What does elective heart surgery mean? What are heart surgeries? Other types of transactions
Heart surgery is performed only when other methods of therapy cannot help the patient's condition. Heart surgery can prevent death in a patient, but the risk of an adverse outcome remains quite high.
Despite the fact that cardiac surgery does not stand still and develops, heart surgery is very difficult to perform. The best specialists in cardiac surgery are engaged in it. But even this important fact cannot shield the operated person from complex consequences.
Complications in the postoperative period can even lead to death.
Indications for surgery
As mentioned earlier, cardiac surgery is used in cases where there are no other options to save the patient's life. Heart surgery requires a very serious approach.
Heart transplantation is considered the most complex and serious surgical intervention. The operation is carried out under the strict supervision of highly qualified specialists.
Indications for heart surgery of any complexity are as follows:
- transient development of ailments of the cardiovascular system;
- in the absence of results with drug treatment;
- late referral to a medical facility.
Heart surgery helps to improve the general condition of the patient and eliminate the symptoms of a tormenting disease.
Cardiac cavity surgery is performed only after a complete diagnostic study and an accurate diagnosis by a cardio specialist.
Methods of surgical interventions
What are heart surgeries?
This is a pretty important question if you are going to have this major surgery. You will also need to know how the operation goes and how it is done.
This is necessary in order to make, perhaps, the main decision in your life, on which all future fate will depend.
Closed Interventions
This is a heart operation that does not affect the organ itself. It is done without touching the heart. For its implementation, there is no need for special equipment, except for such as the instruments of the surgeon.
The heart cavity does not "open". That is why it is called "closed".
Such an intervention is performed at the initial stage of the development of the disease, when the patient's condition can only be improved by operations.
Open Interventions
There is also open surgery. This type of operation requires the opening of the heart cavities in order to eradicate the existing pathology.
Open heart surgery is performed using a special device - heart-lung machine or heart-lung machine.
With an open intervention, the cavities are open, the heart and pulmonary organs are disconnected from blood circulation. This makes it possible to intervene on a "dry" organ.
All blood through the vein goes to specialized surgical equipment. There they pass through artificial lungs, enriched with oxygen and release carbon dioxide, transforming from the blood of a vein into an arterial one. Then it is driven by a special pump into the aorta of the operated person, in other words, into the systemic circulation.
Innovative techniques help to create all the "insides" of the equipment (also an artificial lung), with which the patient's blood comes into contact, "disposable", that is, once for one person. This will reduce the possible disastrous consequences.
Today, the heart-lung machine helps to stop the functioning of the heart organ and lungs for several hours. Thereby allowing to carry out the hardest operations of open character.
X-ray surgical interventions
This type of intervention began to be used quite recently. But thanks to innovative equipment, they occupy an important place in heart surgery.
With the help of a special catheter, surgical instruments are inserted into a strip section of the cardiac organ, or into the opening of the vessel. Further, with the help of the pressure that the device creates, the valves of the abdominal incisions are opened. They amplify or distort the partitions, or vice versa, using the device, the distortion is eliminated.
Special tubes are introduced into the lumen of the necessary vessel, thereby helping to slightly open it.
The process during such operations is carefully monitored by a special computer and control is made over each action. Thanks to this, operations are performed with less risk of injury and with a greater likelihood of a favorable outcome.
If you have had an X-ray surgery, the effectiveness of it is higher.
Action plan before surgery
Before surgery on the cardiac organ, preparation is necessary. If you have enough time, at least a few days or weeks, you need to take care of your body. Eat healthy, nutrient-rich foods.
Get plenty of rest, walk in the fresh air, do physical exercises that the treating specialist recommended to you.
Proper nutrition
Try to eat only natural foods every day and more than once, even if you have no appetite. Your body needs to consume plenty of proteins, vitamins and minerals.
Thanks to a healthy diet, the surgical intervention itself and the rehabilitation period are more favorable.
Rest
Do not force your body to overwork before surgery. The more you rest, the stronger and stronger your body will become.
If you want to visit relatives or invite you to visit, say that you need to gain strength before a difficult process. Relatives will always understand you and will not be offended.
Nicotine use
It's no secret for everyone that smoking affects negatively even the body of a completely healthy person. What can we say about patients with cardiac pathology.
Nicotine affects the heart in the following negative way: it develops arteriosclerosis, increases pressure in the blood vessels, and makes the heart vessels tighten. It also narrows blood-forming arteries and increases the concentration of mucous fluid in the pulmonary organs.
This leads to more difficult adaptation after surgery.
rehabilitation period
After a surgical intervention on the cardiac organ, if an insufficient amount of time has passed, it is even forbidden to get out of the ward bed. The entire rehabilitation period, the patient is in the intensive care unit.
This department is intended for patients who have a risk of death.
A special dietary diet plays a huge role in rehabilitation. His attending specialist appoints individually for each patient. You can start eating only with lean gruels and vegetable broths, but after a few days the diet increases significantly.
