Going for heart surgery can feel overwhelming, but understanding the procedure can help ease your concerns.

Heart surgery encompasses several types of procedures, including:

• Coronary artery bypass grafting (CABG) to improve blood flow to the heart

• Heart valve repair or replacement

• Surgery to correct heart rhythm problems

• Procedures to repair heart defects or damaged heart tissue

In this "Ask the Specialist" Q&A, get your questions answered by Clinical Assistant Professor Zameer on:

1. What is needed to prepare before heart surgery?

2. What actually happens during the procedure?

3. How is the recovery journey and rehabilitation process like?

4. What are ways to support better healing and to return to daily activities?

Simply email your questions to the email address shown above and have your concerns addressed by our cardiothoracic surgeon. This Q&A is for a limited time only so submit your questions now!

About Clin Asst Prof Zameer Abdul Aziz

Clinical Assistant Professor Zameer Abdul Aziz is a Consultant with the Department of Cardiothoracic Surgery at the National Heart Centre Singapore. His special interest is in adult cardiac surgery, heart failure surgery and aortic surgery.

Questions and answers on heart surgery

1. Question by Carlos

Hi Dr Zameer,

May I check if Vitamin K (or K2?) really helps clear up the heart blockages?

Answer by Dr Zameer Abdul Aziz

Hi Carlos

There is currently no evidence for the use of Vitamin K to treat heart blockages. A systematic review of controlled trials concluded that the evidence is insufficient to recommend vitamin K supplementation for the prevention of cardiovascular disease.

While some studies suggest that vitamin K2 may have some beneficial effects on vascular health, it is not a cure for ischemic heart disease (commonly known as heart blockages).

Treatment recommendations are based on established guidelines for managing ischaemic heart disease. 

Depending on how many blockages there are, how severe they are, and their location, doctors may recommend a procedure to insert stents (called percutaneous coronary intervention) or coronary artery bypass surgery. 

Every patient is different, so in addition to looking at the anatomy of these blockages, doctors will also carefully consider other important factors such as patient age, cardiac function, overall health, and medical history before deciding on the best treatment approach.

2. Question by Mdm Lam

Dear Doctor,

I have a congenital heart murmur and the cardiologist who was my primary cardio doctor did not recommend any surgery since age 35.

I am in my early 70s, no symptoms of breathlessness, palpitations, high blood pressure. Undertake low impact exercise daily.

My question is: As we age, valves, heart chambers undergo degeneration like other parts of our body. Will my valve require any corrective surgical procedures? Considering my age, any surgical procedure will have higher risk vs when I was 35.

Thank you.

Answer by Dr Zameer Abdul Aziz

Dear Mdm Lam

Thank you for your question! I am glad that you are well in your 70s and lead an active lifestyle still.

In response to your question, our heart valves, like other parts of our body, are susceptible to degeneration with age. They may become stiff due to calcium/fibrous deposits and open less easily or become loose and leak over time.

Patients with valvular dysfunction would normally be monitored with follow-up visits and may require investigation with echocardiography to assess the valve and heart function over time.

This will allow doctors to have more information on the severity and any consequences that may affect the heart, as well as determine if any procedure is necessary.

At NHCS, heart valve operations are one of the most common heart surgeries, and patients typically range from young ages to the elderly who are in their 80s. 

However, not every patient with a valve condition may require surgery. At times, doctors may continue to monitor with surveillance echocardiography and assess the patients’ symptoms.

3. Question by Jane

Hi Dr,

I've been experiencing more symptoms (leg cramps, lower physical exertion tolerance, random dry cough) but not really sure if they're related to my heart ASD which remains at around 10mm when i checked last year.

My next appointment is next year Oct but I'm thinking of going for my ASD repair this year. Or shall i get my heart checked again first? Thank you.

Answer by Dr Zameer Abdul Aziz

Dear Jane

An ASD (atrial septal defect) is more commonly known as a hole in the heart between the left and right atrial chambers of the heart that occurs from birth.

It may present with several symptoms:

• Shortness of breath

• Reduced effort tolerance or ability to exercise

• Leg swelling

• Irregular heartbeat or arrhythmias

In addition to the above, ASD carries a higher risk of stroke and heart failure in certain patients.

If you would like to have your ASD closed, you will have to undergo preoperative investigations including blood tests, ECG, a chest radiograph as well as an echocardiogram (which will assess the ASD and the valves, chambers, structure and function of the heart). Depending on your age, you may or may not be required to undergo a test to evaluate your coronary arteries as well.

If you are considering, please discuss with your doctor regarding your procedure and they will arrange the necessary tests and explain the procedure to you in detail.

4. Question by JS

Dear Dr,

I would like to ask the following questions.

a) After undergoing a bio-prosthetic valve replacement, is there anything to take note in order to optimise the lifespan of the valve?

b) After undergoing valve replacement and getting back to running long distances, how does one know if one is pushing too much?

c) An alternative to valve replacement is percutaneous intervention, what is that and who would be suitable for that?

