What is the name of the operation on the heart? How is heart surgery performed? Course of open heart surgery
How are operations performed?
An operation is an intervention in the human body with a violation of its integrity. Each disease requires an individual approach, which naturally affects the way the operation is performed.
How heart surgery is done: preparation for surgery
Heart surgery (cardiac surgery) is one of the most difficult to perform, dangerous and responsible type of surgical intervention.
Planned operations are usually carried out in the morning. Therefore, the patient is not allowed to eat or drink in the evening (for 8-10 hours), and immediately before the operation, a cleansing enema is made. This is necessary in order for the anesthesia to work as it should. 
The place where operations are performed must be sterile. In medical institutions, special rooms are used for these purposes - operating rooms, which are regularly sterilized by quartz treatment and special antiseptics. In addition, all medical personnel who take part in the operation wash themselves before the procedure (you even have to rinse your mouth with an antiseptic solution), and also change into special sterile clothes, put on sterile gloves on your hands.
The patient is also put on shoe covers, a cap on his head, and the operation field is treated with an antiseptic. If necessary, before the operation, the patient's hair is shaved if the surgical field is covered with it. All these manipulations are necessary to avoid infection of the surgical wound with bacteria or other dangerous active microorganisms.
Narcosis or anesthesia
Anesthesia is a general anesthesia of the body with its immersion in drug-induced sleep. 
During surgical interventions on the heart, general anesthesia is used, and in some cases, during endovideosurgical operations, spinal anesthesia, in which a puncture is made into the spinal cord at the level of the lower back. Substances that cause pain relief can be administered in various ways - intravenously, through the respiratory tract (inhalation anesthesia), intramuscularly or in combination.
Course of open heart surgery
After the person goes into medical sleep and ceases to feel pain, the operation itself begins. The surgeon uses a scalpel to open the skin and soft tissues on the chest. Cardiac surgery may also require an “opening” of the chest. To do this, with the help of special surgical instruments, the ribs are sawn. Thus, doctors “get” to the operated organ and put special dilators on the wound, which provide better access to the heart. Junior medical staff, using suction, removes blood from the surgical field, and also cauterizes cut capillaries and blood vessels so that they do not bleed. 
If necessary, the patient is connected to an artificial heart machine, which will temporarily pump blood through the body, while the operated organ is artificially suspended. Depending on what kind of heart surgery is performed (what kind of damage is eliminated), appropriate manipulations are carried out: it can be the replacement of blocked coronary arteries, the replacement of heart valves in case of defects, vein bypass surgery or the replacement of an entire organ.
Extreme care is required from the surgeon and all staff, as the life of the patient depends on it. It should also be added that during the operation, blood pressure and some other indicators are constantly monitored, which indicate the patient's condition.
Endovideosurgery: stenosis and angioplasty
Today, more and more often, heart surgery is performed not by an open method - with a chest incision, but with access through the femoral artery on the leg, under the control of an X-ray machine and a microscopic video camera. After preparing for 
operation, which is similar for all types of surgical interventions, and putting the patient into a medical sleep, access to the femoral artery is opened through an incision in the leg. A catheter and a probe with a video camera at the end are inserted into it, thanks to which access to the heart is provided.
In this way, angioplasty with stenosis of blood vessels is carried out in cardiac surgery, which is necessary for blockage of the coronary vessels that feed the heart itself with blood. Special stands are installed in the narrowed vessels - cylindrical implants that do not allow the arteries to clog anymore, which prevents the possibility of developing coronary disease.
After the main part of the operation is over and the heart is on its own again 
functions, stitching of damaged nerves, vessels and tissues is performed. The wound is again treated with an antiseptic, the surgical field is closed, soft tissues and skin are sutured with special threads. A medical bandage is applied to the external wound. After the end of all these procedures, the patient is taken out of anesthesia.
Other types of transactions
In addition to the abdominal operations described above, there are also operations performed in a less traumatic way:
- Laparoscopy - is performed using a laparoscope, which is inserted through 1-2 cm incisions in the skin. Most often used in gynecology, gastrectomy and other operations in the abdominal cavity. You can read more about this
- Laser surgery - is carried out using a special laser beam. Usually, operations are performed in this way on the eyes, when removing skin formations, etc. You can read more about the method
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.
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.
Heart valve replacement has been carried out everywhere for many years and has proven to be a safe and very effective operation to restore normal hemodynamics in the heart and the body as a whole.
Throughout life, valves are in constant operation, opening and closing billions of times. By old age, some wear of their tissues may occur, but its degree does not reach critical. Much more damage to the state of the valvular apparatus is caused by various diseases - atherosclerosis, rheumatic endocarditis, bacterial damage to the valves.
age-related changes in the aortic valve
Valvular lesions are most common among the elderly, the cause of which is atherosclerosis, accompanied by deposition of fat-protein masses in the valves, their compaction, calcification. The continuously recurrent nature of the pathology causes periods of exacerbations with damage to the valve tissues, microthrombosis, ulceration, which are replaced by remission and sclerosis. The proliferation of connective tissue ultimately leads to deformation, shortening, compaction and reduced mobility of the valve leaflets - a defect is formed.
Among young patients in need of artificial valve transplantation, mostly patients rheumatism. The infectious-inflammatory process on the valves is accompanied by ulceration, local thrombosis (warty endocarditis), necrosis of the connective tissue that forms the basis of the valve. As a result of irreversible sclerosis, the valve changes its anatomical configuration and becomes unable to perform its function.
Defects of the valvular apparatus of the heart lead to a total violation of hemodynamics in one or both circles of blood circulation at once. With the narrowing of these openings (stenosis), there is no complete emptying of the cavities of the heart, which are forced to work in an enhanced mode, hypertrophying, then depleting and expanding. In case of valve insufficiency, when its valves do not close completely, part of the blood returns in the opposite direction and also overloads the myocardium.
