A Resource for Adult Cardiac Surgery

Health City Cayman Islands has earned distinction in cardiovascular surgery and the care of complex cardiac conditions. Each cardiovascular procedure is performed with precision and exacting standards of excellence. Whenever possible, our surgical team chooses minimally invasive procedures. In the event that a more invasive approach is required, our team uses clinically advanced best practices to reduce risk and prevent infection.

Our cardiovascular surgical services include:

Coronary Artery Bypass Surgery
Coronary artery bypass grafting (CABG)
This is performed both as a minimally invasive procedure as well as using traditional techniques requiring heart-lung machine support. CABG treats blocked heart arteries by creating new passages for blood to flow to the heart muscle. Other arteries or veins from the patient’s body are used to create grafts that reroute the blood around the clogged artery. A patient may undergo one, two, three, or more bypass grafts, depending on how many coronary arteries are blocked. CABG is one of the most standard and effective procedures to improve the supply of blood and oxygen to the heart, relieve chest pain, reduce risk of heart attack, and improve the patient’s ability to engage in physical activity.
CABG using conventional heart-lung machine
Traditionally, coronary artery bypass surgery is performed with the assistance of a heart – lung machine which allows the heart to be stopped, so that the surgeon can operate on a surface which is blood-free and still. The heart-lung machine maintains circulation despite the lack of a heartbeat, removing carbon dioxide from the blood and replacing it with oxygen before pumping it around the body.
CABG beating heart technique
In this technique of performing CABG, the heart-lung machine is not used. Here, instead of stopping the heart, the area where the anastomosis is performed is stabilized with advanced instruments while the rest of the heart pumps blood and circulates blood to the entire body.
Total arterial revascularization: LIMA – RIMA – Y Techniques
Studies show that total arterial revascularization provides better long term survival than a single arterial graft. Survival is improved when a right internal mammary artery (RIMA) is used than radial artery as a second conduit when performing CABG for multi vessel disease. Nearly 50% of CABGs done at HCCI are total arterial using both internal mammary arteries.
Left internal mammary artery (LIMA)
Over the last two decades, many studies have shown better long-term outcomes and survival in patients undergoing CABG with LIMA to the left anterior descending artery. Worldwide, LIMA is considered the gold standard for surgical revascularisation and its usage has been steadily increasing.
Right internal mammary artery (RIMA)
Survival is improved when the right internal mammary artery (RIMA) rather than the radial artery is used as the second conduit when performing CABG for multi-vessel disease. Studies show that total arterial revascularization provides better long-term survival than a single arterial graft.
Y technique:
In this approach, multiple intracoronary stents are inserted in an inverted Y configuration. Stents are inserted into both branches simultaneously followed by a third stent in close proximity, resulting in the Y shape.
Minimally invasive CABG
Minimally invasive coronary artery bypass (MIDCAB) is an option for some patients who require CABG. The benefits of minimally invasive surgery include a smaller incision (3 to 4 inches instead of the 6- to 8-inch incision with traditional surgery) and smaller scars. Other possible benefits include a reduced risk of infection, less bleeding, less pain and trauma, decreased length of stay in the hospital and decreased recovery time.
CABG with associated procedures
A variety of surgical procedures are combined with CABG like valve repairs and replacements, correction of structural defects of the heart, ventricular aneurysms, carotid artery bypass etc. These procedures are combined when an individualized patient treatment plan is developed.
Surgery for ventricular aneurysm
Ventricular aneurysm is a complication of heart attack which develops after a few days or weeks. Here, a portion of the heart musculature thins out and bulges leading to heart failure and arrhythmias. Surgical remodeling of the left ventricle can be combined with revascularization.
Redo CABG
Repeat cardiac operations are technically more demanding due to higher risk profile of the patients. This is usually performed in patients who had previous surgery and presents with symptoms which are not relieved by other modalities of treatments.
Hybrid CABG
This is an alternative to traditional bypass surgery usually performed in patients who are high risk for conventional CABG. In this procedure, coronary artery bypass grafting and stenting are performed during the same procedure. In high risk patients, hybrid CABG has been shown to result in less pain and quicker recovery time. The most important requirement for performing this procedure is a highly sophisticated operating room called ‘HYBRID LAB’. Health City Cayman Islands is the only hospital in the Caribbean to have a hybrid lab.
Other related bypass surgery
When normal blood flow to the heart is partially obstructed due to coronary artery arteriosclerosis, bypass surgery is often the best solution. Various types of bypass surgery can also relieve angina that is not being adequately controlled through medication. Our surgeons will select the most appropriate bypass surgery including single, double, triple, quadruple, and quintuple bypass. This corrects the heart dysfunction, reduces the risk of death, and improves the patient’s quality of life.
Heart Valve Surgery
Valvular heart disease occurs when one of the heart's four valves (mitral, aortic, tricuspid or pulmonary) is not working properly. The cardiac surgeons at Health City Cayman Islands repair and replace all four types of heart valves, and also perform redo valve surgery.