Thank you.

Answer by Dr Zameer Abdul Aziz

Dear JS,

Thank you for your insightful question.

After a valve replacement with a bio-prosthetic valve, I would recommend:

• Good blood pressure control

• Maintaining good control of cholesterol levels with medication as well as a healthy diet

• Not smoking

• Light to moderate intensity exercise

In addition to the above lifestyle factors, good oral hygiene should help to reduce the risk of infection to the artificial valve as well!

It is possible to return to long distance running after heart surgery, but I would recommend a gradual increase in distance and effort.

Generally speaking, monitoring heart rate as well as exercise intensity (how you feel in terms of exertion, breathing, sweating and ability to talk, for example) would be useful to keep in mind.

For certain patients with specific valve conditions, a percutaneous valve implantation may be suitable (Transcatheter Valve Implantation or TAVI). 

These are also bioprosthetic valves which are implanted without removing your own valves. As for which approach and which valve is best for each individual patient, I would recommend consulting with a cardiac surgeon specialist for more information that is tailored to each patient.

5. Question by Sylvester

Hi Dr Zameer,

I have a myocardial bridge mid LAD and was offered minimally invasive unroofing surgery.

But I have frequent PVCs, PACs and sometime atrial tach and NSVT. I cannot do much/exercise without tons of PVCs and SOB. This have been going on for years but is getting worse with time. I am 62 this year.

Is my heart really up for the surgery? I am concerned my heart cannot take the stress of surgery. I am afraid I will get dangerous arrhythmia after surgery.

How can I check or what tests to do to check is heart is able to take the stress of heart surgery? Thank you.

Answer by Dr Zameer Abdul Aziz

Dear Sylvester,

Thank you for your question. Coronary arteries typically lie on the surface of the heart (known as the epicardial surface). 

Myocardial bridging is a specific condition that you are born with where a band of muscle lies over your left anterior descending coronary artery instead and impedes blood flow when it contracts. 

Unroofing is a procedure where the band/bridge of muscle is divided to allow for unrestricted blood flow down the coronary artery.

It is completely natural and understandable to be concerned about requiring heart surgery. It is a significant procedure, however with advances in surgical techniques, technology and well-established methods, it is a safe and effective treatment for many patients.

Like any procedure, there are known risks which include arrhythmia. I would recommend a good discussion with your surgeon regarding the procedure indications, steps, and risks so that you are well informed.

Prior to any surgery, our patients undergo investigations such as coronary angiography and echocardiography, amongst others, to evaluate their condition and their heart’s ability to withstand the procedure. 

It is important to consider not only if your heart can withstand the procedure, but also what the risks of leaving your condition untreated are as well. I hope this helps you in your decision.

6. Question by Halimah

Dear Dr Zameer, 

My father has undergone an emergency heart valve replacement surgery and I have several questions to ask you.

a) Can you explain the procedure of how you replace a ruptured valve? I saw in Grey's Anatomy that a surgeon massaged his patient's heart. Is this common?

b) Is it true that bioprosthetic valves have a shorter life span compared to mechanical valves? If so why would someone choose a bioprosthetic valve?

Thank you.

Answer by Dr Zameer Abdul Aziz

Dear Halimah

Thank you for your question.

Our most common heart valve operations are for the aortic or mitral valves. Unfortunately, due to causes such as degenerative disease or infection, emergency life-saving surgery may be required. Massaging a patient’s heart is called internal cardiac massage and fortunately, it is rarely required!

The procedure involves bringing a patient to a cardiac operating theatre, performing a sternotomy and placing a patient on cardiopulmonary bypass support. Cardiopulmonary bypass support allows us to operate on the heart while keeping good blood pressure and sustaining all other organs safely during the procedure. The patient’s faulty valve is either repaired or removed and a new valve implanted.

There are basically two choices –  a bioprosthetic valve which is anatomically more similar to our own valves, or a mechanical valve. 

Mechanical valves can potentially last much longer, about 20 to 30 years however they require that patients take warfarin which is a strong blood thinner, on a daily basis. It also carries a small risk of bleeding. 

Bioprosthetic valves last for an average of 10 to sometimes 15 years, but do not require warfarin.

Patients who undergo emergency or life-saving procedures may sometimes receive bioprosthetic valves based on their age or medical condition, especially if they have not been counselled properly regarding the many restrictions (e.g. dietary, medication, and lifestyle) that would be needed for patients who receive a mechanical valve. 

Although bioprosthetic valves may last 10 to 15 years, there are treatment options available if these valves deteriorate, such as a repeat surgery or at times, a percutaneous valve implantation within the original bioprosthetic valve.

Ref: G25