An increase in heart failure, stagnation in a large or small circle of blood flow provoke secondary changes in the internal organs, and are also dangerous for acute heart failure, therefore, if measures are not taken in time to normalize intracardiac blood flow, the patient will be doomed to death from decompensated heart failure.
The traditional valve replacement technique involves open access to the heart and its temporary shutdown from circulation. Today, more gentle, minimally invasive methods of surgical correction are widely used in cardiac surgery, which are less risky and as effective as open surgery.
Modern medicine offers not only alternative methods of operations, but also more modern designs of the valves themselves, and also guarantees their safety, durability and full compliance with the requirements of the patient's body.
Heart surgeries, no matter how they are performed, carry certain risks, are technically complex and require the participation of highly qualified cardiac surgeons working in a well-equipped operating room, so they are not performed just like that. With heart disease, for some time, the organ itself copes with the increased load, as its functional abilities are weakened, drug therapy is prescribed, and only if conservative measures are ineffective, the need for surgery arises. Indications for prosthetic heart valves are:
- Severe stenosis (narrowing) of the valve opening, which cannot be eliminated by simple dissection of the valves;
- Stenosis or insufficiency of the valve due to sclerosis, fibrosis, calcium salt deposits, ulceration, shortening of the valves, their wrinkling, limitation of mobility for the above reasons;
- Sclerosis of the tendon chords, disrupting the movement of the valves.
Thus, the reason for surgical correction is any irreversible structural change in the components of the valve, which makes the correct unidirectional blood flow impossible.
There are also contraindications for heart valve replacement surgery. Among them are the serious condition of the patient, the pathology of other internal organs, making the operation dangerous for the life of the patient, severe blood clotting disorders. An obstacle to surgical treatment may be the patient's refusal to operate, as well as the neglect of the defect, when intervention is inappropriate.
The mitral and aortic valves are most often replaced, they are also usually affected by atherosclerosis, rheumatism, and a bacterial inflammatory process.
Depending on the composition, the heart valve prosthesis is mechanical and biological. Mechanical valves made entirely of synthetic materials, they are metal structures with semicircular doors moving in one direction.
The advantages of mechanical valves are their strength, durability and wear resistance, the disadvantages are the need for lifelong anticoagulant therapy and the possibility of implantation only with open access to the heart.
biological valves consist of animal tissues - elements of the pericardium of a bull, valves of pigs, which are fixed on a synthetic ring that is installed in the place where the heart valve is attached. Animal tissues in the manufacture of biological prostheses are treated with special compounds that prevent immune rejection after implantation.
The advantages of a biological artificial valve are the possibility of implantation during endovascular intervention, the limitation of the period of taking anticoagulants within three months. Rapid wear is considered a significant drawback, especially if the mitral valve is replaced with such a prosthesis. On average, a biological valve works for about 12-15 years.
The aortic valve is easier to replace with any type of prosthesis than the mitral valve, therefore, when the mitral valve is damaged, different types of plasty (commissurotomy) are first resorted to, and only if they are ineffective or impossible, the possibility of a total valve replacement is decided.
Preparing for valve replacement surgery
Preparation for surgery begins with a thorough examination, including:
- General and biochemical blood tests;
- Urinalysis;
- Determination of blood clotting;
- electrocardiography;
- Ultrasound examination of the heart;
- Chest X-ray.
Depending on the accompanying changes, the list of diagnostic procedures may include coronary angiography, vascular ultrasound, and others. Mandatory consultations of narrow specialists, conclusions of a cardiologist and therapist.
On the eve of the operation, the patient talks with the surgeon, the anesthetist, takes a shower, dinner - no later than 8 hours before the start of the intervention. It is advisable to calm down and get enough sleep, many patients are helped by talking with the attending physician, clarifying all questions of interest, knowing the technique of the upcoming operation and getting to know the staff.
Technique for heart valve replacement surgery
Heart valve replacement can be performed through open access and in a minimally invasive way without incision of the sternum. Open operation performed under general anesthesia. After immersing the patient in anesthesia, the surgeon treats the operating field - the anterior surface of the chest, dissects the sternum in the longitudinal direction, opens the pericardial cavity, followed by manipulations on the heart.
prosthetic heart valve
To disconnect the organ from the blood flow, a heart-lung machine is used, which allows implanting valves on a non-working heart. In order to prevent hypoxic damage to the myocardium, it is treated with cold saline throughout the operation.
To install the prosthesis, the necessary cavity of the heart is opened using a longitudinal incision, the altered structures of its own valve are removed, an artificial valve is installed in its place, after which the myocardium is sutured. The heart is “started” with an electrical impulse or with direct massage, artificial circulation is turned off.
After the artificial heart valve is installed and the heart is sutured, the surgeon examines the cavity of the pericardium and pleura, removes blood and sutures the surgical wound in layers. To connect the halves of the sternum, metal brackets, wire, screws can be used. Ordinary sutures or cosmetic intradermal sutures with self-absorbable threads are applied to the skin.
Open surgery is very traumatic, so the operational risk is high, and postoperative recovery takes a long time.
endovascular aortic valve replacement
Endovascular technique valve replacement shows very good results, it does not require general anesthesia, so it is quite feasible for patients with severe comorbidities. The absence of a large incision allows you to minimize the stay in the hospital and subsequent rehabilitation. An important advantage of endovascular prosthetics is the possibility of performing surgery on a beating heart without the use of a heart-lung machine.
With endovascular prosthetics, a catheter with an implantable valve is inserted into the femoral vessels (artery or vein, depending on which cavity of the heart needs to be penetrated). After the destruction and removal of fragments of your own damaged valve, a prosthesis is installed in its place, which straightens itself thanks to a flexible stent-frame.
After installing the valve, stenting of the coronary vessels can also be performed. This possibility is very relevant for patients in whom both valves and vessels are affected by atherosclerosis, and in the process of one manipulation two problems can be solved at once.
The third option for prosthetics is from a mini-access. This method is also minimally invasive, but an incision of about 2-2.5 cm is made on the anterior chest wall in the projection of the apex of the heart, a catheter is inserted through it and the apex of the organ to the affected valve. Otherwise, the technique is similar to that for endovascular prosthetics.
