What does elective heart surgery mean? What are heart surgeries? On the appointment of disability and forecasts

Heart surgery helps to cure many diseases of the cardiovascular system that are not amenable to standard therapeutic methods. Surgical treatment can be carried out in different ways, depending on the individual pathology and the general condition of the patient.

Indications for surgical treatment

Cardiac surgery is a field of medicine in which physicians specialize in studying, inventing methods and performing operations on the heart. The most complex and dangerous cardiac surgery is heart transplantation. Regardless of what type of surgery will be performed, there are general indications:

• the rapid progress of the disease of the cardiovascular system;
• ineffectiveness of conservative therapy;
• untimely visit to the doctor.

Heart surgery makes it possible to improve the general condition of the patient and eliminate the symptoms that disturb him. Surgical treatment is carried out after a complete medical examination and the establishment of an accurate diagnosis.

Do operations for congenital heart defects or acquired. A congenital defect is detected in a newborn immediately after birth or before birth on an ultrasound examination. Thanks to modern technologies and techniques, in many cases it is possible to detect and cure heart disease in newborns in time.

An indication for surgical intervention can also be coronary disease, which is sometimes accompanied by such a serious complication as myocardial infarction. Another reason for surgery may be a violation of the heart rhythm, since this disease tends to cause ventricular fibrillation (scattered contraction of fibers). The doctor should tell the patient how to properly prepare for heart surgery in order to avoid negative consequences and complications (such as a blood clot).

Advice: proper preparation for heart surgery is the key to a successful recovery of the patient and prevention of postoperative complications, such as a blood clot or occlusion of the vessel.

Operation types

Cardiac surgeries can be performed on an open heart as well as on a beating heart. Closed heart surgery is usually performed without affecting the organ itself and its cavity. Open heart surgery involves opening the chest and connecting the patient to a ventilator.

During open heart surgery, a temporary cardiac arrest is performed for several hours, which allows you to perform the necessary manipulations. This technique makes it possible to cure complex heart disease, but is considered more traumatic.

Surgery on a beating heart uses special equipment so that the heart continues to contract and pump blood during surgery. The advantages of this surgery include the absence of such complications as embolism, stroke, pulmonary edema, etc.

There are the following types of heart operations, which are considered the most common in cardiology practice:

• radiofrequency ablation;
• coronary artery bypass grafting;
• valve prosthetics;
• Operation Glenn and Operation Ross.

If surgery is performed with access through a vessel or vein, endovascular surgery (stenting, angioplasty) is used. Endovascular surgery is a branch of medicine that allows for surgical intervention under X-ray control and using miniature instruments.

Endovascular surgery makes it possible to cure the defect and avoid the complications that abdominal surgery gives, helps in the treatment of arrhythmias and rarely gives such a complication as a thrombus.

Advice: Surgical treatment of heart pathologies has its advantages and disadvantages, therefore, the most suitable type of operation is selected for each patient, which carries fewer complications for him.

Radiofrequency or catheter ablation (RFA) is a minimally invasive surgical intervention that has a high therapeutic effect and minimal side effects. Such treatment is shown for atrial fibrillation, tachycardia, heart failure and other cardiac pathologies.

By itself, arrhythmia is not a serious pathology requiring surgical intervention, but can lead to serious complications. Thanks to RFA, it is possible to restore a normal heart rhythm and eliminate the main cause of its violations.

RFA is performed using catheter technology and under x-ray control. Heart surgery takes place under local anesthesia and consists in bringing a catheter to the necessary part of the organ, which sets the wrong rhythm. Through an electrical impulse under the action of RFA, the normal rhythm of the heart is restored.

Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for self-treatment. Be sure to consult a doctor!

May God grant everyone to live a long life so that the surgeon's scalpel never touches his heart. However, not always cardiac surgery can be replaced by therapy.

When is surgery necessary?

1. When conservative therapy does not give the desired result.
2. When, despite all the ongoing treatment, the patient's condition continues to deteriorate.
3. When there are severe congenital heart defects, severe arrhythmia, cardiomyopathy.

By urgency, cardiosurgical operations are emergency and planned.

