How is heart surgery performed? Open heart surgery, stages and recovery period Types of heart surgery

Tuesday is the day of the operation. The team is preparing for a long morning of work. During the operation, the chest is opened and the heart is prepared for vessel transplantation.

Disease history

Mr. Thomas, a 59-year-old tanker driver, is married with two adult children. He had shingles with right side neck, and then there was an uncomfortable feeling of constriction in the throat, accompanied by sweating and nausea. He first felt these symptoms while walking up the steps of his truck. They continued, and Thomas decided to seek advice from a therapist.

Thomas's high blood pressure, obesity and long history of smoking were enough reason to get an EKG. Its results showed the presence coronary disease hearts. Thomas was referred to a cardiac expert (a physician who specializes in heart problems - not a surgeon). Despite the applied drug treatment, the pain continued.

Tests confirmed the presence of the disease, including an angiogram (a test using dye injected into an artery to identify narrowing) that revealed a narrowing in the left main coronary artery, affecting both the left and right vessels. Because drug treatment was unsuccessful and angioplasty (stretching the narrowed vessel using a catheter) was not an option, Mr. Thomas was referred for surgery.

Monday

Mr. Thomas is hospitalized. His anamnesis, examination and test data were analyzed. Two units of blood for transfusion are examined for compatibility. The patient is explained the essence of the operation and warned about the risks associated with it. Obtain written consent for CABG.

Tuesday

Early in the morning, Mr. Thomas is prepped for surgery.

7:05 Premedication and anesthesia

8:15 Mr. Thomas was sedated 70 minutes ago and a ventilation tube is already in place. Airways. After applying anesthesia and paralyzing agents, his breathing is supported by a ventilator. Before Mr. Thomas is transferred to the operating room, the anesthesiologist monitors venous and arterial blood flow.

8:16 The operating room is ready for Mr. Thomas. On the left is a table with instruments, on the right is a ready-to-use heart-lung apparatus.

8:25 Patient in the operating room. Skin his chest and legs are treated antiseptic solution to reduce the risk of infection.

8:40 Chest opening

The skin has already been treated, the patient is dressed in sterile clothing. One of the surgeons makes an incision in the leg to remove the vein, and the second one cuts the skin on the chest. After making a preliminary cut with a regular scalpel, he uses an electric one, which cuts the vessels, stopping the bleeding.

8:48 The surgeon separates the breast bone with an air-powered electric saw.

8:55 Artery and vein removal

View of the internal mammary artery in the mirror in the center of the surgical lamp. This artery is very elastic. The top end will remain in place, it will be cut off at the bottom and then connected to the coronary artery.

An angled retractor is placed along the left edge of the sternum to elevate it and expose the mammary artery running along the sternum. inside breasts

At the same time, one of the main veins in the leg - the great saphenous vein - is prepared for transplantation. It was almost completely removed from the left thigh.

9:05 Connection to the heart-lung machine

The heart-lung machine is not yet connected to the patient. One of the five rotating pumps circulates the blood, and the rest are used as side pumps to transport the separated blood to prevent blood loss during surgery. The patient must be given heparin, a drug that thins the blood and prevents the formation of clots as it passes through plastic tubes.

Tubes for the heart-lung machine. On the left - with bright red blood - is the arterial return line, along which blood is flowing back into the patient's aorta. On the right are two tubes that drain blood from the inferior and superior vena cava under the influence of gravity. The incision in the sternum is secured with a spacer.

Part of the heart-lung machine is a membrane oxygenating device that maintains blood circulation in the patient's body. IN this moment the device is filled with blood, carbon dioxide is removed from it. The blood is re-oxygenated and returned to the patient's body.

An arterial return tube is inserted into the aorta (the main artery of the body) and two venous drains are inserted into the vena cava (the main vein of the body).