Heart valve transplantation is in many cases an alternative to heart valve transplantation, which can significantly improve well-being and increase life expectancy. The choice of one of the listed methods of operation and the type of prosthesis depends both on the patient's condition and on the technical capabilities of the clinic.
Open surgery is the most dangerous, and endovascular technique is the most expensive, but, having significant advantages, it is the most preferable for both young and elderly patients. Even if there are no specialists and conditions for endovascular treatment in a particular city, but the patient has the financial opportunity to go to another clinic, then it should be used.
If aortic valve replacement is required, mini-access and endovascular surgery are preferred, while mitral valve replacement is more often performed by an open method due to its location inside the heart.
Postoperative period and rehabilitation
The operation to replace the heart valve is very painstaking and time-consuming, it lasts at least two hours. After its completion, the operated person is placed in the intensive care unit for further observation. After a day and with a favorable condition, the patient is transferred to a regular ward.
After an open operation, the sutures are processed daily, they are removed on the 7-10th day. All this period requires a stay in the hospital. With endovascular surgery, you can go home already for 3-4 days. Most patients note a rapid improvement in well-being, a surge of strength and energy, ease in performing ordinary household activities - eating, drinking, walking, showering, which previously provoked shortness of breath and severe fatigue.
If during prosthetics there was an incision in the sternum, then the pain can be felt for quite a long time - up to several weeks. With strong discomfort, you can take an analgesic, but if swelling, redness progresses in the area of \u200b\u200bthe seam, pathological discharge appears, then you should not hesitate to visit the doctor.
The rehabilitation period takes on average about six months, during which the patient regains strength, physical activity, gets used to taking certain medications (anticoagulants) and regular monitoring of blood clotting. It is strictly forbidden to cancel, independently prescribe or change the dosage of drugs; this should be done by a cardiologist or therapist.
Drug therapy after valve replacement includes:
- Anticoagulants (warfarin, clopidogrel) - for life with mechanical prostheses and up to three months with biological ones under constant coagulation monitoring (INR);
- Antibiotics for rheumatic malformations and the risk of infectious complications;
- Treatment of concomitant angina pectoris, arrhythmias, hypertension, etc. - beta-blockers, calcium antagonists, ACE inhibitors, diuretics (most of them are already well known to the patient, and he simply continues to take them).
Anticoagulants with an implanted mechanical valve make it possible to avoid thrombosis and embolism, which are provoked by a foreign body in the heart, but there is also a side effect of taking them - the risk of bleeding, stroke, therefore regular monitoring of INR (2.5-3.5) is an indispensable condition for life with a prosthesis.
Among the consequences of artificial heart valve transplantation, the most dangerous are thromboembolism, which is prevented by taking anticoagulants, as well as bacterial endocarditis - inflammation of the inner layer of the heart, when antibiotics are required.
At the rehabilitation stage, some disturbances in well-being are possible, which usually disappear after a few months - six months. These include depression and emotional lability, insomnia, temporary visual disturbances, discomfort in the chest and the area of the postoperative suture.
Life after the operation, subject to successful recovery, is no different from that of other people: the valve works well, the heart too, there are no signs of its insufficiency. However, the presence of a prosthesis in the heart will require changes in lifestyle, habits, regular visits to the cardiologist and control of hemostasis.
The first control examination by a cardiologist is carried out about a month after prosthetics. At the same time, blood and urine tests are taken, an ECG is taken. If the patient's condition is good, then in the future the doctor should be visited once a year, in other cases - more often, depending on the patient's condition. If you need to undergo other types of treatment or examinations, you should always warn in advance about the presence of a prosthetic valve.
Lifestyle after valve replacement requires giving up bad habits. First of all, you should stop smoking, and it is better to do this even before the operation. The diet does not dictate significant restrictions, but it is better to reduce the amount of salt and liquid consumed so as not to increase the load on the heart. In addition, the proportion of foods containing calcium should be reduced, as well as the amount of animal fats, fried foods, smoked meats in favor of vegetables, lean meats and fish.
High-quality rehabilitation after heart valve prosthetics is impossible without adequate physical activity. Exercise helps to increase overall tone and train the cardiovascular system. In the first weeks, do not be too zealous. It is better to start with feasible exercises that will serve as a prevention of complications without overloading the heart. Gradually, the volume of loads can be increased.
So that physical activity does not go to the detriment, experts recommend undergoing rehabilitation in sanatoriums, where exercise therapy instructors will help create an individual physical education program. If this is not possible, then all questions regarding sports activities will be clarified by a cardiologist at the place of residence.
The prognosis after transplantation of an artificial valve is favorable. Within a few weeks, the state of health is restored, and patients return to normal life and work. If the work activity is associated with intensive loads, then a transfer to lighter work may be required. In some cases, the patient receives a disability group, but it is not associated with the operation itself, but with the functioning of the heart as a whole and the ability to perform one or another type of activity.
Patient reviews after heart valve replacement surgery are more often positive. The duration of recovery is different for everyone, but most notice a positive trend already in the first six months, and relatives are grateful to surgeons for the opportunity to extend the life of a loved one. Relatively young patients feel good, some, according to the words, even forget about the presence of a prosthetic valve. Older people have a harder time, but they also notice a significant improvement.
Heart valve transplantation can be done free of charge, at the expense of the state. In this case, the patient is put on a waiting list, and preference is given to those who need an operation urgently or urgently. Paid treatment is also possible, but, of course, it is not cheap. The valve itself, depending on the design, composition and manufacturer, can cost up to one and a half thousand dollars, the operation - starting from 20 thousand rubles. It is difficult to determine the upper threshold for the cost of the operation: some clinics charge 150-400 thousand, in others the price of the entire treatment reaches one and a half million rubles.