1. Emergencies are carried out when a person's life is in serious danger. This happens when a myocardial infarction occurs, a blood clot suddenly breaks off, or aortic dissection begins. They do not tolerate delay in surgery when the heart is injured. The consequences of delay are severe.
2. Planned are carried out in accordance with the developed plan for the correction of the patient's health. The date of the operation may be postponed depending on the circumstances. For example: with a cold, to avoid additional stress on the heart, or when the pressure suddenly dropped.

Surgical intervention differs in the technique of execution. There are such types of heart operations:

• with the opening of the chest;
• without opening the chest.

open heart surgery

Chest opening operations

Such surgical intervention is used in especially severe cases, when full accessibility of the heart is required during the operation.

Opening of the chest is performed with such pathologies:

• tetralogy of Fallot (the so-called congenital heart disease with four serious violations of the anatomical structure);
• serious anomalies of intracardiac partitions, valves, aorta and coronary arteries;
• heart tumors.

The patient arrives at the hospital one day before the operation. Passes inspection, gives written consent. Be sure to wash with antibacterial soap and shave your hair. Where do you shave your body hair? The hair will be shaved at the site of the proposed incision. If you are going to have a coronary bypass surgery, you will have to shave your legs and groin. In the case of a heart valve replacement, it is necessary to shave the hair in the lower abdomen and in the groin area.

The surgery is performed under general anesthesia. To gain access to the heart, the surgeon opens the chest of the person being operated on. The patient is connected to an artificial lung ventilation apparatus, the heart stops for a while and surgical manipulations are performed with the organ.

How long the operation takes depends on the severity of the pathology. On average, several hours.

Tetralogy of Fallot

Open heart surgery has two advantages.

1. The surgeon has full access to the patient's heart.
2. Such a surgical intervention is possible without state-of-the-art medical equipment.

However, there are also significant drawbacks.

1. Surgical manipulations with the heart last several hours, which leads to fatigue of the operating team, during the operation there is a higher probability of making an erroneous action.
2. Opening the chest is fraught with various injuries.
3. There is a noticeable scar after heart surgery.
4. Various complications are not excluded:

• myocardial infarction,
• thromboembolism,
• bleeding,
• infections;
• coma after surgery.

1. A long recovery is required with significant limitations in the patient's activities.

In most cases, when surgery is performed with an opening of the chest, disability is given after heart surgery, as after a heart attack.

What operations and under what pathologies are performed on the open heart?

Pathologies of the coronary arteries

Coronary artery bypass grafting is done in case of serious atherosclerotic lesions of the coronary arteries, which led to a severe form of coronary heart disease. The essence of shunting is to create a bypass for blood flow to the heart using a shunt, for which an artery or vein taken from the patient is used. For example: mammary coronary artery bypass grafting (MCB) is performed using the internal mammary (mammary) artery.

Operation Ross

Heart valve defects

Today, valves made from the patient's biological material are used to replace damaged valves.

1. The Ross procedure involves using the patient's own valvular pulmonary artery to replace a diseased aortic valve. An implant is placed in place of the pulmonary valve. Eliminates complications associated with rejection of a valve made of foreign material. Made for both adults and children.
2. The Ozaki operation involves the use of the patient's own tissue. Only in this case, the replacement of the aortic valve is performed with a valve made from the patient's pericardium. Complications with valve rejection are not observed for the same reason.

Such surgical manipulations are within the competence of cardiac surgeons, and are one of the most complex in nature. Heart surgery is a last resort in the treatment of serious cardiovascular diseases, which are resorted to in order to improve the quality of life of the patient, and sometimes even save his life.

In Russia, this type of surgical intervention is not practiced as often as, for example, in America or in European countries. First of all, this is due to the cost of such treatment: not every citizen of the Russian Federation is able to pay the costs of the operation out of his own pocket.

At the same time, this branch of medicine in domestic medical institutions is constantly developing, which makes it possible for patients to receive qualified advice and assistance when applying.

When is heart surgery performed - indications and timing

The main pathologies that may require surgical intervention are:

• Poor myocardial blood supply. A similar condition in medical circles is called coronary heart disease. IHD can lead to the formation of an aneurysm, extensive thrombosis. With all the described ailments, certain surgical procedures on the heart may be required.
• Heart defects that have both innate and acquired nature. Many defects in the structure of the heart valve are incompatible with life. Therefore, such pathologies are diagnosed even in the prenatal period, and the operation itself is carried out in the first days of the baby's life.
• Failures in the frequency, sequence and rhythm of heart contraction, - arrhythmias.