9:25 Cardiac arrest

A clamp is placed on the main artery, the aorta, isolating the heart from artificial blood circulation. A cooled fluid is injected into the isolated aorta to stop the heart. The surgeon puts on special glasses for microsurgery with loupes that provide 2.5 times magnification. The blood vessels he will transplant have a diameter of 2-3 mm, and the sutures are the diameter of a human hair.

A thorough check of the heart is performed to confirm the findings from the angiogram. It is clarified which coronary arteries need to be bypassed. It was decided to make two shunts.

After stopping the blood flow in the left anterior descending artery, a 1 cm incision is made using a surgical loop at the bypass site.

10:00 First bypass

Close-up of a heart. The left internal mammary artery - in the upper left corner - is sutured to the left anterior descending artery so that blood flow to the heart is restored. The arteries are hidden by epicardial fat.

The end of the left internal mammary artery is sutured laterally to the left anterior descending artery. This creates the first bypass shunt.

Position of the first shunt performed. The lower end of the left internal mammary artery, a 3 mm blood vessel, is completely sutured to the left anterior descending artery.

10:22 Second bypass

The second bypass shunt is sewn with its upper end to the aorta, and its lower end to the right posterior descending artery. The cross clamp is removed and blood flow through the heart is restored.

The upper end of the venous shunt connects to the aorta. Part of the aorta is isolated with an arcuate clamp, and a hole is made into which the vein is sutured.

End of both bypass processes. The second shunt, shown on the left side of the diagram, is formed from the saphenous vein of the leg.

11:18 Closing the chest

Blood circulation is restored, the heart contracts after the electric shock with a transition from ventricular fibrillation to sinus mode. Two drains are installed in the front and back parts hearts. The blood thinning effect of heparin was eliminated by the drug protamine. The surgeon stitches the separated halves of the sternum. He will close the skin with an internal absorbable suture.

The nurse places tape on the stitch and on the drainage tubes leading from the patient's chest. The patient will soon be admitted to the ward intensive care where it will be observed.

The human body. Outside and inside. №1 2008

May God grant everyone to live long life so that his heart would never be touched by a surgeon’s scalpel. However, cardiac surgery cannot always be replaced by therapy.

In what cases is surgery necessary?

When conservative therapy does not give the desired result.
When, despite all the treatment, the patient’s condition continues to deteriorate.
When severe congenital heart defects, severe arrhythmia, cardiomyopathy are present.

By urgency cardio surgical operations There are emergency and planned.

Emergency calls 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 delays in surgery when the heart is wounded. The consequences of delay are severe.
Planned ones are carried out in accordance with the developed plan for correcting 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 drops.

Surgical interventions vary in technique. There are the following types of heart surgeries:

with opening of the chest;
without opening the chest.

Operation on open heart

Operations with opening of the chest

This surgery used in especially severe cases when complete accessibility of the heart is required during surgery.

The chest is opened for the following pathologies:

tetralogy of Fallot (the so-called congenital heart defect with four serious anatomical disorders);
serious anomalies of intracardiac septa, valves, aorta and coronary arteries;
heart tumors.

The patient arrives at the hospital one day before the operation. He undergoes an examination and gives written consent. I'll definitely have to wash myself antibacterial soap and shave your hair. Where is body hair shaved? The hair will be shaved at the site of the intended incision. If you have coronary artery bypass surgery, you will have to shave your legs and groin. In case of replacement heart valve It is necessary to shave the hair in the lower abdomen and groin area.

Surgical intervention 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 device, the heart is stopped for a while and surgical manipulations are performed on the organ.

How long the operation lasts depends on the severity of the pathology. On average - several hours.

Tetralogy of Fallot

Open heart surgery has two advantages.

The surgeon has full access to the patient's heart.
Such surgery is possible without state-of-the-art medical equipment.

However, there are also significant drawbacks.

Surgical manipulations with the heart last several hours, which leads to fatigue of the operating team, and during the operation there is a higher probability of making an erroneous action.
Opening the chest is fraught with various injuries.
A noticeable scar remains after heart surgery.
Various complications cannot be excluded:

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

Long-term recovery with significant restrictions in the patient's activities is required.