After the patient is transferred to a regular ward, as a rule, the attending physician will allow the use of the following products:
- cereals from coarse grinding (barley, barley groats, unpolished rice). You can also include oatmeal in the diet 2-3 times a week;
- dairy production: fat-free curd mass, cheese with a fat content of not more than 20%;
- vegetables and fruits: fresh, steamed and in various salads;
- small pieces of boiled chicken, turkey and rabbit. As well as homemade steamed cutlets;
- various varieties of fish: herring, salmon, capelin, etc.;
- all soups without fried ingredients and without fat content.
Under no circumstances should the following foods be consumed.
Let's try to lift the veil of the mystery of their work and find out what types of heart surgeries exist and are carried out today. Is it also possible to perform heart surgery without opening the chest?
When the heart is in the palm of your hand or open surgeries
Open heart surgery is so called because the cardiac surgeon "opens" the patient's chest, cuts through the sternum and all soft tissues, and makes an opening of the chest. Such interventions, as a rule, are performed with the connection of a heart-lung machine (hereinafter referred to as AIC), which is a temporary replacement for the heart and lungs of the operated person. This apparatus is a complex device of rather impressive dimensions, which continues to pump blood through the body when the patient's heart is artificially stopped.
Thanks to AIC, open-heart surgery can be extended for many hours if necessary. Open surgeries are used for valve replacement, coronary artery bypass grafting can also be performed in this way, many heart defects are eliminated by open interventions. It should be noted that AIC is not always used during their implementation.
The body can not always tolerate the intervention of a foreign heart substitute: the use of AIC is fraught with complications such as renal failure, impaired cerebral blood flow, inflammatory processes, and impaired blood rheology. Therefore, some operations on the open heart are carried out in the conditions of his work, without the connection of the AIC.
Such interventions on a beating heart include coronary artery bypass grafting, during this operation on a beating heart, the area of \u200b\u200bthe heart that the surgeon needs is temporarily switched off from work, and the rest of the heart continues to work. Such manipulations require high qualifications and skills of the surgeon, and also have a much lower risk of complications, they are perfect for people over 75 years old, patients with a large arsenal of chronic diseases, patients with diabetes mellitus than operations on an organ that is turned off from the blood circulation.
But all the pros and cons, of course, are determined by the cardiac surgeon. Only the doctor decides to keep the heart working, or stop it for a while. Open surgeries are the most traumatic, having a higher percentage of complications; after surgery, a scar remains on the patient's chest. But sometimes only such an operation can save a person's life, improve his health, return him to a full, happy life.
Intact heart or closed surgeries
If the sternum, heart chambers and the heart muscle itself were not opened during surgery, then these are closed heart surgeries. During such operations, the surgical scalpel does not affect the heart, and the surgeon's work consists in the surgical treatment of large vessels, cardiac arteries and aorta, the chest is also not opened, only a small incision is made on the chest.
Thus, a pacemaker can be installed, heart valve correction, balloon angioplasty, shunting, vascular stenting can be performed. Closed operations are less traumatic, have a lower percentage of complications, unlike open ones. Closed vascular surgery can often be the first step before subsequent heart surgery.
Indications for their conduct is always determined by the doctor.
Achievements of modern cardiac surgery or minimally invasive operations
Cardiac surgery is steadily moving forward, and an indicator of this is the increasing percentage of low-traumatic, high-tech manipulations that allow you to get rid of the pathology of the heart and blood vessels with minimal intervention and impact on the human body. What are minimally invasive interventions? These are surgical operations performed by introducing instruments or special devices, through mini-accesses - 3-4 cm incisions, or without incisions at all: during endoscopic operations, incisions are replaced by punctures.
When performing minimally invasive manipulations, the path to the heart and blood vessels can lie through the femoral vessels, for example - these operations are called endovascular, they are performed under x-ray control. Elimination of congenital malformations, prosthetic heart valves, all operations on vessels (from removal of a blood clot to expansion of the lumen) - all these interventions can be performed using minimally invasive technologies. Emphasis is placed on them in modern cardiac surgery, since a low risk of complications, minimal impact on the body are those huge advantages that patients can appreciate literally on the operating table.
Anesthesia during endoscopic procedures is not required, it is enough just to anesthetize the puncture site. Recovery after heart surgery performed using a minimally invasive technique is ten times faster. Such methods are also indispensable in diagnostics - coronary angiography, a method for examining the vessels of the heart by introducing contrast and subsequent x-ray control. In parallel with the diagnosis according to the indications, the cardiac surgeon can also perform therapeutic manipulations on the vessels - the installation of a stent, balloon dilation in a narrowed vessel.
And diagnosis and treatment by puncture on the femoral artery? Isn't this a miracle? Such miracles for cardiac surgeons are becoming routine. The contribution of endovascular methods of treatment is also invaluable in cases where the threat to the life of the patient is especially acute and minutes count. These are situations of acute coronary syndrome, thromboembolism, aneurysm. In many cases, the availability of the necessary equipment and qualified personnel can save the lives of patients.
When is the operation indicated?