Heart Valve Surgery
Valve surgery can be broadly divided into 1) repair surgery and 2) replacement surgery. The clinical evaluation and various tests determine the best type of procedure for you.  Other factors influencing the decision are the structure of your heart, your age, other medical conditions you have, and your lifestyle.  Valve surgery may be combined with other heart surgeries also.  Health City offers all types of valve surgeries whether it is repair or replacement.
Double valve replacement
Double valve replacement surgery is better known as heart valve replacement surgery. It is performed to replace a damaged valve with a healthy one. The valve replacement helps to prevent further damage to the heart or a heart infection.
Homograft valve replacement
A homograft is donated from a cadaver to be used during complex reconstructive surgery. It typically includes human heart valves and arteries.
Valve replacement with cardiac ablation
When medication is ineffective or cannot be tolerated by patients with arrhythmias, a nonsurgical procedure called catheter ablation may be performed. Under light sedation, thin flexible wires are inserted into a vein in the groin and threaded up into the heart. This procedure is frequently performed with a CABG or valve replacement. The surgeon can use small incisions, radio waves, freezing, microwave energy, or ultrasound energy to create scar tissue. The scar tissue, which does not conduct electrical activity, blocks the abnormal electrical signals causing the arrhythmia.
Surgery for infective endocarditis
Infective endocarditis of valves is most often due to bacterial infection. It can affect the native valves or prosthetic valves. Many a time the treatment requires replacement of the affected valve. The surgery for infective endocarditis is very complex and technically demanding. This may require use of homograft to reduce the chance of further infection. Health City offers surgical treatment for infective endocarditis.
Redo valve surgery
When initial valve surgery fails, redo valve surgery may be medically warranted to improve, and / or save the life of the patient. These surgeries are technically advanced and clinically complicated, therefore they are only performed on chronically ill heart patients.
Ross procedure
This is a complex surgery that can be very effective for treating a damaged aortic valve especially in younger patients. Here, the patient’s damaged aortic valve is replaced with his own pulmonary valve and a treated valve from a cadaver is used in the place of the pulmonary valve. Generally this is an effective procedure for maintaining long term wellness without the need for ongoing medications like blood thinners.
Aortic Surgery
We have a specialized team highly experienced in treating all types of aortic diseases like aneurysms, dissections, trauma etc.  We use advanced treatment options like Endovascular Aneurysm Repair (EVAR), debranching of the aortic arch and renovisceral debranching for treating these conditions. The very advanced hybrid lab helps in doing these procedures in single stage instead of multiple sittings.