Video: a new method for replacing heart valves
With certain cardiac pathologies, a person is recommended prompt elimination of the problem. For example, taking into account individual indications, a heart valve is replaced. Surgical correction (implantation, etc.) is widespread.
When is valve replacement scheduled?
It is indicated for symptoms suggestive of heart failure:
- the occurrence of shortness of breath;
- cardiac edema, pain;
- tachycardia;
- asthmatic manifestations.
If the effect of therapeutic treatment is insufficient, heart surgery is recommended to restore blood circulation.
The indications for it are:
- birth defects;
- defeat as a result of infection;
- lack of required density;
- violations in the valves (wrinkling, shortening, narrowing of the holes);
- the presence of scar tissue (fibrosis);
- inability to cut adhesions.
The operation is recognized as effective and safe.
aortic valve
This anatomical formation contributes to the cessation of the communication of the left ventricle (LV) with the aorta during the period of relaxation of the heart muscle (diastole). The leaflets of this valve close tightly during the impact of the blood stream, preventing its movement from the aorta back into the ventricle. Its area is normally 3-4 cm².
Congenital or acquired defects provoke a danger:
The combination of these factors causes heart defects.
Aortic heart disease
With deviations from the norm, aortic defects occur: combined, stenosis, insufficiency.
The valve leaflets are spliced to reduce the opening. The removal of blood from the ventricle is difficult.
- LV hypertrophy with the exclusion of arterial hypertension and a septal size of 15 mm or more;
- reduction of the hole area to 1 cm or less.
The pressure in the area between the aorta and the ventricle is more than 40 units.
Failure
The leaflets cannot close completely due to damage, and blood from the aorta is able to penetrate back into the ventricle.
Deficiency indicators for surgery:
- the volume of blood ejection into the aorta is less than 50%;
- the volume of reverse blood flow is more than 60 ml during the period of cardiac contraction;
- expansion of the cavity of the left ventricle up to 75 mm.
An open method of intervention with general anesthesia is practiced.
The combined defect arises as a result of a combination of a stenosis with insufficiency.
mitral valve
It is presented in the form of two valves between the atrium and the left ventricle. Blood flows from the first to the second. When the ventricle is compressed, the valve is closed. Blood at this moment is not pushed into the atrium, but through the aorta into the region of the vessels.
Replacing it with minimally invasive methods takes about three hours.. The open method is used in severe cases.
Correction methods
The endovascular method involves the introduction of a catheter with a prosthesis into the incisions of the femoral artery (or brachial) with local anesthesia. For dangerous defects, endovascular replacement is not applicable.
A minithoracotomy is a replacement of the mitral valve. In this case, a heart-lung machine is used. The chest is not completely opened, only a few incisions are made. Anesthesia is prescribed general.
Types of artificial valves
They differ in composition and method of manufacture.
Biological
The biological valve is made from natural tissues of pigs and other animals and is introduced for up to 15 years. After that, the replacement is repeated.
Advantages: no opening of the chest is required, the appointment of anticoagulants is provided only for 3 months.
Disadvantage: quick wear (12-15 years).
Mechanical
It is specially made using hypoallergenic materials such as plastic and metal. Such valves are installed indefinitely.
Advantages: durability, stability.
Disadvantages: obligatory provision of open access to the heart, lifelong anticoagulant therapy.
Donor valves are rarely practiced.
Features of preparation for surgery
In preparation for the operation, the following recommendations should be followed:
- Conduct appropriate diagnostics, which may include:
- echocardiography;
- laboratory tests of urine, blood (general and biochemical tests);
- chest x-ray;
- blood clotting test;
- Ultrasound of the heart.
- Take advantage of the advice of specialists who will be directly involved in the operational process:
- anesthetist;
- cardiologist;
- surgeon;
- specialist in respiratory therapy;
- middle medical staff.
- For 8 hours before the operation, completely refuse food. Before this, during the day, eat light food to avoid overloading the heart.
- Prepare psychologically, enlist the support of relatives.
Before the operation, you should rest, sleep. Take a shower no later than 8 hours before the intervention.
Priority for surgery and its cost
Prosthetic heart valves can be done free of charge, at the expense of the state. But for this you need to register in the queue. Benefits are available for emergencies.
Paid options are faster, but they are expensive.
The average cost of an implant is about one and a half thousand dollars, the operation itself is estimated from 70 to 400 thousand rubles, in some clinics and more.
Cardiac pathologies requiring surgical intervention are diseases subject to quotas. However, each clinic is issued by the Ministry of Health of the Russian Federation only a certain number of budget quotas, which are distributed by the commission.
Operation sequence
The operation to replace the heart valve begins after special preparation (breathing exercises, enema, etc.) and the introduction of anesthesia devices.
Difficulty in aortic valve replacement
Prosthetics of the aortic valve of the heart is carried out on an open organ. After opening the chest, the heart is connected to artificial blood flow. Without mandatory disclosure, the procedure is performed in a serious condition of the patient, unstable hemodynamics.
The methods of such surgical intervention provide access to the organ through the area of the femoral vein. The process is monitored on a special screen using vessel contrasting.
The biological material allows, after taking anticoagulants for a three-month period after the operation, to subsequently do without them.
Operation steps
After special preparation (it is described above) and the introduction of general anesthesia, surgical intervention involves the following steps:
- processing of the surgical field;
- longitudinal dissection of the sternum, opening of the pericardial cavity;
- connection of the artificial blood circulation mechanism;
- manipulations on the heart (removal of the affected valve);
- installation (implantation) of an artificial prosthesis;
- control of the functions of the implanted prosthesis, checking the seams;
- turning off artificial blood flow, "starting" the heart;
- suturing.
The procedure takes place under general anesthesia. Myocardial treatment throughout the operation (at least 2 hours) is performed with cold saline.
At the end of the process, the operated person is sent to the intensive care unit. He is not allowed to get up for two days. Initially, pain behind the sternum persists, high fatigue. On the fifth day, the patient can be discharged. Seams are processed daily. They are removed for 7-10 days.