It is up to an experienced cardiac surgeon or a council of doctors to decide whether an operation is indicated, as well as to determine the type of surgical intervention on the heart and blood vessels. The doctor can make a conclusion after a thorough examination, familiarization with the history of the development of the disease, monitoring the patient. The doctor should know the ins and outs of the disease very well: how long the patient has been suffering from cardiac pathology, what medications he takes, what chronic diseases he has, when he felt worse ... After evaluating all the pros and cons, the doctor makes his verdict: whether to have surgery or not. If the situation develops according to the above scheme, then we are dealing with a planned cardiac surgery.
It is shown to the following people:
- lack of effect from adequate drug therapy;
- rapidly progressive deterioration of well-being against the background of ongoing treatment with pills and injections;
- severe arrhythmias, angina pectoris, cardiomyopathy, congenital and acquired heart defects requiring correction.
But there are situations when there is no time for reflection, questioning and analysis of the medical history. We are talking about life-threatening conditions - a blood clot broke off, an aneurysm exfoliated, a heart attack occurred. When the time goes by for minutes, emergency cardiac surgery is performed. Stenting, coronary artery bypass grafting, thrombectomy of the coronary arteries, radiofrequency ablation can be performed urgently.
Consider the most common types of heart surgery
- CABG - coronary artery bypass grafting "on hearing" in many, probably because it is performed for coronary heart disease, which is extremely common among the population. CABG can be performed both open and closed, and combined techniques with endoscopic inclusions are also performed. The essence of the operation is to create bypass routes of blood flow through the vessels of the heart, restoring normal blood supply to the myocardium, which leads to a better supply of oxygen to the heart muscle.
- RFA - radiofrequency ablation. This type of surgical intervention is used to eliminate persistent arrhythmias, when drug therapy is powerless in the fight against arrhythmias. This is a minimally invasive intervention, which is performed under local anesthesia, a special conductor is inserted through the femoral or subclavian vein, which supplies an electrode to the focus of pathological impulses in the heart, the current flowing through the electrode to the pathological focus destroys it. And the absence of a focus of pathological impulses means the absence of arrhythmia. 12 hours after the manipulation, the patient is already allowed to get up.
- Prosthetic or plastic heart valves. Prosthetics means complete valve replacement, the prosthesis can be mechanical or biological. And plastic implies the elimination of defects in the "native" valve or valve apparatus. There are certain indications for these interventions, which are clearly known to cardiac surgeons.
- Installing a pacemaker. Cardiac arrhythmias, severe bradycardia may be indications for installation, which, thanks to modern technology, can also be performed endoscopically.
Cardiac surgery is a branch of medicine dedicated to the surgical treatment of the heart. With pathologies of the cardiovascular system, such intervention is an extreme measure. Doctors try to restore the patient's health without surgery, but in some cases only cardiac surgery can save the patient. Today, this field of cardiology uses the latest advances in science to return the patient to health and a fulfilling life.
Indications for operations
Invasive interventions on the heart is a complex and risky job, it requires skill and experience, and the patient - preparation and implementation of recommendations. Since such operations are risky, they are carried out only when absolutely necessary. In most cases, the patient is trying to rehabilitate with the help of medicines and medical procedures. But in cases where such methods do not help, heart surgery is needed. Surgical intervention is carried out in a hospital and complete sterility, the operated is under anesthesia and the control of the surgical team.
Such interventions are needed for congenital heart defects or acquired. The former include pathologies in the anatomy of the organ: defects in valves, ventricles, impaired blood circulation. Most often they are discovered even during the bearing of a child. Heart disease is also diagnosed in newborns, often such pathologies need to be eliminated urgently in order to save the life of the baby. Among the acquired diseases, ischemic disease is in the lead, in this case, surgery is considered the most effective method of treatment. Also in the heart area there are: impaired blood circulation, stenosis or valve insufficiency, heart attack, pericardial pathology and others.
Heart surgery is prescribed in situations where conservative treatment does not help the patient, the disease progresses rapidly and threatens life, with pathologies that require urgent and urgent correction, and in advanced forms of diseases, a late visit to the doctor.
The decision on the appointment of the operation is made by a council of doctors or. The patient must be examined to establish an accurate diagnosis and type of surgical intervention. They identify chronic diseases, stages of the disease, assess the risks, in which case they talk about a planned operation. If emergency assistance is needed, for example, when a blood clot is torn off or an aneurysm is exfoliated, minimal diagnostics are performed. In any case, the function of the heart is restored surgically, its departments are rehabilitated, blood flow and rhythm are normalized. In severe situations, the organ or its parts are no longer amenable to correction, then prosthetics or transplantation is prescribed.
Classification of heart operations
In the area of the heart muscle, there can be dozens of different diseases, these are: insufficiency, narrowing of the lumen, ruptures of blood vessels, stretching of the ventricles or atria, purulent formations in the pericardium, and much more. To solve each problem, surgery has several types of operations. They are distinguished by urgency, effectiveness and method of influencing the heart.
The general classification divides them into operations:
- Buried - used to treat arteries, large vessels, aorta. During such interventions, the chest of the operated person is not opened, the heart itself is also not affected by the surgeon. Therefore, they are called "closed" - the heart muscle remains intact. Instead of a strip opening, the doctor makes a small incision in the chest, most often between the ribs. Closed types include: shunting, balloon angioplasty, stenosis of blood vessels. All these manipulations are designed to restore blood circulation, sometimes they are prescribed to prepare for a future open operation.