Aortic root replacement (Bentall procedure)
This specialized cardiac surgery involves replacement of damaged aortic valve, aortic root and ascending aorta along with re-implantation of coronary arteries into the graft. In the more advanced valve sparing aortic root replacement the patient’s aortic valve is kept intact, although it may be repaired, reimplanted. By preserving the natural aortic valve, patients avoid the need for life long anticoagulation therapy.
Valve sparing aortic root replacement
In this procedure, the patient’s aortic valve is kept intact, although it may be repaired, reimplanted, and reconnected to a new section of aortic tissue. By preserving the natural aortic valve, patients avoid the need for lifelong anticoagulation therapy, such as the medication warfarin.
Surgical repair of all types of aneurysms
Surgical repair of all types of aneurysms
Most aneurysms occur in the aorta, which is the largest artery in the body. An aortic aneurysm occur when a segment of aortic wall becomes abnormally large or balloons outward. Abdominal aortic aneurysm is the most common type, but thoracic aortic aneurysms can also occur, affecting the portion of aorta that passes through the chest. While aneurysms can start small and be asymptomatic, the increasing pressure causes the bulge to expand, weaken and rupture in some patients. Aneurysms are often found coincidentally during an examination or test like CT scan or ultrasound, and repaired as soon as possible if indicated. Our cardiovascular surgeons repair aortic aneurysms regardless of where they occur in the body; thoracic aortic aneurysms in the chest cavity, thoracoabdominal aneurysms extending from the chest into the abdomen, and abdominal aortic aneurysms in the abdominal portion of the aorta. The surgeons decides, depending on the anatomy and various other factors, whether to treat these aneurysms with open surgical technique or using endovascular stents.
Emergency surgery for aortic dissection
The aorta is the main artery that carries blood away from the heart to the rest of the body. When an aortic dissection occurs, the blood being pumped forcefully through the aorta splits the layers of the artery wall, allowing a build-up of blood to continually leak into the space. This further splits the artery wall, trapping the blood that is coming from the heart. This is a medical emergency that requires a rapid response and surgical intervention to repair the aorta.
Surgery for aortoarteritis (Takayasu's disease)
This is a chronic inflammatory disease involving the aorta, the arteries arising from the aorta, and often, the pulmonary arteries. The inflammation leads to stenosis, occlusion of the involved artery, and / or aneurysm formation. There are various types of this disease, but all are serious and can have life-threatening consequences if not appropriately diagnosed and treated. Treatment is a three-step process, as follows. First, the immune reaction that has caused the damage is suppressed with corticosteroids such as prednisone. Second, infections are brought under control using antibiotics. Finally, surgery may be performed to repair the aorta and any other organs that may have been damaged.
Congenital Heart Disease
Although congenital heart disease is often considered a paediatric condition, advances in surgical treatment mean most infants who once died of congenital heart defects survive well into adulthood. In other cases, the defects may not be detected until early adulthood. For adults born with congenital heart defects, we perform open-heart surgery, patent ductus arteriosus (PDA) and additional closures, shunts, and other specialty procedures.

Adults who were born with congenital heart defects have unique cardiac anatomy and conditions. For patients who were born with moderate to severe heart defects or had heart surgery as a child, it is beneficial to consult with one of our cardiovascular surgeons. Depending on the specific needs of each patient, our specialists can surgically improve heart function, blood flow, and oxygenation, replace valves, and in the most advanced cases – perform human and artificial heart transplantation. We offer open-heart surgery for congenital heart defects and other complex congenital lesions that cannot be surgically repaired via minimally invasive techniques.