Recovery after surgery
Modern valve implantation operations are performed with minimal risk. A person is discharged from the hospital on the fifth or sixth day, if there are no complications. However, the person undergoing this procedure must change their lifestyle.
Rehabilitation after surgery is important. The motor mode should be gentle:
- when planting, keep your legs at a right angle in the area of \u200b\u200bthe knees, do not cross them;
- before getting up from a chair, you should move to the edge;
- before getting out of bed, first roll onto your side;
- to lift objects from below, do not bend over, but sit down.
New movements should be added gradually, in a gentle mode. At first, the legs may swell, sleep and appetite may be disturbed, visual disturbances may occur.
Bouts of depression can be replaced by excessive cheerfulness. But these phenomena are temporary. Life after surgery quickly returns to normal.
With proper rehabilitation, after a few months (six months), the patient restores normal heart function and feels healthy.
It is important to undergo annual scheduled examinations, treatment, ensure proper dietary nutrition, and practice restorative physical education, which is important for breathing. For 2-4 weeks, you must follow the rehabilitation instructions prescribed by the doctor, control the fluid balance, and regularly monitor your health.
Annual surveys
They are shown to everyone who has gone through such an operation. Dispensary cardiological supervision includes:
- echocardiography (EchoCG);
- blood tests (clinical, biochemical);
- x-ray.
In addition, an INR test is performed monthly, reflecting the indicators of the blood coagulation system. During the consultation, the attending physician may prescribe medications, antibiotics, immunostimulants.
Foods and medicines rich in calcium are prohibited. In case of any deterioration in well-being, a doctor should be consulted without delay.
Diet after surgery
There are no strict restrictions in nutrition, but it is not recommended to abuse the intake of individual products.
- salt;
- coffee drinks;
- animal fats;
- carbohydrates.
- vegetable oils;
- fresh fruits and vegetables;
- fish.
In general, the diet is not strict, with standard recommendations. Alcohol consumption should be kept to a minimum. Smoking should also be limited.
Physical exercise
Activity in the post-rehabilitation period is practically unlimited. Only excessive loads and competitive sports should be excluded.
Consulting a doctor will help each individual in these matters. Recommended exercises, walking with increasing load, walking.
Physical activity has a positive effect on the state of blood vessels, the heart, strengthens the body as a whole. There are cases of returning to professional sports after surgery.
Complications and consequences of the operation
After surgical valve replacement, consequences and complications are possible. The most common are:
- instability of the surgical wound;
- migration of the implanted prosthesis;
- stroke, heart attack;
- complications due to prolonged immobility.
With any operation, there is a certain risk. To prevent thromboembolic complications and bleeding, anticoagulants with an individually selected dose are prescribed.
In any case, implanted prostheses are foreign bodies that can affect blood clotting and the formation of blood clots.
On the appointment of disability and forecasts
Non-working group II is determined for a period of one year after the completion of the operation to restore the myocardium. In the future, it is possible to transfer to group 3.
When establishing disability, cognitive deviations (reduction of mental abilities) are taken into account individually.
How long do they live with an artificial valve? The average life expectancy in this case is approximately 20 years. However, theoretically, the life of the valve is much longer (up to 300 years, according to doctors).
Contraindications for surgery
During surgery, there are always risks. Therefore, diseases of the internal organs can become an obstacle to the implementation of surgical intervention:
- severe heart disease;
- damage to the valve tissue of an infectious nature;
- thrombosis;
- exacerbation of rheumatism;
- complex valve deformity.
An obstacle may also be the patient's unwillingness, the neglect of the pathology. The main thing is to calculate the expediency and save life.
Heart valve surgeries are not uncommon these days. They are carried out regularly and successfully, thanks to the constant modernization of the process.
If the operation is performed out of time, there is a risk of developing pathologies due to the expansion of the left ventricle. This aggravates heart failure. With a quality operation, you will no longer have to experience pain. Forecasts are favorable. Only a scar will remind you of the transferred procedure.
Despite the fact that medical scientists are working to improve the technique of heart valve transplant surgery (biological and mechanical), and constantly create progressive versions of artificial valves, complications sometimes occur after heart valve replacement surgery.
Postoperative complications
Complications should not be confused with the process of wear of an artificial valve, which eventually becomes unusable. So, biological valves begin to function worse gradually, over 5–10 years, and mechanical valves can “work” without problems for 20–25 years, however, in this case, a person will have to constantly take anticoagulants (when transplanting biological valves, this is not required) .
Given the above trends, doctors recommend, in the process of treating heart disease, if necessary, that biological valves be transplanted to the elderly, for whom a ten-year valve life is acceptable, and besides, they do not have to drink additional drugs. Young patients are offered mechanical valves that do not fail for more than 20 years, although at the same time they have to prescribe drugs that prevent blood clotting .
Important: heart attack and stroke are the cause of almost 70% of all deaths in the world!
Hypertension and pressure surges caused by her in 89% of cases the patient is killed with a heart attack or stroke! Two-thirds of patients die in the first 5 years of the disease!
Death statistics during surgery
In people under 50 years of age, heart valve replacement surgery is usually uneventful, and the mortality rate does not exceed 1 percent. However, the older the patient, the higher the chance of dying during this heart surgery.
Mortality during heart valve replacement surgery:
Given the statistics and the fact that mechanical valves fail much less often, doctors decide which valve (biological or mechanical) to replace the “failed” patient's own heart valve.
A startling discovery in the treatment of hypertension
It has long been widely believed that It is impossible to get rid of HYPERTENSION permanently. To feel relief, you need to continuously drink expensive pharmaceuticals. Is it really? Let's figure it out!
Complications after surgery
Any heart surgery is a complex surgical procedure that can sometimes become complicated, causing unforeseen problems.
Growth of scar tissue - in some patients, at the site of valve replacement, there is a rapid growth of fibrous scar tissue. This can happen with both a seated biological valve and a transplanted mechanical valve. This complication leads to thrombosis of the artificial valve and will require repeated emergency surgery. However, after 2008, there was no report of this complication, that is, modern methods for carrying out the transplant procedure make it possible to avoid this scourge.