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

What operations and for what pathologies are performed on an open heart?

Pathologies of the coronary arteries

Coronary artery bypass surgery is performed in case of serious damage to the coronary arteries by atherosclerosis, leading to severe coronary heart disease. The essence of bypass surgery is to create a bypass path 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 (MCBG) is performed using the internal mammary artery.

Operation Ross

Heart valve defects

Nowadays, to replace damaged valves, valves made from biological material patient.

Ross's operation involves the use of its own pulmonary artery a patient with a valve apparatus to replace a pathologically altered aortic valve. An implant is installed instead of the pulmonary valve. Eliminates complications associated with rejection of a valve made of foreign material. It is done for both adults and children.
The Ozaki procedure involves using the patient's own tissue. Only in this case, the aortic valve is replaced with a valve made from the patient's pericardium. Complications with valve rejection are not observed for the same reason.

Let's try to lift the veil of secrecy about their work and find out what types of heart operations exist and are performed today. Is it possible to perform heart surgery without opening the chest?

When the heart is in the palm of your hand or open surgery

Open heart surgery is so called because the heart surgeon “opens” the patient’s chest, cuts the sternum and that’s it. soft fabrics, performs an opening of the chest. Such interventions are usually performed with the connection of a heart-lung machine (hereinafter referred to as the artificial blood circulation machine), which is a temporary replacement for the heart and lungs of the person undergoing surgery. This device is a complex device of quite impressive size that continues to pump blood throughout the body when the patient’s heart is artificially stopped.

With AIC, open-heart surgery can be extended over many hours if necessary. Open operations are used when replacing valves, coronary artery bypass grafting can also be performed in this way, many heart defects are eliminated by performing open interventions. It should be noted that AIK is not always used when conducting them.

The body cannot always tolerate the intervention of a foreign cardiac substitute: the use of an artificial cardiac circuit is fraught with complications such as renal failure, disturbance of cerebral blood flow, inflammatory processes, blood rheology disorders. Therefore, some open-heart operations are performed under operating conditions, without connecting the artificial blood pressure pump.

Such interventions on a beating heart include coronary artery bypass surgery; during this operation on a beating heart, the area of the 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 of age, patients with a large arsenal of chronic diseases, patients with diabetes mellitus than operations on an organ that is switched off from the blood circulation.

But all the pros and cons are, of course, determined by the cardiac surgeon. Only the doctor decides to leave the heart beating or stop it temporarily. Open operations are the most traumatic, having a higher percentage of complications after surgery on chest the patient is left with a scar. But sometimes only such an operation can save a person’s life, improve his health, and return him to a full, happy life.

Intact heart or closed operations

If during the surgical intervention the sternum, heart chambers and the heart muscle itself were not opened, then these are closed heart operations. When performing such operations, the surgical scalpel does not touch the heart, and the surgeon’s work consists of surgical treatment of large vessels, cardiac arteries and the aorta, and the chest is not opened, only a small incision is made on the chest.

In this way, a pacemaker can be installed, heart valve correction, balloon angioplasty, bypass surgery, and vascular stenting can be performed. Closed operations less traumatic, have a lower percentage of complications in contrast to open ones. Closed vascular surgery can often be the first step before subsequent cardiac surgery.

Indications for their implementation are always determined by the doctor.

Achievements of modern cardiac surgery or minimally invasive operations

Cardiac surgery is confidently moving forward, and an indicator of this is the increasing percentage of low-traumatic, high-tech manipulations that make it possible to get rid of the pathology of the heart and blood vessels with minimal intervention and impact on human body. What are minimally invasive interventions? These are surgical operations carried out by introducing instruments or special devices through mini-accesses - 3-4 centimeter incisions, or without incisions at all: when performing endoscopic operations the 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 defects, prosthetic heart valves, all operations on blood vessels (from removing a blood clot to expanding the lumen) - all these interventions can be performed using minimally invasive technologies. on them in modern cardiac surgery emphasis is placed on the fact that the low risk of complications and minimal impact on the body are huge advantages that patients can appreciate literally on the operating table.

