**Heart surgery** is performed with the aim of treating and correcting problems caused by **heart failure**. One of the ways to diagnose heart problems is echocardiography by a specialist in cardiology and echocardiography. For diagnosis and treatment of heart diseases, you can visit the doctor's office. In this article, we are going to review **types of heart surgeries** and their implementation methods: ### Coronary artery bypass surgery or open heart surgery **Coronary artery bypass**, which is also known as open heart surgery, is one of the most common methods to improve **blood flow in the heart muscle**. This surgery is usually performed for people who have severe blockages in **coronary vessels**. In this situation, fat and plaques accumulate in the walls of the vessels and cause narrowing of the vessels; As a result **blood flow** is disturbed and may lead to chest pain or even **heart attack**. However, nowadays, in many cases, less invasive techniques such as angioplasty are used instead of open surgery. ### Angioplasty or stenting **Angioplasty** is a procedure to open **narrowed or blocked heart vessels** using a small balloon. After the vein is opened, a device called a stent, which is a metal mesh tube, is placed in place to keep the vein open. This method helps to reduce the symptoms of angina and is also known as percutaneous coronary intervention (PCI). ### Transmyocardial laser surgery (TMR) **TMR surgery** is usually used when other treatment options have not been successful. This procedure may be performed in combination with open heart surgery, but in some patients it can be performed only through a small incision in the chest. In this method, the surgeon uses a laser to create fine channels in the **myocardium** that extend to the left ventricle. Although the exact mechanism of action of this treatment is still not completely clear, many experts believe that the creation of these pathways can stimulate the growth of new blood vessels and bring more oxygen to the affected areas, which is effective in reducing the pain caused by angina. **Repair or replacement of heart valves** For the proper functioning of the heart, the blood must flow only in a certain direction, and this responsibility is on the shoulders of **heart valves**. Healthy valves open and close regularly so that the blood flow is properly directed between the **cavities of the heart and blood vessels**. These valves have leaflets that allow blood to flow when opened and then close to prevent its return. At times, the leaflets may thicken or stiffen, preventing them from fully opening. In such a situation, valve repair surgery is performed. Other times, the leaflets don't close properly and blood backs up; In this case **complete replacement of the valve** will be a more appropriate solution. Depending on the patient's condition, the surgeon decides to reconstruct the valve or replace it completely. ### **Minimally invasive methods to treat valves** For example, in cases where the mitral or pulmonary valve is too narrow, the doctor can fix the problem by using a catheter inserted through a large vein. The tip of this catheter is guided into the narrowed valve, and by inflating a balloon at the tip, the valve is dilated to improve blood flow. This method is less dangerous and less invasive than open heart surgery. Also, the same technique is used to replace a defective aortic valve. In this type of treatment, the catheter is inserted from an artery in the groin area and goes to the heart. Although valve replacement surgery is still considered a common and traditional method, the use of catheter-based methods is considered a safe and effective option, especially for patients who cannot tolerate open surgery. ### **Treatment of cardiac arrhythmia or ablation** **Cardiac arrhythmia** is called a disorder in the **regular heartbeat**. In this condition, the heart may beat very fast or abnormally slowly. Most arrhythmias are harmless, but some can be serious and even life-threatening. When the heart's rhythm deviates from normal, the heart's ability to pump blood effectively decreases. This lack of blood flow can damage vital organs such as the brain, heart and other organs. In the early stages, medication is usually prescribed to control the arrhythmia, but if the medication is ineffective, surgery is considered as the next solution. Among the **surgery for arrhythmia**, we can mention the implantation of a **pacemaker** (or heart battery) and a cardioverter. ** Pacemaker ** is a small device that is placed under the skin of the chest or abdomen and regulates the ** beat ** using wires that are connected to the ** cavities of the heart **. This device controls the heart rhythm with mild electrical pulses and is activated when needed. Most pacemaker models have sensors that activate the device if an irregular rhythm is detected. Cardioverter is also a small device that is installed under the skin like a pacemaker. This device continuously monitors the heart's rhythm and if it detects an abnormal rhythm, it delivers an electric shock to the heart to return the **beat** to a normal state. In some surgeries, the doctor creates new pathways for electrical signals to pass through the heart. This method is especially used in the treatment of atrial fibrillation, which is the most common type of serious arrhythmia. In less invasive procedures, intense heat or cold energy is used to disable abnormal electrical pathways in the heart. ### Aneurysm repair **Aneurysm** is a kind of balloon-shaped protrusion in the wall of one of the arteries or the heart muscle, which occurs when the wall of the vessel suffers from structural weakness. Internal blood pressure can cause the expansion of this weak point and gradually cause a bulge in it. Over time, this area can rupture, causing severe and often fatal internal bleeding. Aneurysm can also cause cracks in the inner layers of the vessel walls and lead to bleeding between these layers. The most common location of an aneurysm in the heart is the left ventricle. To treat this disorder, **aneurysm repair surgery** is performed, during which the damaged part of the vessel or heart wall is replaced with a patch or graft. This replacement strengthens the weakened structure and prevents further rupture or severe complications. ### Heart transplant operation One of the advanced methods in **heart surgery** is **heart transplantation**, during which the damaged heart of the patient is replaced with a healthy heart from a deceased donor. This type of surgery is usually performed for patients who have severe heart failure. **Heart failure** occurs when the heart's function in pumping blood effectively decreases and can no longer meet the vital needs of the body. In acute cases, when no other medical or surgical treatment has responded, **heart transplant** is proposed as the last treatment solution. ### Cardioversion or cardiac shock Cardioversion is a treatment for cardiac arrhythmia in which a controlled electrical shock is used to restore the heart's normal rhythm. This shock is delivered to the heart by a device called a defibrillator to reset the uncoordinated electrical pathways. This procedure is usually performed under general anesthesia or sedation and can be repeated if needed. Also, in some patients, defibrillators are used that are permanently implanted in the body to perform the shock function automatically when necessary. ### Surgery to implant an artificial heart or ventricular assist device In some patients who have severe heart failure and do not respond to common treatments, **mechanical pumps** are used to support heart function. By helping to pump blood, these devices maintain proper blood flow and can be used temporarily or long-term depending on the patient's condition. If both ventricles of the heart do not function properly, **left and right ventricle replacement devices** are used. Open heart surgery is usually required to implant these devices. ### Robotic heart surgery Among other modern methods in **heart surgery with minimal invasion**, we can mention the use of **robotic surgery** technology. In this method, with the help of a computer system, the surgeon controls the surgical instruments that are connected to the narrow arms of the robot. These instruments are inserted into the chest through small incisions and allow the surgeon to perform the operation with high precision without extensive incisions. Robotic surgery is usually used for complex cases, and full control of the robotic arms is always in the hands of the surgeon, and the system is not automated at all.