- Open - carried out after opening the sternum, sawing the bones. The heart itself during such manipulations can also be opened to get to the problem area. As a rule, for such operations, the heart and lungs must be stopped. To do this, connect the heart-lung machine - AIC, it compensates for the work of "disconnected" organs. This allows the surgeon to accurately perform the work, in addition, the procedure under the control of AIC takes longer, which is necessary when eliminating complex pathologies. During open operations, AIC may not be connected, but only the desired zone of the heart can be stopped, for example, during coronary artery bypass grafting. Opening the chest is necessary to replace valves, prosthetics, and eliminate tumors.
- X-ray surgery - similar to a closed type of operation. The essence of this method is that the doctor moves a thin catheter through the blood vessels, and gets to the very heart. The chest is not opened, the catheter is placed in the thigh or shoulder. The catheter is injected with a contrast agent that stains the vessels. The catheter is advanced under X-ray control, the video image is transmitted to the monitor. Using this method, the lumen in the vessels is restored: at the end of the catheter there is a so-called balloon and a stent. At the site of narrowing, this balloon is inflated with a stent, restoring the normal patency of the vessel.
The safest are minimally invasive methods, that is, X-ray surgery and a closed type of surgery. With such work, the risk of complications is the least, the patient recovers faster after them, but they can not always help the patient. Complex operations can be avoided with periodic inspections. The earlier the problem is identified, the easier it is for the doctor to solve it.
Depending on the condition of the patient, there are:
- planned operation. It is carried out after a detailed examination, within the agreed time frame. A planned intervention is prescribed when the pathology does not pose a particular danger, but it cannot be postponed.
- Urgent - these are operations that need to be done in the next few days. During this time, the patient is prepared, all the necessary studies are carried out. The date is set immediately after receiving the necessary data.
- Emergency. If the patient is already in serious condition, the situation may worsen at any time - an operation is prescribed immediately. Before her, only the most important examinations and preparations are carried out.
In addition, surgical care can be radical or auxiliary. The first implies the complete elimination of the problem, the second - the elimination of only part of the disease, improving the patient's well-being. For example, if a patient has a pathology of the mitral valve and stenosis of a vessel, the vessel is first restored (auxiliary), and after a while valve plastic surgery (radical) is prescribed.
How operations are done
The course and duration of the operation depends on the pathology being eliminated, the patient's condition, and the presence of concomitant diseases. The procedure can take half an hour, and can stretch for 8 hours or more. Most often, such interventions last 3 hours, are carried out under general anesthesia and AIC control. First, the patient is prescribed an ultrasound of the chest, urine and blood tests, an ECG, and a consultation with specialists. After receiving all the data, they determine the degree and place of the pathology, decide whether there will be an operation.
As part of the preparation, a low-fat, spicy, and fried diet is also prescribed. For 6-8 hours before the procedure, it is recommended to refuse food and drink less. In the operating room, the doctor assesses the well-being of the ward, introduces the patient into a medical sleep. With minimally invasive interventions, local anesthesia is sufficient, for example, during X-ray surgery. When anesthesia or anesthesia takes effect, the main actions begin.
Heart valve repair
There are four valves in the heart muscle, all of which serve as a passage for blood from one chamber to another. The most commonly operated valves are the mitral and tricuspid valves, which connect the ventricles to the atria. Stenosis of the passages occurs with insufficient expansion of the valves, while the blood does not flow well from one department to another. Valve insufficiency is a poor closure of the cusps of the passage, while there is an outflow of blood back.
Plastic surgery is carried out open or closed, during the operation, special rings or sutures are applied manually along the diameter of the valve, which restore the normal lumen and narrow the passage. Manipulations last an average of 3 hours; with open views, an AIC is connected. After the procedure, the patient remains under the supervision of doctors for at least a week. The result is normal blood circulation and functioning of the heart valves. In severe cases, native leaflets are replaced with artificial or biological implants.
Elimination of heart defects
In most cases, defects are congenital, the cause of this can be hereditary pathologies, bad habits of parents, infections and fever during pregnancy. At the same time, children may have various anatomical abnormalities in the region of the heart, often such anomalies are poorly compatible with life. The urgency and type of surgery depends on the condition of the child, but they are often prescribed as early as possible. For children, heart surgery is performed only under general anesthesia, and under the supervision of medical equipment.
At an older age, heart defects develop with defects in the interatrial septum. This happens with mechanical damage to the chest, infectious diseases, due to concomitant heart disease. To eliminate such a problem, an open operation is also needed, more often with artificial cardiac arrest.
During manipulations, the surgeon can “patch” the septum with a patch, or suture the defective part.
Shunting
Coronary artery disease (CHD) is a very common pathology that affects mainly the generation over 50 years of age. Appears due to impaired blood flow in the coronary artery, which leads to oxygen starvation of the myocardium. There is a chronic form, in which the patient has constant attacks of angina pectoris, and an acute one is a myocardial infarction. They try to eliminate chronic pain conservatively or with the help of minimally invasive techniques. Acute requires urgent intervention.