Anesthesia is not required during endoscopic procedures; it is enough to numb the puncture site. Recovery after heart surgery performed using minimally invasive techniques is tens of times faster. Such methods are also irreplaceable in diagnostics - coronary angiography, a method for studying the vessels of the heart by introducing contrast and subsequent X-ray control. In parallel with diagnostics, according to indications, the cardiac surgeon can also perform therapeutic manipulations on blood vessels - installation of a stent, balloon dilatation in a narrowed vessel.

And diagnosis and treatment by puncture on femoral artery? Isn't this a miracle? Such miracles are becoming routine for cardiac surgeons. The contribution of endovascular treatment methods is also invaluable in cases where the threat to the patient’s life is especially acute and minutes count. These are situations of acute coronary syndrome, thromboembolism, aneurysm. In many cases, the presence necessary equipment and qualified personnel, allows you to save the lives of patients.

When is surgery indicated?

Deciding whether surgery is indicated, as well as deciding on the type of surgical intervention on the heart and blood vessels, is the job of an experienced cardiac surgeon or a council of doctors. The doctor can make a conclusion after a thorough examination, familiarization with the history of the development of the disease, and observation of the patient. The doctor must know very well the ins and outs of the disease: how long the patient has been suffering from cardiac pathology, what medications he is taking, what chronic diseases has when he felt worse... Having assessed all the pros and cons, the doctor makes his verdict: to have surgery or not. If the situation develops according to the scheme described above, 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 due to treatment with tablets and injections;
severe arrhythmias, angina pectoris, cardiomyopathies, congenital and acquired heart defects requiring correction.

But there are situations when there is no time for thinking, questioning and analyzing the medical history. We are talking about life-threatening conditions - a blood clot has broken off, an aneurysm has dissected, or a heart attack has occurred. When time ticks down to minutes, emergency cardiac surgery is performed. Stenting, coronary artery bypass surgery, thrombectomy of the coronary arteries, and radiofrequency ablation can be performed urgently.

Let's look at the most common types of heart surgery

CABG - coronary artery bypass grafting is “heard of” by 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 pathways for blood flow through the vessels of the heart, restoring normal blood supply to the myocardium, which ensures a better supply of oxygen to the heart muscle.
RFA - radiofrequency ablation. This type of surgical intervention is used to eliminate persistent rhythm disturbances when drug therapy turns out to be 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, supplying 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 allowed to get up.
Prosthetic or plastic surgery of heart valves. Prosthetics means complete valve replacement; the prosthesis can be mechanical or biological. And plastic surgery 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.
Installation of a pacemaker. Heart rhythm disturbances and severe bradycardia may be indications for installation, which, thanks to modern technologies, can also be performed endoscopically.

Cardiac surgery is a branch of medicine dedicated to surgical treatment hearts. For pathologies of cardio-vascular system such intervention is a last resort. 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 full life.

Indications for operations

Invasive cardiac interventions are complex and risky work; it requires skill and experience, and the patient – preparation and implementation of recommendations. Because such operations involve risks, they are performed only when absolutely necessary. In most cases, they try to rehabilitate the patient with the help of medications and medical procedures. But in cases where such methods do not help, heart surgery is needed. The surgery is performed in a hospital setting and in complete sterility, the patient being operated on is under anesthesia and under the control of the surgical team.

Such interventions are needed when congenital defects hearts or acquired. The first include pathologies in the anatomy of the organ: defects of the valves, ventricles, impaired blood circulation. Most often they are discovered during pregnancy. Heart defect It is also diagnosed in newborns; often such pathologies need to be eliminated urgently in order to save the baby’s life. Among acquired diseases, coronary disease is the leader; in this case, surgery is considered the most effective method treatment. Also in the heart area there are: impaired blood circulation, stenosis or valve insufficiency, heart attack, pericardial pathologies and others.

