Heart and vascular surgery

Cardiovascular surgery in New Hampshire

Our cardiothoracic and vascular surgeons at Appledore Medical Group are dedicated to high-quality treatment for diseases impacting the heart, lungs and vascular system.

Heart and vascular conditions we treat

Our dedicated team specializes in diagnosing and treating a wide range of heart and vascular issues, including:

• Aortic disease
• Aortic dissection
• Abdominal Aortic Aneurysm (AAA)
• Aortic Root Aneurysm
• Ascending Aneurysm
• Carotid artery disease
• Descending Aneurysm
• Peripheral Artery Disease (PAD)
• Popliteal aneurysm
• Iliac aneurysm
• Femoral aneurysm
• Peripheral Artery Disease (PAD)
• Thoracic aortic aneurysm (TAA)

Heart and vascular specialists

As a nationally-recognized destination for heart and vascular care, our award-winning team includes board-certified cardiologists, cardiac surgeons, nurse practitioners, physician assistants, nurses, technologists and others who are leaders in their field. We provide you with the latest and most advanced treatment options in the region.

Our expert teams use state-of-the-art technology to provide patients with advanced surgical procedures, such as minimally invasive heart surgeries.

Before visiting one of our cardiothoracic and vascular surgeons, please view our patient health forms.

Advanced cardiovascular and vascular surgical care

Heart and vascular disease will affect over one million Americans each year, according to the American Heart Association. However, advanced surgical techniques and expert care can be key factors in treating cardiovascular conditions.

Our multispecialty heart and vascular teams—including physicians, cardiothoracic and vascular surgeons, anesthesiologists and nurses — provide the comprehensive care you need to regain heart health.

Cardiovascular surgery

Our heart surgeons provide specialty surgical services for heart diseases and disorders using the most advanced surgical techniques available. Our surgeons perform cardiac surgeries and procedures including:

• Complex repair of thoracic-aortic diseases
• Coronary artery bypass grafting (CABG)
• Cardiac mechanical assist devices, including ECMO
• Minimally invasive surgical ablation for atrial fibrillation
• Minimally invasive valve surgery
• Reoperative open heart surgery
• Surgical removal of cardiac tumors
• Transcatheter aortic valve replacement (TAVR)

Vascular surgery

Cardiovascular surgery, also known as cardiac surgery or heart surgery, refers to any surgical procedure involving the heart or the blood vessels that carry blood to and from the heart.

Beyond providing highly skilled surgical care, our team develops a comprehensive and personalized treatment plan for each patient. We provide specialty surgical services for heart diseases and disorders using the most advanced surgical techniques available.

Our heart surgeons perform cardiac surgeries and procedures, including:

• Complex repair of thoracic-aortic diseases
• Coronary artery bypass grafting (CABG)
• Cardiac mechanical assist devices, including ECMO
• Minimally invasive surgical ablation for atrial fibrillation
• Minimally invasive valve surgery
• Reoperative open heart surgery
• Surgical removal of cardiac tumors
• Transcatheter aortic valve replacement (TAVR)

Coronary artery bypass graft (CABG)

A coronary artery bypass graft (CABG) can reroute blood flow around a blocked artery. Bypass surgery improves blood flow around severely blocked arteries and alleviates the symptoms of coronary artery/heart disease. During the surgery, a portion of artery or vein is taken from another part of your body. This is called grafting. One end of the graft is attached to the aorta (the major blood vessel in the body) and the other end is sewn to the coronary artery, beyond the blockage. The result is a new pathway — a bypass — for blood to flow to the heart. One or more grafts may be used depending on the number and extent of blockage.

In many situations, bypass surgery can safely and effectively be performed without using the heart-lung machine. This is referred to as beating heart or off-pump coronary artery bypass (OPCAB) surgery. Our surgeons perform both on-pump and off-pump bypass surgery based on the needs of the patient and the severity of the coronary artery disease.