To prevent complications or alleviate the disease, apply:
- aorto-coronary bypass;
- balloon angioplasty;
- transmyocardial laser revascularization;
- stenting of a coronary artery.
All these methods are aimed at restoring normal blood flow. As a result, enough oxygen is supplied to the myocardium with blood, the risk of a heart attack is reduced, and angina pectoris is eliminated.
If you need to restore normal patency, angioplasty or stenting is enough, in which the catheter is moved through the vessels to the heart. Before such an intervention, coronary angiography is performed to accurately determine the blocked area. Sometimes blood flow is restored bypassing the affected area, while a bio-shunt (often a section of the patient's own vein from the arm or leg) is sutured to the artery.
Recovery after interventions
After surgery, the patient remains in the hospital for another 1-3 weeks, all this time the doctors will assess his condition. The patient is discharged after verification and approval by the cardiologist.
The first month after surgical procedures is called the early postoperative period, at this time it is very important to follow all the doctor's recommendations: diet, calm and measured lifestyle. Nicotine, alcohol, junk food and physical activity are prohibited regardless of the type of intervention.
The doctor's recommendations should also contain a warning about the dangers and complications. At discharge, the doctor will set the date for the next appointment, but you need to seek help and unscheduled if the following symptoms occur:
- sudden fever;
- redness and swelling at the incision site;
- discharge from the wound;
- persistent chest pain;
- frequent dizziness;
- nausea, bloating and stool disorders;
- breathing difficulties.
At scheduled examinations, the cardiologist will listen to the heartbeat, measure the pressure, and listen to complaints. To check the effectiveness of the operation, ultrasound, computed tomography, x-ray examinations are prescribed. Such visits are scheduled once a month for six months, then the doctor will see you once every 6 months.
Often, in addition to surgical care, medications are prescribed. For example, when prosthetic valves are artificially implanted, the patient drinks anticoagulants for life.
In the postoperative period, it is important not to self-medicate, since the interaction of permanent drugs and other medications can give a negative result. Even conventional painkillers need to be discussed with. To keep fit and restore health faster, it is recommended to be outdoors more often, walk on foot.
Life after heart surgery will gradually return to its previous course, a full recovery is predicted within a year.
Cardiac surgery offers many methods for the rehabilitation of the heart. Such operations are designed to restore the patient's physical and moral strength. You should not be afraid or avoid such procedures, on the contrary, the sooner they are carried out, the greater the chances of success.
Heart surgeries are very common these days. Modern cardiac surgery and vascular surgery are very advanced. Surgical intervention is prescribed in the case when conservative drug treatment does not help, and, accordingly, the normalization of the patient's condition is impossible without surgery.
For example, heart disease can only be cured by surgery, this is necessary in the case when blood circulation is severely disturbed due to pathology.
And as a result, a person feels bad and severe complications begin to develop. These complications can lead not only to disability, but also to death.
Often prescribed surgical treatment of coronary heart disease. Since it can lead to myocardial infarction. Due to a heart attack, the walls of the cavities of the heart or aorta become thinner and protrusion appears. This pathology can also be cured only by surgery. Quite often, operations are performed due to disturbed heart rhythm (RFA).
They also perform heart transplantation, that is, a transplant. This is necessary when there is a complex of pathologies due to which the myocardium is not able to function. Today, such an operation prolongs the life of the patient by an average of 5 years. After such an operation, the patient is put on disability.
Operations can be carried out urgently, urgently, or a planned intervention is prescribed. It depends on the severity of the patient's condition. An emergency operation is performed immediately, immediately after the diagnosis is established. If such an intervention is not carried out, then the death of the patient may occur.
Such operations are often performed on newborns immediately after birth with congenital heart disease. In this case, even minutes are important.
Urgent operations do not require fast execution. In this case, the patient is prepared for some time. As a rule, it is several days.
A planned operation is prescribed if at this time there is no danger to life, but it must be carried out to prevent complications. Doctors prescribe surgery on the myocardium only if it is necessary.
Invasive Research
Invasive methods for examining the heart are to conduct catheterization. That is, the study is carried out through a catheter, which can be installed both in the cavity of the heart and in the vessel. With the help of these studies, you can determine some indicators of the work of the heart.
For example, blood pressure in any part of the myocardium, as well as determine how much oxygen is in the blood, evaluate cardiac output, vascular resistance.
Invasive methods allow you to study the pathology of the valves, their size and degree of damage. This study takes place without opening the chest. Cardiac catheterization allows you to take an intracardiac electrocardiogram and phonocardiogram. This method is also used to monitor the effectiveness of drug therapy.
Such studies include:
With selective coronary angiography, contrast is injected into one of the coronary arteries (right or left).
Coronary angiography is often performed in patients with angina pectoris 3-4 functional class. In this case, it is resistant to drug therapy. Doctors need to decide what type of surgical treatment is needed. It is also important to carry out this procedure for unstable angina.