Heart surgery is prescribed in situations where conservative treatment does not help the patient, the disease progresses quickly and threatens life, in case of pathologies that require urgent and immediate correction, and in advanced forms of the disease, a late visit to the doctor.

The decision to prescribe an 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 risks, in this case they talk about elective surgery. If needed emergency help, for example, when a blood clot breaks off or an aneurysm dissects, minimal diagnostics are performed. Anyway surgically the function of the heart is restored, its parts are rehabilitated, blood flow and rhythm are normalized. IN difficult situations, the organ or its parts can no longer be corrected, then prosthetics or transplantation are prescribed.

Classification of heart operations

There can be dozens of different diseases in the area of the heart muscle, these are: failure, narrowing of the lumens, 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 person being operated on is not opened, and the heart itself is also not touched by the surgeon. That’s why 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: bypass surgery, balloon angioplasty, stenting of blood vessels. All these manipulations are designed to restore blood circulation, sometimes they are prescribed to prepare for future open surgery.
Open – carried out after opening the sternum and sawing the bones. The heart itself can also be opened during such manipulations to get to problem area. Typically, the heart and lungs must be stopped for such operations. To do this, they connect the artificial blood circulation machine - AIK, it compensates for the work of the “disabled” organs. This allows the surgeon to carry out the work carefully, and the procedure under AI control takes longer, which is necessary when eliminating complex pathologies. During open operations, the AIC may not be connected, but only the desired zone of the heart is stopped, for example, when coronary artery bypass grafting. Opening the chest is necessary to replace valves, prosthetics, and eliminate tumors.
X-ray surgery - similar to closed type operations. The essence of this method is that the doctor blood vessels moves a thin catheter and gets to the very heart. The chest is not opened; the catheter is placed in the thigh or shoulder. A contrast agent is supplied through the catheter, which stains the vessels. The catheter is advanced under X-ray control, and 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 normal patency of the vessel.

The safest are minimally invasive methods, that is, x-ray surgery and closed type operations. With such work there is the least risk of complications, the patient recovers faster after them, but they cannot always help the patient. To avoid complex operations possible with periodic inspection. The earlier the problem is identified, the easier it is for the doctor to solve it.

Depending on the patient’s condition, there are:

Planned surgery. It is carried out after a detailed examination, within a specified time frame. Planned intervention is prescribed when the pathology does not pose any particular danger, but it cannot be postponed.
Emergency are operations that need to be done in the next few days. During this time, the patient is prepared and all the necessary studies are carried out. The date is set immediately after receiving the necessary data.
Emergency. If the patient is already in in serious condition, at any moment the situation can worsen - surgery is prescribed immediately. Before it, only the most important examinations and preparations are carried out.

In addition, surgical assistance can be radical or auxiliary. The first implies complete elimination of the problem, the second - elimination of only part of the disease, improving the patient’s well-being. For example, if a patient has a pathology mitral valve and stenosis of a vessel, first the vessel is restored (auxiliary), and after some time valve plastic surgery is prescribed (radical).

How the operations are done

The course and duration of the operation depends on the pathology being treated, the patient’s condition, and the presence of concomitant diseases. The procedure may take half an hour or may take 8 hours or more. Most often, such interventions last 3 hours, take place under general anesthesia and control of an artificial cardiologist. First, the patient is prescribed a chest ultrasound, urine and blood tests, an ECG, and consultation with specialists. After receiving all the data, the degree and location of the pathology is determined, and it is decided whether there will be an operation.

As part of the preparation, a diet with low content, fatty, spicy and fried. 6-8 hours before the procedure, it is recommended to refuse food and drink less. In the operating room, the doctor assesses the patient’s well-being and puts the patient into medical sleep. For minimally invasive interventions, local anesthesia is sufficient, for example during X-ray surgery. When the anesthesia or anesthesia takes effect, the main actions begin.

