• Exercise regularly

• Maintain a healthy weight for you

Additionally, monitoring your risk factors is equally important. Talk with your primary care doctor or cardiologist about assessing and managing your:

• Blood pressure

• Cholesterol

• Diabetes

Dr. Kereiakes also recommends a blood test to evaluate your lipoprotein(a) or Lp(a) level. Lipoprotein(a) is an inherited form of cholesterol that can significantly increase your risk of heart attack and stroke.

In addition to prevention through lifestyle and monitoring, research is helping shape the future of heart care. As one of the nation’s leading gene therapy centers, The Lindner Center is advancing new approaches to prevention and treatment. Investigators are using an advanced technology called CRISPR to target genes linked to cardiovascular disease.

“If you have a defect that results in high cholesterol, we can modify your genetic makeup and ‘fix’ your problem,” Dr. Kereiakes says. “We call it ‘one shot, one and done.’ You may not need to take high doses of medication for the rest of your life.”

How can you handle anxiety about your surgery?

It’s normal to feel anxious or scared when you are facing heart surgery. You may worry that you’re too old, that the risks are too high, or that you may need another surgery in the future. These are common concerns, and our multidisciplinary team works together to address them.

Each week, our subspeciality physicians, cardiac surgeons, cardiologists, and imaging specialists meet to design customized treatment plans for every patient. They carefully consider which procedures are safest and most appropriate based on a patient’s age and risk factors.

During surgery, they have access to the most durable, long-lasting valves and stents that limit the need for repeat procedures.

In addition to thoughtful treatment planning and leading-edge tools, The Christ Hospital Health Network offers compassionate, supportive care that’s second to none, Dr. Smith says.

“When you come to The Christ Hospital, our team is prepared. It’s not just me taking care of you. It’s a cast of 100 or more people who will be here to support you during and after your procedure,” he says. “When you leave the hospital, you’re going to get the same support. We’re going to help you through this. You can come to our hospital with confidence that we’re going to take great care of you.”

Schedule your consultation

If you have been told you may need heart surgery or are unsure what to do next, the multidisciplinary cardiovascular team at The Christ Hospital Health Network is ready to evaluate your condition and help you understand your options. Regardless of your age or diagnosis, our team will work with you to determine the best path forward based on your unique needs.

“We have a team of the best doctors in the Midwest working collectively to make recommendations for every patient. That offers assurance and comfort,” Dr. Kereiakes says.