Also, invasive procedures include punctures and probing of the heart cavities. With the help of probing, it is possible to diagnose heart defects and pathologies in the LV, for example, it can be tumors, or thrombosis. To do this, use the femoral vein (right), a needle is inserted into it through which the conductor passes. The needle diameter becomes about 2 mm.
When performing invasive studies, local anesthesia is used. The incision is small, about 1-2 cm. This is necessary to expose the desired vein for the installation of the catheter.
These studies are carried out in different clinics and their cost is quite high.
Surgery for heart disease
Heart defects include
- stenosis of the heart valves;
- insufficiency of heart valves;
- septal defects (interventricular, interatrial).
valve stenosis
These pathologies lead to many disorders in the work of the heart, that is, the goals of operations for defects are to relieve the load from the heart muscle, restore the normal functioning of the ventricle, as well as restore contractile function and reduce pressure in the heart cavities.
To eliminate these defects, the following surgical interventions are performed:
Often, after heart disease surgery, a person is given a disability.
Operations on the aorta
Open surgeries include:
- Prosthetics of the ascending aorta. At the same time, a valve-containing conduit is installed; this prosthesis has a mechanical aortic valve.
- Prosthetics of the ascending aorta, while the aortic valve is not implanted.
- Prosthetics of the ascending artery and its arch.
- Surgery to implant a stent graft in the ascending aorta. This is an endovascular intervention.
Prosthetics of the ascending aorta is the replacement of this section of the artery. This is necessary in order to prevent serious consequences, for example, a break. To do this, prosthetics are used by opening the chest, and endovascular or intravascular interventions are also performed. In this case, a special stent is installed in the affected area.
Of course, open-heart surgery is more effective, since in addition to the main pathology - aortic aneurysm, it is possible to correct the concomitant one, for example, stenosis or valve insufficiency, etc. And the endovascular procedure gives a temporary effect.
When prosthetics of the aortic arch are used:
- Open distal anastomosis. This is when the prosthesis is installed, so that it does not affect its branches;
- Arc semi-replacement. This operation consists in replacing the artery where the ascending aorta passes into the arch and, if required, replacing the concave surface of the arch;
- Subtotal prosthetics. This is when the replacement of branches (1 or 2) is required during prosthetics of the arterial arch;
- Complete prosthetics. In this case, the arch is prosthetized together with all supra-aortic vessels. This is a complex intervention that can cause neurological complications. After such an intervention, a person is given a disability.
Coronary artery bypass grafting (ACS)
CABG is open-heart surgery that uses a patient's vessel as a shunt. This heart operation is needed in order to create a bypass for the blood, which will not affect the occlusive section of the coronary artery.
That is, this shunt is installed on the aorta and brought to the area of the coronary artery not affected by atherosclerosis.
This method is quite effective in the treatment of coronary heart disease. Due to the installed shunt, the blood flow to the heart increases, which means that ischemia and angina pectoris do not appear.
CABG is prescribed if there is angina pectoris, in which even the smallest loads cause seizures. Also, indications for CABG are lesions of all coronary arteries, and if an aneurysm of the heart has formed.
During CABG, the patient is put into general anesthesia, and then, after opening the chest, all manipulations are performed. This operation can be performed with or without cardiac arrest. And also, depending on the severity of the pathology, the doctor decides whether it is necessary to connect the patient to a heart-lung machine. The duration of CABG can be 3-6 hours, it all depends on the number of shunts, that is, on the number of anastomoses.
As a rule, the role of the shunt is performed by a vein from the lower limb, and sometimes a part of the internal thoracic vein, the radial artery, is also used.
Today, CABG is performed, which is performed with minimal access to the heart, while the heart continues to work. Such an intervention is considered not as traumatic as the others. In this case, the chest is not opened, the incision is made between the ribs and a special expander is also used so as not to affect the bones. This type of CABG lasts 1 to 2 hours.
The operation is performed by 2 surgeons, while one makes an incision and opens the sternum, the other operates on the limb to take a vein.
After carrying out all the necessary manipulations, the doctor installs drains and closes the chest.
CABG significantly reduces the likelihood of a heart attack. Angina pectoris does not appear after surgery, which means that the quality and duration of the patient's life increase.
Radiofrequency ablation (RFA)
RFA is a procedure that is performed under local anesthesia, since the basis is catheterization. Such a procedure is carried out in order to exfoliate the cells that cause arrhythmia, that is, the focus. This happens through a catheter-conductor, which conducts an electric current. As a result, tissue formations are removed by RFA.
After conducting an electrophysical study, the doctor determines where the source is located, which causes a rapid heartbeat. These sources can be formed along the conducting paths, as a result of which an anomaly of the rhythm manifests itself. It is RFA that neutralizes this anomaly.
RFA is carried out in case of:
- when drug therapy does not affect the arrhythmia, and also if such therapy causes side effects.
- If the patient has Wolff-Parkinson-White syndrome. This pathology is perfectly neutralized by RFA.
- If a complication may occur, such as cardiac arrest.
It should be noted that RFA is well tolerated by patients, since there are no large incisions and opening of the sternum.
