The Benefits of Being Awake During Heart Surgery

FEBRUARY 21, 2018
By UH

Older patients or those with health conditions that have an increased risk of complications from surgery are ideal candidates for minimally invasive heart procedures that allow the patient to be awake during surgery.

For some heart procedures, the patient is given medicine to relax but is not fully sedated. A local anesthetic is given and a catheter (thin tube) is inserted through an artery in the groin. The doctor reaches the heart through this catheter and repairs the problem. The patient is left with only a tiny incision where the catheter was inserted and, in most cases, can go home the next morning.

At University Hospitals Harrington Heart & Vascular Institute, our heart team performs a variety of procedures using this minimally invasive approach, including replacement of the aortic valve and repair of congenital defects – conditions that used to require a major open-heart surgery under general anesthesia. Now, aortic valve replacements are routinely done in awake patients using transcatheter aortic valve replacement (TAVR) – a minimalist approach developed and introduced in the U.S. by our experts at UH.

Guilherme Attizzani, MD, co-director of the Valve and Structural Heart Disease Center at UH, notes that performing heart procedures such as TAVR on the awake patient is beneficial for many reasons, including:

  • No need for general anesthesia, which can pose certain health risks and extend recovery time.

  • No need for intubation, which can increase the risk of pulmonary infection and/or pneumonia.

  • No need for cardiopulmonary bypass, which interferes with the body’s natural processes.

  • Minimal recovery time and much shorter hospital stay, which lessens the risk of hospital-acquired infections and complications.

  • The awake patient can respond to questions, enabling their surgical team to make adjustments as needed to ensure they remain calm, comfortable and pain free.

Another advantage, according to the institute’s president and pioneer in this approach, Marco Costa, MD, PhD, is the ability to monitor the neurologic status of the patient throughout the procedure. Although rare, there is a small (< 2 percent) risk of stroke during surgery and, if the patient is under general anesthesia, there’s no way to know until they wake up – and then it can be too late. With an awake patient, the surgeon can interact with them and watch for early warning signs and take immediate action if a stroke or mini-stroke (TIA) is suspected.

Who can have awake procedures?

A transcatheter approach to heart procedures actually makes treatment available to many patients who might not have been treated in the past. Open heart surgery and general anesthesia undoubtedly saves lives, but elderly patients or those with other health conditions may be at increased risk of complications or a difficult recovery after surgery; and many are not offered treatment options. With this new minimally invasive approach, chronological age alone is not a barrier to care.

Related Links:

UH Harrington Heart & Vascular Institute
UH Interventional Cardiovascular Center

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