Vascular surgery

Our vascular surgeons perform operations of the arteries and veins. We offer multiple options for vascular surgery, including:

• Carotid disease surgery, including minimally invasive carotid stenting (TCAR)
• Open and advanced endovascular treatment of abdominal aortic aneurysm (AAA)
• Peripheral arterial disease (PAD) surgery
• Surgery for dialysis access, including endovascular and peritoneal
• Varicose vein treatment
• Venous disease surgery

Heart valve disease

Heart valve disease refers to any of several conditions that prevent one or more of the valves in the heart from functioning effectively. It most often occurs in the mitral valve or the aortic valve, both on the left side of the heart. There are two common types of valve disease: stenosis (narrowing of the valve) and insufficiency (valve leakage). Left untreated, heart valve disease can reduce how well the heart is able to pump blood to the body, effecting quality of life and sometimes becoming life-threatening.

Minimally-Invasive Treatment Options

Depending on various factors, for some patients needing valve repair or replacement, a minimally-invasive approach may be recommended. We have a leading program for minimally-invasive treatments for both valve repair and replacement, including:

• TAVR
• Percutaneous mitral valve replacement

Types of treatments offered

Our skilled team will work with you to determine the most appropriate treatment based on your symptoms, condition, and lifestyle.

Lifestyle Adjustments and Medications

Less severe, smaller aneurysms can usually be managed with lifestyle changes, like better diet and exercise, and with certain medications. Depending on their size, they may not immediately require repair and can be monitored with repeated screening. Patients with an abdominal aortic aneurysm (AAA) should not smoke. If you have an AAA, you should also work with your primary care provider to manage your blood pressure and maintain a low-fat, low-cholesterol diet.

Interventional and Surgical Treatments

Our skilled team will work with you to determine the right treatment for your symptoms, condition and lifestyle.

• Abdominal aortic aneurysm's (AAA): AAA can be surgically repaired through an incision in the abdomen or through an endovascular procedure to insert a stent graft. Your vascular surgeon will work with you to determine the best approach based on your unique needs.
• Aortic dissection: Aortic dissection is a life-threatening condition that typically requires immediate treatment, including emergency surgery. Less severe dissections may be initially treated with medications. Our team has pioneered cutting-edge endovascular treatments for certain types of aortic dissection, being the first in New England to make these minimally-invasive options available to patients.
• Fenestrated Endovascular Aortic Repair (FEVAR) - A minimally-invasive procedure that allows surgeons to repair complex aortic aneurysms involving the arteries to your kidneys and other organs using wires and catheters rather than through a large incision. FEVAR differs from endovascular aneurysm repair (EVAR) as this type of graft has holes (fenestrations) so that the arteries to critical organs such as your kidneys can be preserved through the placement of covered stents.
• Peripheral Artery Disease (PAD): Several procedures can help improve blood flow in patients with PAD, including angioplasty and stenting. Angioplasty involves a balloon inserted into the artery through a small tube called a catheter, which the doctor inflates to clear the blockage. A stent is a small mesh tube that stays in the artery and helps keep it open. Certain cases may be suitable for an atherectomy, which uses laser technology to dissolve the plaque that’s blocking the artery. In some situations, vascular surgery may be appropriate to help restore blood flow. Failure to treat PVD may result in a loss of limb (amputation), poor wound healing, decreased mobility, pain or stroke.
• Thoracic Aortic Aneurysm (TAA): Our team provides minimally invasive, stent graft procedures to treat aneurysms. If your TAA is severe, you may need a bypass procedure to repair the aneurysm with a new section of blood vessel, called a graft. Our skilled team will work with you to determine the right treatment based on your symptoms, condition, and lifestyle.
• Transient Ischemic Attack (TIA): A carotid endarterectomy may be appropriate for you if you have already had a TIA or stroke as a result of a carotid artery blockage. This is a procedure to remove the plaque causing the blockage. Carotid stenting can also be performed to prop open a narrowed artery with a stent.
• Transcarotid artery revascularization (TCAR): TCAR is a clinically proven, minimally invasive, safe approach for patients with carotid artery disease who are at high risk for traditional open surgery. The TCAR procedure is unique in that blood flow is temporarily reversed during the procedure so that any small bits of plaque that may break off are diverted away from the brain, preventing a stroke from happening. A stent is then placed inside the artery to stabilize the plaque, minimizing the risk of a future stroke.