The catheter is inserted through a puncture in the thigh. Only the area through which the catheter is inserted is anesthetized.
The guide catheter reaches the myocardium, and then a contrast agent is injected. With the help of contrast, the affected areas become visible, and the doctor directs the electrode to them. After the electrode acted on the source, the tissues are scarred, which means that they will not be able to conduct the impulse. After RFA, a bandage is not needed.
Carotid surgery
There are such types of operations on the carotid artery:
- Prosthetics (used with a large lesion);
- Stenting is performed if stenosis is diagnosed. In this case, the lumen is increased by installing a stent;
- Eversion endarterectomy - at the same time, atherosclerotic plaques are removed along with the inner lining of the carotid artery;
- Carotid endarectomy.
These operations are performed under both general and local anesthesia. More often under general anesthesia, as the procedure is performed in the neck and there are discomfort.
The carotid artery is occluded, and in order to continue the blood supply, shunts are installed, which are bypass routes.
Classical endarterectomy is done if long plaque lesions are diagnosed. During this operation, the plaque is peeled off and removed. Next, the vessel is washed. Sometimes it is still necessary to fix the inner shell, this is done with special seams. At the end, the artery is sutured with a special synthetic medical material.
Endarterectomy of the carotid arteries
Eversion endartectomy is performed in such a way that the inner layer of the carotid artery at the site of the plaque is removed. And after that they fix, that is, sew. For this operation, the plaque should be no more than 2.5 cm.
Stenting is performed using a balloon catheter. This is a minimally invasive procedure. When the catheter is located at the site of stenosis, it inflates and thereby expands the lumen.
Rehabilitation
The period after heart surgery is no less important than the operation itself. At this time, the patient's condition is monitored by doctors, and in some cases, cardio training, therapeutic diets, etc. are prescribed.
Other recovery measures are also needed, such as wearing a bandage. The bandage at the same time fixes the seam after the operation, and of course the entire chest, which is very important. Such a bandage should be worn only if the operation is performed on the open heart. The cost of these items may vary.
The bandage that is worn after heart surgery looks like a T-shirt with tightness clamps. You can purchase male and female versions of this bandage. The bandage is important to prevent lung congestion by coughing regularly.
Such prevention of stagnation is quite dangerous because the seams can disperse, the bandage in this case will protect the seams and contribute to strong scarring.
Also, the bandage will help prevent swelling and bruising, promotes the correct location of organs after heart surgery. And the bandage helps to relieve the load from the organs.
After heart surgery, the patient needs rehabilitation. How long it will last depends on the severity of the lesion and the severity of the operation. For example, after CABG, immediately after heart surgery, you need to start rehabilitation, this is a simple exercise therapy and massage.
After all types of heart surgery, medical rehabilitation, that is, supportive therapy, is needed. In almost all situations, the use of antiplatelet agents is mandatory.
If there is high blood pressure, then ACE inhibitors and beta-blockers are prescribed, as well as drugs to lower blood cholesterol (statins). Sometimes the patient is prescribed physical procedures.
Disability
It should be noted that disability is given to people with diseases of the cardiovascular system even before surgery. There must be evidence for this. From medical practice, it can be noted that they necessarily give disability after coronary artery bypass grafting. Moreover, there may be a disability of both 1 and 3 groups. It all depends on the severity of the pathology.
People who have circulatory disorders, grade 3 coronary insufficiency, or have had a myocardial infarction are also entitled to disability.
Regardless of whether the operation was performed or not yet. Patients with grade 3 heart defects and combined defects can apply for disability if there are persistent circulatory disorders.
Clinics
| Clinic name | Address and phone | Type of service | Price |
|---|---|---|---|
| NII SP im. N. V. Sklifosovsky | Moscow, Bolshaya Sukharevskaya sq., 3 |
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| KB MGMU them. Sechenov | Moscow, st. B. Pirogovskaya, 6 |
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| FSCC FMBA | Moscow, Orekhovy Boulevard, 28 |
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| NII SP im. I.I. Janelidze | St. Petersburg, st. Budapestskaya, 3 |
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| SPGMU them. I.P. Pavlova | St. Petersburg, st. L. Tolstoy, 6/8 |
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| MC "Shiba" | Derech Sheba 2, Tel Hashomer, Ramat Gan |
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| link to article.
Open heart surgery is one of the methods of treating cardiovascular diseases, in which special surgical procedures are performed. The general principle is that there is an intervention in the human body in order to carry out the necessary activities on the open heart. In other words, this is such an operation, during which an opening or dissection of the region of the human sternum is performed, affecting the tissues of the organ itself and its vessels.
Open heart surgery
Statistics show that the most common intervention of this type among adults is an operation in which artificial blood flow is created from the aorta to healthy areas of the coronary arteries - coronary artery bypass grafting.
This operation is performed for the treatment of severe coronary heart disease, which occurs due to the development of atherosclerosis, in which there is a narrowing of the vessels supplying blood to the myocardium, their elasticity decreases.