Bleeding as a result of taking anticoagulants - in the people, anticoagulants are called drugs that "thinn" the blood, but to be precise, these pharmacological agents do not make the blood more "fluid", they prevent the formation of blood clots, increasing the time of blood clotting. This property of anticoagulants makes it possible for blood, in any case, even if a clot begins to form in close proximity to the valve, to “wash it away” from the valve before it turns into a blood clot.
However, it happens that people who take anticoagulants for valve transplantation begin to suffer from bleeding in other organs of their body, and most often this is the stomach. Therefore, all patients are strongly advised to monitor the color of urine and feces (in case of bleeding, they darken) and contact your doctor for any signs of gastric distress.
Thromboembolism - a serious complication caused by valve thrombosis. The symptoms of thromboembolism are:
- dyspnea;
- dizziness;
- clouding of consciousness;
- loss of vision and hearing;
- numbness and weakness all over the body.
If at least one of the above symptoms occurs, the patient should immediately consult a doctor or call an ambulance.
Prosthetic valve infection - any, the most sterile foreign object placed inside a living body, can be subjected to infection. Therefore, if you have a fever, long-term respiratory problems (more than two days), or any infectious diseases, you should consult a doctor who, through tests and other tests (for example, MRI of the heart), will determine whether an infection of the artificial heart valve has occurred, or whether everything went well.
In order to avoid the development of infection of the implant, people with artificial valves, when visiting a dentist, as well as during procedures such as colonoscopy, gastroscopy, angiography, cardiac catheterization, etc., should inform doctors that they have an artificial heart valve. .
You should also be careful with skin infection from any accidental wounds, cuts, abrasions and blisters from shoes.
Hemolytic anemia - this complication occurs extremely rarely and is expressed in damage to a large number of red blood globules in contact with the implanted valve. Symptoms that hemolytic anemia has developed are:
- constant weakness;
- persistent fatigue and lethargy.
Although the symptoms of hemolytic anemia are similar to those of the body's reaction to taking anticoagulants, these complications have completely different mechanics of occurrence and development. Therefore, the patient should not figure out for himself what caused the ailment, but should immediately consult a doctor who, having made a diagnosis, will provide the correct treatment.
What valves to put (video)
The Russian industry produces many different products of the highest quality, which have no analogues in the world. Unfortunately, the same cannot be said for artificial heart valves.
Today, one of the best mechanical heart valves is Carbomedics Tophead. There are other excellent foreign analogues. Unfortunately, this cannot be said about Russian products - they are not so reliable, and they fail and quickly fail. Therefore, if we are talking about a young patient, it is better to pay more and put a European implant.
True, there is hope that soon, on the market of medical products, mechanical heart valves will appear that are not inferior and even superior in quality to foreign ones.
From this article you will learn: how the valve is replaced on the heart, who is assigned this operation. Possible complications, rehabilitation period. Life after such an operation.
Valves are structures that ensure the correct direction of blood flow. There are four valves in the human heart:
- Aortic.
- Pulmonary.
- Mitral.
- Tricuspid.
Due to various medical conditions, surgery may be required to replace one or more of them. The decision to perform a surgical intervention is made by a cardiologist, and a cardiac surgeon performs the operation. The patient is treated by the attending cardiologist.
Briefly about heart valves: what are they and why are they needed
All valves open during myocardial contraction and close during relaxation of the heart.
Valve arrangement
Structure and functions
When is valve replacement necessary?
The most common indications for replacing any of the valves are:
- insufficiency (when the valve does not close completely, and blood can flow in the opposite direction);
- stenosis (narrowing, due to which it is not able to open normally, and not enough blood moves in the right direction).
Most often, replacement of the aortic or mitral valve is required. Malformations of the tricuspid (tricuspid) usually appear in combination with defects of other valves. This requires the replacement of all valves affected by the disease.
The operation is performed with such a degree of valve damage, in which blood circulation is significantly impaired. The following symptoms appear:
- chest pain;
- fainting;
- dyspnea.
The doctor can also inform the patient about the need for surgery without severe symptoms, based on EchoCG data.
What are the indications for a heart ultrasound to replace a valve?
Another indication for valve replacement is infective endocarditis. With this disease, surgery is needed if:
- two weeks of antibiotic treatment had no effect;
- rapidly progressing heart failure;
- an intracardiac abscess appeared;
- blood clots form in the heart.
Contraindications
The operation cannot be performed with such pathologies:
- acute myocardial infarction;
- stroke;
- exacerbation of severe chronic diseases (diabetes mellitus, bronchial asthma, etc.).
Types of artificial valves, their features
They can be divided into two groups:
- Mechanical.
- Biological.
The latter are produced from animal tissues: the endocardium of pigs or the pericardium of calves.
For aortic valve defects, the Ross operation is popular, when a pulmonary valve is installed in place of the aortic valve (it is replaced with a biological prosthesis).
Advantages and disadvantages of biological prostheses:
Advantages and disadvantages of mechanical prostheses:
The feasibility of using different valves:
How is the operation performed
On the eve of surgery to replace the valve, the patient is prescribed sedatives.
12 hours before the manipulation you can not eat. Also stop taking any medications.
The operation itself is performed under general anesthesia. Lasts 3-6 hours. The operation is performed on an open heart using a heart-lung machine.
Carrying out heart surgery using a heart-lung machine
The operation is done in several stages:
- preparatory actions (introduction of the patient into deep sleep, preparation of the surgical field, etc.);
- incision and opening of the sternum;
- connecting the patient to a heart-lung machine;
- removal of the diseased valve;
- installation of a mechanical or biological prosthesis;
- disconnection from the heart-lung machine;
- closure of the sternum and suturing.
For the first 2-4 weeks after the operation, you will stay in the clinic in the hospital.