Common indications for heart surgery are the following pathological conditions:

1. Active deterioration of vital signs against the background of the development of underlying heart disease.
2. The inability of drug therapy to cope with the manifestations of the disease.
3. Noticeable deterioration in the functioning of the heart muscle that cannot be eliminated with medications.
4. advanced stage of the disease. This happens when the patient does not seek qualified help in time.

It should also be taken into account that any surgical manipulations on the heart carry a risk and are fraught with the development of a number of exacerbations in the rehabilitation period. Doctors turn to such treatment when other measures do not bring the desired effect.

In addition, heart surgery requires a comprehensive examination of the patient and careful preparation for the operation. This will ensure a successful recovery and minimize the likelihood of postoperative complications.

Based on the patient's condition, the type of surgical intervention under consideration is:

• emergency. In such a situation, examination and preparation are carried out in a minimal amount, and the operation itself is carried out as soon as possible. This type of manipulation is prescribed for life-threatening conditions, when every minute counts: with aneurysm rupture, extensive myocardial infarction. Often, emergency interventions on the heart are performed on newborns with complex heart disease.
• Urgent. There is time for diagnostic and preparatory measures, but not much. After receiving the results of the examination, surgical treatment of the heart disease is carried out.
• planned. In some medical sources, this type of operation is called elective. After a detailed study of the patient's condition by a cardiac surgeon, a final decision is made on the need for surgical intervention. Together with the patient or his parents (when operating on a child), the exact date of the operation is agreed.

Closed and open heart surgeries - how they are performed and to whom they are prescribed

Based on the type of defect that needs to be eliminated, various methods of surgical intervention are used:

Note!

Not so long ago, a new direction in the treatment of heart defects began to be applied in cardiac surgery - X-ray surgery. In essence, they are minimally invasive - the doctor makes small incisions or punctures, and brings special instruments to the heart zone through the catheter. An access point can be, incl. and femoral vessels. Using cans, you can increase the diameter of the narrowed valve - or reduce it by opening the patch (its design is similar to an umbrella). With the help of expanding tubules, vascular stenosis is eliminated.

The progress of the entire procedure is monitored through the monitor screen - this ensures the effectiveness of the operation, as well as its safety for the patient. In addition, during the manipulation under consideration, general anesthesia is not used: the doctor is limited to anesthesia with mini-accesses.

X-ray surgery can be both the main and auxiliary methods of treating errors in the work of the heart.

Most popular types of heart surgery

To date, the following operations are used in cardiac surgery practice:

1. With coronary heart disease:

2. In case of diagnosing heart disease:

3. In the presence of arrhythmia:

In cases where the treatment of individual anatomical structures of the heart is impossible or ineffective, and the main organ for pumping blood cannot cope with its main function, they perform heart transplant .

This operation is fraught with a number of complications, among which is graft rejection.

Today, scientists are conducting research to maximize the life extension of those who have survived heart transplants.

Morning. Petroverigsky lane, 10. At this Moscow address in the Kitay-Gorod area, I arrived at the angiography.su federal center for the diagnosis and treatment of cardiovascular diseases, which is part of the state research center for preventive medicine, to put on a sterile suit again and visit in the operating room.

Angiography is a method of examining blood vessels using x-rays and contrast fluid. It is used to detect damage and defects. Without it, the operation that I am going to talk about - stenting - would not have been possible.

There will still be some blood. I think I should warn impressionable people about this before they open the post in its entirety.

Who has never heard of cholesterol plaques, he did not watch the show of Elena Malysheva. Plaques are deposits on the inner walls of blood vessels that have accumulated over the years. They are similar in texture to thick wax. The plaque consists not only of cholesterol, calcium in the blood sticks to it, making the deposits even more dense. And this whole structure slowly but surely clogs the vessels, preventing our fiery motor, or rather the pump, from delivering nutrients and oxygen to various organs, including the heart itself.

Before the advent of the stenting method, which will be discussed, the doctors were armed with only the surgical method of bypass surgery, which became popularly famous thanks to Boris Nikolayevich Yeltsin's heart surgery in 1996 in a round operating room. I remember this case vividly (a memory from childhood), although a lot of famous people have done a similar operation.

