How does heart surgery work? Surgeries and invasive studies of the heart. Intact heart or closed operations

Heart operations are performed very often today. Modern cardiac surgery and vascular surgery are very developed. Surgical intervention is prescribed when conservative drug treatment does not help, and accordingly, normalization of the patient’s condition is impossible without surgery.

For example, a heart defect can only be cured surgically, this is necessary in the case when blood circulation is severely impaired due to pathology.

And as a result of this, the person feels unwell and begins to develop severe complications. These complications can lead not only to disability, but also to death.

Often prescribed surgery coronary heart disease. Since it can lead to myocardial infarction. As a result of a heart attack, the walls of the cavities of the heart or aorta become thinner and protrusion appears. This pathology can also only be cured surgically. Surgeries are often performed due to abnormal heart rhythm (RFA).

They also perform heart transplantation, that is, transplantation. This is necessary in the case when there is a complex of pathologies due to which the myocardium is not able to function. Today, such an operation prolongs the patient’s life by an average of 5 years. After such an operation, the patient is entitled to disability.

Operations can be performed urgently, urgently, or scheduled intervention. This depends on the severity of the patient's condition. Emergency surgery carried out immediately, immediately after diagnosis. If such intervention is not carried out, the patient may die.

Such operations are often performed on newborns immediately after birth with congenital heart disease. In this case, even minutes matter.

Emergency operations do not require quick implementation. In this case, the patient is prepared for some time. As a rule, this is several days.

A planned operation is prescribed if there is no danger to life at this time, but it must be carried out in order to prevent complications. Doctors prescribe myocardial surgery only if it is necessary.

Invasive research

Invasive methods for examining the heart involve catheterization. That is, the study is carried out through a catheter, which can be installed both in the heart cavity and in a vessel. Using these studies, you can determine some indicators of heart function.

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 make it possible to study the pathology of the valves, their size and the degree of damage. This study is carried out without an autopsy. 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:

In 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 of functional class 3-4. In this case, it is resistant to drug therapy. Doctors need to decide what kind of surgical treatment is needed. It is also important to carry out this procedure for unstable angina.

Invasive procedures also include punctures and probing of the heart cavities. Using sounding, you can diagnose heart defects and pathologies in the left ventricle, for example, these could be tumors or thrombosis. To do this, use the femoral vein (right), a needle is inserted into it through which a conductor passes. The needle diameter becomes about 2 mm.

When performing invasive examinations, local anesthesia is used. The incision is small, about 1-2 cm. This is necessary to expose the right vein for catheter installation.

These studies are carried out in different clinics and their cost is quite high.

Surgery for heart disease

Heart defects include

heart valve stenosis;
heart valve insufficiency;
septal defects (interventricular, interatrial).

Valve stenosis

These pathologies lead to many disturbances in the functioning of the heart, that is, the goals of operations for defects are to relieve the load on the heart muscle, restore the normal functioning of the ventricle, as well as restore contractile function and reduce pressure in the cavities of the heart.

To eliminate these defects, the following surgical interventions are performed:

Often, after surgery for a heart defect, a person is given disability.

Surgeries on the aorta

Open surgical procedures include:

Prosthetics of the ascending aorta. In this case, a valve-containing conduit is installed; this prosthesis has a mechanical aortic valve.
Prosthetic replacement of the ascending aorta, without the aortic valve being implanted.
Prosthetics of the ascending artery and its arch.
Surgery to implant a stent graft in the ascending aorta. This is an endovascular intervention.

Ascending aorta replacement is the replacement of this section of the artery. This is necessary in order to prevent serious consequences, such as rupture. 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 operations on open heart more effective, since in addition to the main pathology - aortic aneurysm, it is possible to correct the accompanying one, for example, stenosis or valve insufficiency, etc. But the endovascular procedure gives a temporary effect.

When replacing the aortic arch, the following is used:

Open distal anastomosis. This is when the prosthesis is installed so that its branches are not affected;
Half-replacement of the arc. This operation consists of replacing the artery where the ascending aorta meets the arch and, if required, replacing the concave surface of the arch;
Subtotal prosthetics. This is when, when replacing an artery arch, replacement of branches (1 or 2) is required;
Complete prosthetics. In this case, the arch is prosthetic along with all supra-aortic vessels. This is a complex intervention that can cause neurological complications. After such an intervention, the person is entitled to disability.

Coronary artery bypass grafting (CABG)

CABG is an open-heart surgery that uses the patient's blood vessel as a shunt. This heart surgery is needed to create a bypass for blood that will not affect the occlusive portion of the coronary artery.

That is, this shunt is installed on the aorta and brought to a section of the coronary artery unaffected by atherosclerosis.

This method is quite effective in the treatment of coronary heart disease. Due to the installed shunt, blood flow to the heart increases, which means ischemia and angina pectoris do not occur.

CABG is prescribed if you have angina pectoris, in which even the smallest loads cause attacks. Also, indications for CABG are lesions of all coronary arteries, and if a cardiac aneurysm has formed.