The general principle of the operation: the patient's own biomaterial (a fragment of an artery or vein) is taken and sutured in the area between the aorta and the coronary vessel in order to bypass the place affected by atherosclerosis, in which blood circulation is impaired. After the operation is performed, the blood supply to a certain area of the heart muscle is restored. This artery / vein supplies the heart with the necessary blood flow, while the artery in which the pathological process occurs is bypassed.
Coronary artery bypass grafting Today, taking into account the progress in medicine, for surgical treatment on the heart, it is enough to make only small incisions in the corresponding area. Another intervention, more complex, will not be needed. Therefore, the concept of "open heart surgery" sometimes misleads people.
Reasons for open heart surgery
- The need to replace or restore the patency of blood vessels for the correct flow of blood into the heart.
- The need to repair defective areas in the heart (for example, valves).
- The need to place special medical devices to maintain the working capacity of the heart.
- The need for transplantation operations.
What you need to know about coronary artery bypass surgery?
Time spending
According to medical data, this type of operation takes no less than four and no more than six hours. In rare, especially severe cases, when the operation requires more work (creation of several shunts), an increase in this period may be observed.
The first night after heart surgery and all medical procedures, patients spend in the intensive care unit. After three to seven days have passed (the exact number of days is determined by the patient's well-being), the person is transferred to a regular ward.
Operation Hazards
Despite the qualifications of doctors, no one is immune from unplanned situations. What is the danger of surgery, and what risk can it carry:
- infection of the chest due to an incision (this risk is especially high for people who are obese, diabetic, or undergo a second operation);
- myocardial infarction, ischemic stroke;
- heart rhythm disturbances;
- thromboembolism;
- increased body temperature for a long time;
- cardiac discomfort of any nature;
- pain of a different nature in the chest area;
- pulmonary edema;
- short-term amnesia and other transient memory problems;
- loss of a significant amount of blood.
These negative consequences, as statistics show, occur much more often when using an artificial blood supply device.
The risk of unpleasant consequences is always present Preparation period
In order for the planned operation and general treatment to be successful, it is important not to miss anything significant before they begin. To do this, the patient must tell the doctor:
- About medications that are currently being used. These may include medications prescribed by another doctor, or those that the patient purchases himself, including dietary supplements, vitamins, etc. This is important information and should be announced before surgery.
- About all chronic and past diseases, health deviations that are currently available (runny nose, herpes on the lips, indigestion, fever, sore throat, fluctuations in blood pressure, etc.).
The patient should be prepared for the fact that two weeks before the operation, the doctor will ask him to refrain from smoking, excessive alcohol consumption, taking vasoconstrictor drugs (for example, nasal drops, ibuprofen, etc.).
On the day of the operation, the patient will be asked to use a special antibacterial soap, which significantly reduces the risk of infection during the operation. In addition, a few hours before the intervention, you can not eat food and drink water.
Operation
When open heart surgery is performed, the following actions are sequentially performed:
- The patient is placed on the operating table.
- He is given general anesthesia.
- When the anesthesia begins to take effect and the patient falls asleep, the doctor opens the chest. To do this, he makes an incision in the appropriate area (usually it is no more than 25 sentiments in length).
- The doctor dissects the sternum, partially or completely. This allows access to the heart and aorta.
- Once access is secured, the patient's heart is stopped and connected to a heart-lung machine. This allows the surgeon to calmly perform all manipulations. Today, technologies are used that allow in some cases to perform this operation without stopping the heartbeat, while the number of complications is lower. than traditional intervention.
- The doctor creates a shunt around the damaged part of the artery.
- The cut part of the chest is fixed with a special material, most often with a special wire, but in some cases plates are used. These plates are often used for the elderly or for people who have had frequent surgeries.
- After the operation is completed, the incision is sutured.
Postoperative period
After the operation is completed and the patient wakes up, he will find two or three tubes in his chest. The role of these tubes is to drain excess fluid from the area around the heart (drainage) into a special vessel. In addition, an intravenous tube is installed for the flow of therapeutic and nutrient solutions into the body and a catheter into the bladder to remove urine. In addition to the tubes, devices are connected to the patient to monitor the work of the heart.
The patient should not worry, in case of questions or discomfort, he can always contact the medical workers who will be assigned to monitor him and promptly respond if necessary.
The duration of the recovery period depends not only on physiology, but also on the person himself. Each patient should understand that rehabilitation after surgery is not a quick process. After six weeks of treatment, some improvements can be observed, and only after six months will all the benefits of the operation become visible.
But each patient is able to speed up this rehabilitation process, while avoiding new heart ailments, which reduces the risk of a second operation. To do this, it is recommended to take the following measures:
- follow the diet and special diet prescribed by the attending physician;
- limit salty, fatty, sweet foods);
- devote time to physiotherapy exercises, walks in the fresh air;
- stop drinking alcohol frequently;
- monitor the level of cholesterol in the blood;
- track blood pressure.
If these measures are followed, the postoperative period will pass quickly and without complications. But you should not rely on general recommendations, the advice of your attending physician, who has studied the medical history in detail and is able to draw up an action plan and a diet during the recovery period, is much more valuable.