Shunting is an abdominal operation. A person is given anesthesia, they cut the chest (they cut it, they can’t do it with one scalpel), they stop the heart and start the artificial circulation system. The beating heart beats very strongly and interferes with the operation, so it has to be stopped. To get to all the arteries and shunt, you need to get the heart and turn it over. A shunt is a donor artery taken from the patient himself, for example, from the arm. A lot of stress on the body.

During stenting, the patient remains conscious (everything happens under local anesthesia), can hold his breath or take deep breaths at the request of the doctor. Blood loss is minimal, and the incisions are tiny, because the arteries are entered through a catheter, which is usually inserted into the femoral artery. And they put a stent - a mechanical vasodilator. All in all, an elegant operation (-:

The operation for Sergei Iosifovich was done in three stages. I ended up on the final operation in the series. You cannot place all stents at once.

The surgical table and the angiograph (a semicircular device hanging over the patient) form a single mechanism that works together. The table moves back and forth, and the machine rotates around the table to take x-rays of the heart from different angles.

The patient is placed on the table, fixed and connected to the heart monitor.

To make it clear the device of the angiograph, I will show it separately. It's a small angiograph, not as big as the ones in the operating room. If necessary, it can even be brought to the ward.

It works quite simply. An emitter is installed below, a converter is installed at the top (a smile is pasted on it), from which a signal with an image is already transmitted to the monitor. Scattering of X-rays in space does not actually occur, however, everyone present in the operating room is protected. About eight such operations are performed per day.

Through a vessel on the arm or thigh, as in our case, a special catheter is inserted.

A thin metal wire, a conductor, is inserted through the catheter into the artery to deliver the stent to the site of the blockage. I was amazed at its length!

The stent - a mesh cylinder - is attached to the end of this wire in a compressed state. It is mounted on a balloon that will be inflated at the right time to deploy the stent. Initially, this design is not thicker than the conductor itself.

This is what an open stent looks like.

And this is a scale model of a different type of stent. In the case when the walls of the vessels are damaged, they are installed with a membrane. They not only support the vessel in the open state, but also serve as the walls of the vessels.

All through the same catheter, an iodine-containing contrast agent is injected. With the blood flow, it fills the coronary arteries. This allows the x-ray to visualize them and calculate the blockage sites, on which stents will be placed.

Here is such an Amazon basin obtained by injecting contrast.

All eyes on monitors! The entire stent placement process is observed through X-ray television.

After the stent is delivered into place, the balloon on which it is attached must be inflated. This is done using a device with a manometer (pressure meter). This device, which looks like a large syringe, is visible in the photo with long conductor wires.

The stent expands and is pressed into the inner wall of the vessel. To ensure that the stent has expanded correctly, the balloon remains inflated for twenty to thirty seconds. It is then deflated and pulled out of the artery on a wire. The stent remains and maintains the lumen of the vessel.

Depending on the size of the affected vessel, one or more stents may be used. In this case, they are overlapped one after the other.

And here's how the stent works. Below are screenshots from the X-ray TV. In the first picture, we see only one artery, a curly one. But another one should be visible, below it. Because of the plaque, the blood flow is completely blocked.

The thick sausage on the second is a stent that has just been deployed. The arteries are not visible because the contrast is not running in them, but the wires are just visible.

The third one shows the result. An artery appeared, blood flowed. Now compare the first picture with the third one again.

The concept of expanding the affected areas of the vessel with the help of a certain frame was proposed by Charles Dotter forty years ago. The development of the method took a long time, the first operation using this technology was performed by a group of French surgeons only in 1986. And only in 1993, the effectiveness of the method was proven to restore the patency of the coronary artery and keep it in a new state in the future.

Currently, foreign companies have developed about 400 different models of stents. In our case, this is Cordis from Johnson & Johnson. Artem Shanoyan, head of the department of X-ray endovascular diagnostic and treatment methods at the center, answered my question about Russian stent manufacturers that they simply do not exist.

The operation takes about half an hour. A pressure bandage is applied to the puncture site. From the operating room, the patient is sent to the intensive care unit, and two hours later to the general ward, from where you can already scribble joyful SMS to relatives. And in a few days they will be able to see each other at home.

Lifestyle restrictions typical for heart patients are usually removed after stenting, the person returns to normal life, and observation is carried out periodically by a doctor at the place of residence.