Atrial septal defect (ASD)
This is a hole in the wall (septum) that separates the two upper chambers of the heart. This defect allows oxygen-rich blood to leak into the oxygen-poor blood chambers in the heart. A small hole may close on its own, but a larger one usually requires surgery.
Ventricle septal defect (VSD)
This is a hole in the wall (septum) separating the two lower chambers of the heart. The oxygen-rich blood then gets pumped back to the lungs instead of out to the body, causing the heart to pump harder. A small hole may close on its own, but a larger one usually requires surgery.
Total anomalous pulmonary venous connection (TAPVC)
This is a congenital heart defect in the veins leading from the lungs to the heart. The blood does not take the normal route from the lungs to the heart and out to the body. Instead, the veins from the lungs attach to the heart in abnormal positions and causes oxygenated blood to enter or leak into the wrong chamber.
Atrioventricular (AV) canal defect
There are two types of atrioventricular canal defects: complete and partial. The complete form is a combination of several closely related heart problems that result in a large defect in the centre of the heart, affecting all four chambers where they would normally be divided. The defect allows extra blood to flow to the lungs, causing the heart to overwork and the heart muscle to enlarge.
Sinus of Valsalva (RSOV)
This is a rare condition, usually congenital, that typically originates in the right or non-coronary aortic sinus. This type of aneurysm may cause asymptomatic murmur, angina, symptoms of valvular insufficiency, or outflow obstruction. When rupture occurs, the aneurysm may produce serious instability including acute heart failure or sudden death. If rupture is suspected, immediate diagnosis is pursued with transesophageal echocardiography or cardiac catheterization.
Transposition of the great arteries (TGA)
In this heart defect which is present at birth, the two main arteries leading out of the heart, the pulmonary artery and the aorta, are switched in position or transposed.
Patent ductus arteriosus (PDA) closure
This is a fairly common congenital heart defect that occurs when a temporary blood vessel, called the ductus arteriosus, does not close soon after birth. This can cause an enlarged heart and weakened blood flow. In rare cases, PDA goes undetected until adulthood, when the patient experiences symptoms including heart palpitations, shortness of breath, and pulmonary hypertension (high blood pressure in the lungs).
Repair of coarctations of aorta
Coarctation of the aorta is a narrowing of the aorta located just beyond the “arch” of the aorta. The blockage can increase blood pressure in the arms and head, while reducing pressure in the legs. At times, the narrowing of the aorta is so severe that there is essentially no connection between the upper and lower portions of the aorta (interrupted aortic arch). Patients may develop coronary artery disease, leaving them vulnerable to heart attacks. Surgery repairs the narrowing in the arch, opening it to restore normal blood flow.
Closures, shunts, and other specialty procedures
Adults with congenital heart disease may or may not have been diagnosed as an infant or child. As a result, they can have a wide array of heart disease ranging from small holes in the heart to valve failure. Our cardiovascular surgeons are skilled at using closures, shunts, and specialty surgical procedures to address paradoxical embolization, endocarditis, valve deterioration, and other conditions that may result from adult congenital heart disease.
Vascular Heart Surgery
Vascular heart surgery focuses on the repair of the valves of the heart. It is a surgical subspecialty for the treatment of several types of aneurysms, debranching of aortic arch, renovisceral debranching, and endovascular aortic aneurysm repair (EVAR).

Repair of abdominal aortic aneurysm, thoracic aortic aneurysm, thoracoabdominal aortic aneurysm
Most aneurysms occur in the aorta, which is the largest artery in the body. An aortic aneurysm is a bulging or ballooning of a weakened part of the aortic artery wall. The normal pressure of blood from the pumping of the heart causes the weakened portion of the aorta to slowly stretch and bulge, leading to the formation of an aneurysm. Aortic aneurysms are dangerous because of the risk that they will rupture, which causes life-threatening internal haemorrhaging.

