The actor Bill Paxton entered Cedars-Sinai Medical Center in Los Angeles last February for surgery to fix a faulty heart valve and a bulge in a major artery. But after 11 days, Paxton, then 61, died. Now, in a lawsuit against the surgeon and the hospital, his family alleges that his death stemmed not from the underlying heart problems but from complications linked to the procedures meant to correct them.
The lawsuit also claims that the surgery wasn't necessary and that the surgeon used a "maverick" technique, failed to disclose potential risks, and left the operating room too soon, leading to delays in treating those complications. (A spokesperson from Cedars-Sinai said it could not comment on Paxton's case due to patient privacy.)
While only a small percentage of heart surgery patients die during the operation, all put their lives in the hands of the surgeon and the hospital. Indeed, as Paxton's lawyers write in the lawsuit, there's a power imbalance between doctors, who are "learned, skilled, and experienced in medical procedures and conditions," and patients and their families, who know "little or nothing" about the operation. (Read about 5 common heart procedures.)
With our guide for heart surgery patients, you can begin to right that imbalance: to learn when to ask the hard questions, what to anticipate, and what to guard against. And you can use our ratings to choose a hospital with a proven record of success. (See our top heart hospitals.)
Knowledge Is Powerful
Open-heart surgery is no small matter. Surgeons often saw through the breastbone to open the chest, connect the patient to a heart-lung machine, stop the heart, then repair it. Despite the complexity, doctors performed more than 200,000 such procedures in the U.S. in 2015.
The percentage of people who die during or soon after heart bypass surgery—the most common heart surgery in the U.S.—has been cut nearly in half since 1990. (In 2016, it was 2.1 percent.) This improvement is even more impressive given that patients today are having heart surgery at an older age.
For experienced surgeons, the procedures can sometimes seem almost routine. But for patients and their families, the prospect of heart surgery can be scary.
When Sharran Greenberg, an attorney in Chicago, learned that she needed a heart valve replaced, she decided to face that fear head on. She learned as much as she could about the procedure, researching it extensively and peppering her surgeon with questions.
All that helped calm her nerves. "I was much better off knowing what was in store for me than worrying about what could happen," Greenberg says.
Insist On an Open Exchange
When you're considering heart surgery, nothing about the operation should be a mystery. "The biggest fear patients have is of the unknown," says Suzanne Fredericks, Ph.D., graduate program director in the school of nursing at Ryerson University in Toronto, who has conducted extensive research on cardiac care.
At her hospital, patients can see where they will have surgery and where they will recover, and connect with former patients, she says.
Doctors should also discuss the potential benefits of the surgery but be honest about the risks, too, so patients can make fully informed decisions. (Read "3 Questions to Ask Before You Have Heart Surgery.")
The Society of Thoracic Surgeons (STS), the main professional group that represents heart surgeons, provided Consumer Reports with the data used in our heart hospital ratings and has a risk calculator at riskcalc.sts.org. Use it with your doctor's help, and ask him or her to carefully review the results with you.
From her research, Greenberg was prepared to face the post-op pain, which actually proved reassuring. When waking up from surgery, she remembers thinking with relief, "Well, I can't be dead, because I am in terrible pain."
More important, she knew that her pain would soon diminish and that in time she would be stronger, with the prospect of many vigorous years ahead.
Download a PDF of our hospital ratings, which show the hospitals that share their data with CR and score well in both heart bypass and aortic valve replacement surgeries.
5 Common Heart Procedures
1. Coronary Artery Bypass Grafting (CABG)
Plaque that grows in the heart's arteries can prevent the organ from getting enough oxygen-rich blood. To fix the problem, a surgeon takes healthy sections of a vein or artery from your leg or chest wall and uses them to bypass blockages in up to four arteries.
2. Percutaneous Coronary Intervention (PCI)
Sometimes doctors use this less invasive procedure to treat blockages by inserting and inflating a tiny balloon in an artery, often propping it open with a stent.
3. Aortic Valve Replacement (AVR)
The aortic valve is designed to open as the heart pumps, allowing blood out, and to close between beats, preventing blood from flowing back in. But some people are born with a faulty valve or develop one over time. Surgeons can repair a bad valve or replace it with a mechanical one or one made from human or animal tissue. When AVR is too risky, surgeons can perform transcatheter aortic valve replacement (TAVR), a less invasive but less proven surgery that is performed through a catheter inserted in the leg or groin and threaded up to the heart.
4. Aneurysm Repair
When an artery wall weakens and begins to bulge, surgeons can patch or bypass the weakened part before it bursts.
5. Arrhythmia Treatment
A heart that beats too slowly, too quickly, or irregularly is sometimes controlled with one of two permanently implanted devices. A pacemaker uses electric impulses to regulate the heartbeat. An implantable cardioverter defibrillator (ICD) shocks the heart when it detects a dangerous rhythm, resyncing it. In rare cases, rhythm disorders must be corrected through an open-heart surgery known as a maze procedure, which reroutes the electrical pathways in the heart.
Editor's Note: This article also appeared in the July 2018 issue of Consumer Reports magazine.