Convergent Procedure

In some patients, atrial fibrillation (A-Fib) occurs intermittently, known as paroxysmal A-Fib. This type is often well-managed with medications or catheter ablation, which blocks the electrical impulses from causing the irregular heartbeat. In other patients, A-Fib can become persistent (lasting up to a year) or long-standing (lasting more than a year). Persistent and long-standing A-Fib are more challenging to treat, and medications and catheter ablation may be less effective in these cases.

Historically, the only effective treatment for persistent and long-standing A-Fib was a surgical intervention called the maze procedure. This procedure requires open-chest surgery and is typically performed only when patients need heart surgery for another condition. Recently, a new approach has been developed that combines two minimally invasive techniques — one in the cardiovascular operating room and one in the electrophysiology (EP) lab — to address persistent A-Fib. This hybrid approach is known as the convergent procedure.

Structural heart disease

Any time an abnormality or defect weakens the heart’s structure — its walls, valves and muscles—it’s referred to as structural heart disease. In a healthy heart, the four valves work together to move blood from the upper to the lower chambers, pushing it out to the lungs and other organs. One or more defective valves can affect the heart’s normal function and may lead to serious health complications.

Structural heart defects can be treated through traditional open-heart surgery or through several minimally invasive procedures.

Structural heart conditions and services

Patent Foramen Ovale (PFO)

A Patent Foramen Ovale (PFO) is a small hole between the left and right upper chambers of the heart. While everyone is born with this hole, it typically closes on its own. A PFO exists when that hole doesn’t close naturally.

According to the American Heart Association (AHA), about 25% of Americans have a PFO. Many people with a PFO are unaware of it and do not experience any health problems. However, for a small number of patients, a PFO can increase the risk of stroke, transient ischemic attack (TIA) and heart attack. The AHA reports that up to half of patients who have had a stroke of unknown cause or who have had a stroke before age 55, have a PFO.

A hole in the heart itself does not cause a stroke. Instead, the hole allows blood to flow between the right and left chambers of the heart. Problems can arise if a blood clot travels through the hole to the brain, potentially causing a stroke.

If treatment is needed, your cardiologist will consult with your neurologist on a plan. Possible treatment options may include:

• Blood thinning medication to prevent blood clots and stroke
• Device closure using cardiac catheterization
• Minimally-invasive surgical repair, where the PFO is closed by placing a small device across the hole in the heart through the vein in the leg

Transcatheter aortic valve replacement (TAVR)

Transcatheter aortic valve replacement (TAVR) is a state-of-the-art, minimally invasive treatment for severe aortic stenosis, which is the narrowing of the aortic valve.

If severe aortic stenosis is left untreated, it can be fatal. When medication management is insufficient, replacement becomes necessary. The TAVR procedure involves replacing the diseased valve with a transcatheter heart valve.

Transcatheter Edge-to-Edge Repair (TEER)

The Transcatheter Edge-to-Edge Repair (TEER) is a minimally invasive procedure to treat mitral regurgitation. It is for patients who are suffering from symptoms of valve-related congestive heart failure but aren’t responding to medication treatment and aren’t suitable candidates for surgery.

Valve insufficiency, or a leaky valve, causes a condition known as regurgitation. When this happens, blood that is supposed to be pumped out of the heart backflows, or leaks, back into the chamber. Patients can feel weak, light headed, short of breath and experience chest pain. TEER closes the center of the mitral valve, allowing blood to flow to either side of the device and decreasing leakage.