Postoperative period
For the first two days, the patient is prescribed bed rest. During this time, you may have:
- chest pain;
- visual disturbances;
- poor appetite;
- insomnia and drowsiness;
- leg swelling.
Tell your doctor if these signs occur, but don't panic—the symptoms usually go away within a few weeks.
Talk to your doctor about any changes in how you feel.
Possible Complications
The most dangerous complication is the occurrence of blood clots. The risk is higher with a mechanical prosthesis, especially in place of a mitral or tricuspid valve.
To prevent this complication, a constant intake of anticoagulants (Aspirin, Warfarin), as well as injections of Heparin in the postoperative period is necessary.
Infective endocarditis of the installed valve is in second place in terms of frequency of occurrence. The risk is increased with the installation of a biological prosthesis. Endocarditis can also occur during the installation of a mechanical prosthesis. In this case, microorganisms from adjacent tissues penetrate the synthetic material and become even more difficult to reach. This complication is very dangerous and often fatal.
- Chills.
- Fever.
- Violation of the established valve (again there are signs of heart failure).
Treatment of this complication involves antimicrobial therapy, and if it is ineffective, repeated surgical intervention.
To prevent endocarditis, all patients are prescribed antibiotics in the postoperative period.
The prognosis after such heart surgery is favorable. Surgery significantly reduces the risk of death from heart failure and improves quality of life.
Mortality after surgery is only 0.2%. The lethal outcome is mainly associated with thrombosis or endocarditis. Therefore, it is very important to take all the preventive drugs prescribed by the doctor.
Life after surgery
In the first year after valve replacement, you need to go to the doctor for a check-up every month. In the second year - once every six months. Thereafter, once a year.
During the examination, an ECG and EchoCG must be done.
Throughout life, you must follow these rules:
- Give up bad habits and drinking coffee.
- Take anticoagulants prescribed by your doctor.
- Follow a diet: give up fatty, fried, salty, eat more fruits, vegetables and dairy products.
- Work no more than 8 hours a day.
- Sleep at least 8 hours a day.
- Do not lead a sedentary lifestyle, walk more, spend at least 1-2 hours a day in the fresh air.
Physical exercise
Competitive sports and hard work are contraindicated.
It is possible and necessary to perform therapeutic exercises, agreed with the attending physician.
Precautions for future surgeries
Any surgical intervention, even dental, can provoke endocarditis. Therefore, be sure to inform the surgeon that you have undergone heart valve replacement surgery.
To prevent an inflammatory process in the heart, you need to take an antibiotic 30-60 minutes before the surgical procedure. It can be Amoxicillin, Azithromycin, Ampicillin or Cephalexin to choose from. Check this with your doctor first.
Hello! Last year, in October, I was diagnosed with heart disease. Tricuspid insufficiency of the heart valve, and pulmonary hypertension, besides, Raynaud's syndrome. They said for an operation, I went through all the medical examinations and tests. A few days later, I I was supposed to be sent for an operation. But I refused in the last minutes, I was very scared, I don’t know what will happen next. I also have a goiter. What should I do, please tell me, I am completely at a loss.
Hello, Natalia. If your local doctors suggest you have surgery, you need to decide, because over the years complications come, not improvements. But it's up to you to decide.
Good afternoon Please tell us how to be! The husband is a dynamic patient for 5 years. In 2013, I was diagnosed with infection, endocorditis. I sent documents for valve replacement to the Novosibirsk clinic, but they refused. Now he is in the hospital, there was pulmonary edema. At present, the edema has been eliminated, he was transferred from the intensive care unit to the rheumatology department. There, the Doctor said that “edema is the beginning of the end”, that they can’t help and will be discharged. What should we do? HELP SAVE YOUR HUSBAND. Where can we turn for help?
Hello Veronica. I really sympathize with you, but our site does not keep links with any clinics. You need to search.
It has been 5 months since mitral and aortic valve replacement surgery. He had a long fever and cough, and there was congestion in his lungs and liver. After taking antibiotics for a long time, she coped with these problems. Now, against the background of not feeling bad, there are days when severe shortness of breath appears. Myrcative arrhythmia did not go away. I accept: nebivolol, tlrosemide, lazortan and xarelto. Bio valves. Age 60 years. Periodically, a burning sensation appears in the whole body, or as if under a current. What to do? Thank you.
Lussy, our site does not prescribe treatment, this is unacceptable via the Internet. Based on your comment, an additional face-to-face consultation with a cardiologist is needed regarding the adjustment of the medications taken.
Hello. My mom had heart surgery to replace her mitral valve with an artificial one. The operation was February 8, 2018. And the other day, she started to get really pissed off. What could it be?
Hello Nastya. This may be a circulatory disorder, vasospasm, increased pressure, etc. you need to contact your doctor.
Hello, in 2004 Tetrado fallo was operated on. Now there is insufficiency of the pulmonary valve (I don’t have it, there is a mono-cusp) operation is recommended. I’m very afraid, I have two small children. They said the risk of the operation is very high, I don’t know what to do and how much I can do without it? How dangerous is this operation?
Olga, if they offer help, you need to decide. Any operation is a risk. However, no one can accurately judge the outcome in advance. I wish you more optimism and everything will be fine!
Hello, I had an operation, I changed the valve. Thank you for your support too!
Hello Olga. We are very glad that you dared and changed your life for the better.
There are a lot of reasons for the development of intercostal neuralgia, these are: degenerative processes in the spinal column, especially in chronic or acute form, constant worries and stresses, poisoning of the body with various toxins or chemicals, an acute shortage of vitamin B, which in many cases occurs due to intestinal inability suck it up, etc. others
To eliminate neuralgia, you need to know the exact cause. Eliminates pain with antispasmodic and sedative. For example, spazmolgon plus phytosed.
Try drinking a decoction of several herbs: chamomile and lemon balm. They need to be taken in equal parts, pour boiling water and boil in a water bath for 15 minutes. Next, add a teaspoon of honey. Consume 2 times a day.