Our cardiovascular surgeons repair aortic aneurysms regardless of where they occur in the body; thoracic aortic aneurysms in the chest cavity, thoracoabdominal aneurysms extending from the chest into the abdomen, and abdominal aortic aneurysms in the abdominal portion of the aorta. During surgery, the cardiovascular surgeon repairs or removes an aneurysm through an incision in the skin. The excess blood and plaque is removed and then stents, clips, clamps, or coils may be inserted to block the aneurysm and prevent blood from flowing into it.
Debranching of aortic arch
The aortic arch is the portion of the heart’s main artery (aorta) from where the branches to brain and both upper limbs originates. Any significant disease of the aortic arch usually needs replacement of the arch and reimplantation of these branches.  This is considered to be a very high risk procedure. The debranching approach has dramatically lowered this risk. During this procedure, the aortic arch is “de-branched” by sewing bypass grafts to the blood vessels of the aortic arch in order to seal off the aneurysm. This procedure is usually done in a hybrid operating suite. Debranching is the best choice for a patient who is considered too high a risk for a traditional operation.
Renovisceral debranching
This is another highly complex hybrid technique used to repair thoracoabdominal aneurysms and dissections.  These types of aneurysms present a formidable surgical challenge, and conventional open repair is associated with significant rates of mortality and morbidity including paraplegia.  Repair through complete visceral debranching and endovascular aneurysm exclusion is a viable option for older patients who are high risk.
Endovascular aortic aneurysm repair (EVAR)
This is a type of endovascular procedure used to treat an aortic aneurysm or dissection. The procedure involves the placement of an expandable stent graft into the aorta without operating directly on the aorta. It is one of the most common techniques used to repair aneurysms or dissections and it reduces the pain and recovery time compared to the open technique.
Carotid endarterectomy
The carotid arteries are major blood vessels in the neck that supply blood to the brain, neck, and face. This is a surgical procedure used to reduce the risk of stroke, by correcting the narrowing (stenosis) of the carotid artery. In endarterectomy, the surgeon opens the artery and removes the plaque. A newer procedure, called endovascular angioplasty and stenting, threads a catheter up from the groin around the aortic arch, and up to the carotid artery. The catheter uses a balloon to expand the artery, and a stent is inserted to hold the artery open.
Carotid bypass surgery
This procedure restores proper blood flow to the brain. Blood flow in one or both of the arteries can become partly or totally blocked by fatty material called plaque. The underlying disease, called atherosclerosis, can reduce the blood supply to the brain and cause a stroke. When other procedures are not appropriate for the patient, the carotid artery can be surgically bypassed to restore blood flow.
Aortabifemoral bypass
This is a procedure used to bypass diseased large blood vessels in the abdomen and groin. If the blockage is in the arteries in the pelvis, the bypass is made from the aorta in the abdomen to the femoral arteries in the groin. To bypass the blocked blood vessel, blood is redirected through a graft made of synthetic material, which is sewn above and below the diseased artery. The artificial blood vessel is formed into a Y shape with a single end attached to the aorta. The two split ends of the Y are sewn below.
Left Ventricular Assist Device (LVAD) And Other Complex Procedures
Left ventricular assist device (LVAD) implantation
One of the most ground breaking improvements for heart failure patients is the LVAD. The LVAD is a mechanical pump that is implanted inside a patient’s chest to help a weakened heart ventricle pump blood throughout the body. It is used as a bridge to transplantation, and also as destination therapy. Destination therapy offers long-term support to terminally ill patients whose health makes them ineligible for heart transplantation. Health City Cayman Islands performed the very first LVAD procedure ever done in the Caribbean in August 2014, and performed a second successful LVAD procedure in December of that year.

Studies have demonstrated that permanent LVAD devices doubled the one-year survival rate of patients with end-stage heart failure, compared to medication therapy alone. However, implantation comes with risks including infection, stroke, and bleeding.
Pulmonary thromboendarterectomy (PTE)
This is a surgical procedure that removes organized clotted blood (thrombus) from the pulmonary arteries. The surgery is performed to improve blood flow and normal gas exchange of the blood so that the patient can breathe easier. It prevents heart failure and premature death, alleviates stress on the right side of the heart by correcting the pulmonary hypertension, and improves the patient’s quality of life.

PTE is an 8 to 10-hour procedure that involves opening the chest and attaching the patient to a heart-lung machine, then cooling the patient’s body to about 64 to 68 degrees Fahrenheit. The cold temperature reduces the body’s need for oxygen and provides organ protection. During the critical parts of the surgery, the surgeons turn off the heart-lung machine, stopping heart circulation for up to 20 minutes to create a bloodless surgical field. Then the surgeons open the arteries blocked by chronic clots and scar tissue. They repeat the on-off process with the heart-lung bypass machine until all of the obstructing material is removed.
Emergency cardiac and vascular surgeries
We perform emergency cardiac and vascular surgeries to save lives including those for cardiopulmonary arrest, hypertensive emergency, aortic dissection, chest pain, dysrhythmia, and acute pulmonary edema.

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