Heart valve surgery

The heart muscle has four valves, 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 when the valves are insufficiently widened, and blood flows poorly from one section to another. Valve insufficiency is a poor closure of the valves of the passage, and there is an outflow of blood back.

The plastic surgery is performed openly or closed; during the operation, special rings or sutures are applied manually along the diameter of the valve, which restore normal lumen and narrowing of the passage. Manipulations last on average 3 hours; for open types, an AIK 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, the original valves are replaced with artificial or biological implants.

Elimination of heart defects

In most cases, defects are congenital, the reason for this may be hereditary pathologies, bad habits parents, infections and fever during pregnancy. At the same time, children may have different anatomical abnormalities in the heart area; often such anomalies are poorly compatible with life. The urgency and type of surgery depend on the child’s condition, 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 older ages, heart defects develop due to atrial septal defects. This happens when mechanical damage chest, infectious diseases, due to concomitant heart disease. To eliminate this problem, open surgery is also needed, often with artificial cardiac arrest.

During the manipulations, the surgeon can “patch” the septum using a patch, or sutured the defective part.

Bypass surgery

Coronary artery disease (IHD) is a very common pathology that mainly affects the generation over 50 years of age. Appears due to impaired blood flow in the coronary artery, which leads to oxygen starvation myocardium. There is a chronic form, in which the patient constant attacks angina, and acute – myocardial infarction. They try to eliminate chronic ones conservatively or using minimally invasive techniques. Acute requires urgent intervention.

To prevent complications or alleviate the disease, use:

coronary artery bypass grafting;
balloon angioplasty;
transmyocardial laser revascularization;
coronary artery stenting.

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 heart attack is reduced, and angina is eliminated.

If it is necessary to restore normal patency, angioplasty or stenting is sufficient, 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 surgical intervention the patient remains in the hospital for another 1-3 weeks, during which time doctors will evaluate 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; during this time it is very important to follow all the doctor’s recommendations: diet, a calm and measured lifestyle. Nicotine, alcohol, junk food and physical exercise prohibited regardless of the type of intervention.

The doctor's recommendations must also contain a warning about dangers and complications. Upon discharge, the doctor will set a date for the next appointment, but you need to seek help unscheduled if the following symptoms occur:

sudden fever;
redness and swelling at the incision site;
discharge from the wound;
constant chest pain;
frequent dizziness;
nausea, bloating and stool disorders;
difficulty breathing.

During routine examinations, the cardiologist will listen to your heartbeat, measure your blood pressure, and listen to your complaints. To check the effectiveness of the operation, ultrasound is prescribed, CT scan, X-ray studies. Such visits are scheduled once a month for six months, then the doctor will see you once every 6 months.

Often except surgical care prescribe medications. For example, when replacing valves with artificial implants, the patient takes anticoagulants for life.

In the postoperative period, it is important not to self-medicate, since the interaction of permanent medications and other medications can give a negative result. Even regular painkillers need to be discussed with. To keep in shape and restore health faster, it is recommended to visit more often fresh air, to walk.

Life after heart surgery will gradually return to normal; full recovery is predicted within a year.

Cardiac surgery offers a variety of methods for cardiac rehabilitation. Such operations are designed to restore physical and moral strength to the patient. There is no need to be afraid or avoid such procedures; on the contrary, the sooner they are carried out, the greater the chances of success.

Open heart surgery is one of the treatment options cardiovascular diseases, in which special surgical procedures are performed. General principle boils down to the fact that there is an intervention in the human body for the purpose of carrying out necessary measures on an open heart. In other words, this is an operation during which an opening or dissection of the human sternum area is performed, affecting the tissues of the organ itself and its vessels.

Open heart surgery

Statistics say that the most common intervention of this type among adults is an operation that creates artificial blood flow from the aorta to healthy areas coronary arteries– coronary artery bypass grafting.

This operation is performed to treat severe coronary heart disease, which occurs due to the development of atherosclerosis, in which the vessels supplying blood to the myocardium narrow and their elasticity decreases.