Good afternoon, my mother underwent mitral valve prosthetics with a mechanical valve, tricuspid valve plasty. The area of the left atrioventricular orifice was 1.2 cm2, SV = 65. She had restenosis. For the first time in 2007, a closed commissurotomy was performed. As the surgeons said after the operation. She had a big heart (there was hypertrophy). She was operated on, she spoke normally, walked. Then, after 2 days, according to the doctors, her heart stopped, because of this, cerebral edema developed. She was immediately transferred to intensive care. Dad and I are not allowed into intensive care. Doctors say his condition is stable. Tell me please. What could cause cardiac arrest and cerebral edema? I am very worried about her, she is my life, my everything. ((((((((.
Hello Faridun. There can be many reasons for cardiac arrest and the development of cerebral edema, for example, a sharp violation of blood circulation. It is impossible to state such facts with certainty. You need to believe and hope that everything will work out.
The doctor replaced my mitral and aortic valves. The question in nutrition is whether spices can be eaten.
I was urgently shown an operation to replace the valve, for a year now I have been living without it, I am afraid and I have a job 12 in 12 will I be able to work? And how is the postoperative period?
Hello Victoria. You have to choose between work or health. With heart disease, work for 12 hours is contraindicated. You can't delay the operation. If the valve stops functioning properly, then the person develops heart failure. At the same time, the cardiac muscle wears out, blood stasis forms in all internal organs. As a result: the human body is depleted. Over time, these complications lead to death. Much depends on the professionalism of surgeons and the specific method of installing the prosthesis. The total time of the patient's stay in the cardiac surgery center: from 2 weeks to 1.5 months.
Be healthy!
My husband underwent heart surgery on January 31 to replace the methal valve with an artificial one. Discharged after 5 days with fever. The temperature is right now. They prescribed a drug for the temperature of the suppository Diclofenac or voltaren.
When you make candles, the temperature disappears. When will it be ok?
Maybe instead of Warfarin something better and inexpensive is needed. This drug gives a complication on the stomach. In short, they cut everyone out, but we are not doctors, I don’t know how to care.
The most difficult thing is that the pressure is low. At first it was 80/57, now it's 100/60 and there is an arrhythmia.
Help, plz.
I was in the hospital in (Sklifa)
Lyudmila, Ivanovna, blood pressure can decrease by removing the obstruction to normal blood flow (after mitral valve replacement), which should stabilize over time. In addition, patients after prosthetics receive a lot of drugs, and it is possible that among them there are also those that reduce blood pressure. Check all the drugs that have been prescribed, and if there is an antihypertensive, reduce its intake by 2 times. And for the causes of high body temperature after valve replacement surgery, there can be a lot. Most often it is infective endocarditis, the addition of a respiratory infection (pleurisy, pneumonia, acute respiratory viral infections, etc.), exacerbation of any chronic inflammatory process that exists before surgery. It is important to establish the cause. If the patient was examined by a specialist, the drugs were prescribed, do not change the medicines yourself, just try to give them to your husband after eating, then the effect of irritation of the mucous membrane will be the least.
Be healthy.
Thank you very clearly written in simple words
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The operation on the heart, which at one time was compared with the first manned flight into space, is exactly 50 years old. It is very pleasant that our surgeon Vasily Kolesov conceived and executed it. Now it is one of the most common procedures in the world to prevent a heart attack and bears the name of its developer.
"The Soviet surgeon dared to raise his hand on his heart" - in 1964 this news outraged the entire world medical community. No one believed that coronary heart disease could be treated with surgery. Numerous experiments on animals ended unsuccessfully. But Vasily Ivanovich Kolesov, a professor at the Leningrad Medical University, proves that operating on a healthy heart in dogs and a diseased heart in humans is not the same thing, and he decides on a bold experiment.
Stanislav Pudyakov then assisted the surgeon. He recalls: a 44-year-old patient was tormented by severe pain in the region of the heart.
“His idea, if compared historically, is similar to the thoughts of Tsiolkovsky, who said that tomorrow we will be on the moon. They didn’t believe him until they really flew. And until Vasily Ivanovich did this first operation, no one believed in it” - says Stanislav Pudyakov.
The surgeon operated on a beating heart, which was also hard to believe. No one had done this before Kolesov, neither in our country nor in the world. Moreover, the doctor literally felt the sore spot with his hands. The equipment for diagnosing heart diseases simply did not exist then.
To restore the normal blood supply to the heart, Kolesov singled out the internal thoracic artery and sewed it to the coronary artery below the narrowing caused by the so-called atherosclerotic plaque. The blood flow went around, the patient was saved from a heart attack.
After the operation, people quickly returned to normal life and forgot about the pills forever. About operations that saved people from heart attacks and pains in the heart, they started talking abroad as a sensation. American magazines wrote about Kolesov: "Pioneer of coronary surgery."
“There were confessions among colleagues, among foreigners. A lot of Americans, Germans, French came, they looked at these operations with great curiosity and really wanted to continue what was started here,” says surgeon Alexander Nemkov.
Vasily Kolesov immediately warned: it would not be easy for young surgeons to repeat this. From now on, operations must be performed on a stopped heart. The advice was regarded as a guide to action. In 1967, American surgeons put them on stream.
The method of treatment of coronary heart disease, proposed by Vasily Ivanovich Kolesov, is considered the most effective after 50 years. Operations are performed by the best cardiac surgeons in clinics around the world. This is aerobatics, because, in fact, doctors must restart the main human organ.
“Speaking specifically about the operation of Vasily Ivanovich Kolesov, it is now being performed widely on a beating heart. What he did is incredible. The range of suture material that we use has changed, the needle holders that we use have changed incredibly. We use special magnifying lenses and we see this artery magnificently, which can be a millimeter, a millimeter and a half,” says surgeon Leo Bokeria.
Like half a century ago, coronary heart disease is the most common disease in the world. Now we can say with confidence that doctors have learned to deal with it. Thanks to the revolutionary method of Vasily Kolesov, even the most difficult patients can be saved.