The general principle of the operation: the patient’s own biomaterial (a fragment of an artery or vein) is taken and sewn into the area between the aorta and coronary vessel to bypass the area 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 it flows pathological process, costs.

Coronary artery bypass grafting

Today, taking into account progress in medicine, to carry out surgical treatment on the heart it is enough to make only small incisions in the appropriate area. Another intervention, more complex, will not be needed. Therefore, the concept of “open heart surgery” sometimes misleads people.

Reasons for prescribing 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 restore defective areas in the heart (for example, valves).
The need to place special medical devices to maintain heart function.
The need for transplantation operations.

What do you need to know about coronary artery bypass surgery?

Time spending

According to medical data, this type of operation takes at least four and no more than six hours. In rare, especially severe cases, when the operation requires a larger volume of work (creation of several shunts), an increase in this period may be observed.

The first night after heart surgery and all medical manipulations 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.

Dangers during surgery

Despite the qualifications of doctors, no one is immune from unplanned situations. What is the danger of surgical intervention, and what risk can it carry:

infection of the chest due to the incision (this risk is especially high for people who are obese, have diabetes, or are undergoing repeated surgery);
myocardial infarction, ischemic stroke;
heart rhythm disturbances;
thromboembolism;
increased body temperature for a long time;
cardiac discomfort of any nature;
pain of various nature in the chest area;
pulmonary edema;
short-term amnesia and other transient memory problems;
loss of a significant amount of blood.

Data Negative consequences, as statistics show, occur much more often when using an artificial blood supply apparatus.

Risk unpleasant consequences always present

Preparation period

In order for the planned operation and general treatment were successful, it is important not to miss anything significant before they begin. To do this, the patient must tell the doctor:

ABOUT medicines that are currently in use. These may include medications prescribed by another doctor, or those that the patient purchases himself, including dietary supplements, vitamins, etc. This important information, and it must be announced before surgery.
About all chronic and past diseases, health problems that currently exist (runny nose, herpes on the lips, upset stomach, elevated temperature, sore throat, hesitation blood pressure and etc.).

The patient should be prepared for the fact that two weeks before the operation the doctor will ask him to refrain from smoking, overuse alcohol, drinking vasoconstrictor drugs(for example, nasal drops, ibuprofen, etc.).

On the day of the operation, the patient will be asked to use a special bactericidal soap, which significantly reduces the risk of infection during the procedure. In addition, several hours before the intervention you should not eat or drink water.

Carrying out the operation

When open heart surgery is performed, the following steps are performed sequentially:

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 centimeters in length).
The doctor cuts 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 in some cases make it possible to perform this operation without stopping the heartbeat, while the number of complications is lower. than with traditional intervention.
The doctor creates a shunt to bypass the damaged section of the artery.
The cut part of the chest is secured with a special material, most often a special wire, but in some cases plates are used. These plates are often used for elderly people or for people who have undergone frequent surgical operations.
After the surgery is performed, the incision is sutured.

Postoperative period

After the operation is completed and the patient awakens, 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 to allow therapeutic and nutritional solutions to enter the body and a catheter into bladder to remove urine. In addition to tubes, devices are connected to the patient to monitor heart function.

The patient should not worry; in case of questions or discomfort, he can always contact medical workers, which 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

Every 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 every patient is able to speed up this rehabilitation process, while avoiding new heart diseases, which reduces the risk of reoperation. To do this, it is recommended to take the following measures:

follow a diet and special diet prescribed by the attending physician;
limit salty, fatty, sweet foods);
spend time physical therapy, walks in the fresh air;
stop frequent drinking of alcohol;
monitor blood cholesterol levels;
monitor blood pressure.

If these measures are followed, the postoperative period will pass quickly and without complications. But don't rely on general recommendations, much more valuable is the advice of your attending physician, who has studied the medical history in detail and is able to draw up an action plan and diet for recovery period.