When performing CABG, the patient is put under general anesthesia, and then after opening the chest, all manipulations are carried out. This operation can be performed with or without cardiac arrest. And also, depending on the severity of the pathology, the doctor decides whether the patient needs to be connected 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 a shunt is performed by a vein from lower limb, also sometimes use part of the internal mammary vein, radial artery.

Today, CABG is performed, which is performed with minimal access to the heart and at the same time the heart continues to beat. This intervention is considered not as traumatic as others. In this case, the chest is not opened; an incision is made between the ribs and a special expander is used so as not to affect the bones. This type of CABG lasts from 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 the patient’s quality and life expectancy increases.

Radiofrequency ablation (RFA)

RFA is a procedure performed under local anesthesia, as the basis is catheterization. This procedure is carried out in order to exfoliate the cells that cause arrhythmia, that is, the focus. This occurs through a guide catheter that conducts an electrical current. As a result, tissue formations are removed using RFA.

After conducting an electrophysical study, the doctor determines where the source that causes the rapid heartbeat is located. These sources can be formed along pathways, resulting in a rhythm anomaly. It is RFA that neutralizes this anomaly.

RFA is performed in the following cases:

When drug therapy does not affect 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 such as cardiac arrest may occur.

It should be noted that RFA is well tolerated by patients, since there are no large incisions or opening of the sternum.

A catheter is inserted through a puncture in the thigh. Only the area through which the catheter is inserted is numbed.

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 points an electrode at them. After the electrode has acted on the source, the tissues become scarred, which means they will not be able to conduct the impulse. After RFA, a bandage is not needed.

Carotid artery surgery

These types of operations are distinguished into carotid artery:

Prosthetics (used for large lesions);
Stenting is performed if stenosis is diagnosed. In this case, the lumen is increased by installing a stent;
Eversion endarterectomy - in this case, atherosclerotic plaques are removed along with the inner lining of the carotid artery;
Carotid endarectomy.

Such operations are performed under both general and local anesthesia. Most often under general anesthesia, since the procedure is performed in the neck area and there are unpleasant sensations.

The carotid artery is pinched, and in order for the blood supply to continue, shunts are installed, which are bypass routes.

Classic endarterectomy is done if long plaque lesions are diagnosed. During this operation, the plaque is detached and removed. Next, the vessel is washed. Sometimes it is still necessary to fix the inner shell; this is done with special stitches. Finally, the artery is sutured using a special synthetic medical material.

Carotid endarterectomy

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 it, that is, sew it on. To perform 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, for example, you need to wear a bandage. The bandage secures the suture after the operation, and of course the entire chest, which is very important. This type of bandage should only be worn if open heart surgery is performed. The cost of these products may vary.

The bandage worn after heart surgery looks like a T-shirt with tightness fixers. You can purchase men's and female options this bandage. The bandage is important because it is necessary to prevent congestion of the lungs, for this you need to cough regularly.

Such prevention of stagnation is quite dangerous because the seams can come apart; in this case, the bandage will protect the seams and promote durable scarring.

The bandage will also help prevent swelling and hematomas, and promote the correct location of organs after heart surgery. And the bandage helps relieve stress on 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 begin rehabilitation, this is simple exercise therapy and massage.

After all types of heart surgery, drug rehabilitation is needed, that is, maintenance therapy. In almost all situations, the use of antiplatelet agents is mandatory.

If there is an increased arterial pressure, then ACE inhibitors and beta-blockers are prescribed, as well as drugs to lower blood cholesterol (statins). Sometimes the patient is prescribed physical therapy.

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 disability is necessarily given after coronary artery bypass grafting. Moreover, there may be a disability of both groups 1 and 3. It all depends on the severity of the pathology.

People who have circulatory disorders, stage 3 coronary insufficiency, or have suffered a myocardial infarction are also entitled to disability.

Regardless of whether the operation has been performed or not yet. Patients with heart defects of the 3rd degree and combined defects can apply for disability if there are persistent circulatory disorders.

Clinics

link to article.

Clinic name	Address and telephone	Type of service	Price
Research Institute of SP named after. N.V. Sklifosovsky	Moscow, Bolshaya Sukharevskaya square, 3	CABG without IR CABG with valve replacement Aortic stenting Valve replacement Valvoplasty	64300 rub. 76625 rub. 27155 rub. 76625 rub. 57726 rub. 64300 rub. 76625 rub.
KB MSMU im. Sechenov	Moscow, st. B. Pirogovskaya, 6	CABG with valve replacement Angioplasty and stenting of coronary arteries Aortic stenting Valve replacement Valvoplasty Aneurysm resection	132,000 rub. 185500 rub. 160,000-200,000 rub. 14300 rub. 132200 rub. 132200 rub. 132000-198000 rub.
FSCC FMBA	Moscow, Orekhovy Boulevard, 28	Angioplasty and stenting of coronary arteries Aortic stenting Valve replacement Valvoplasty	110000-140000 rub. 50,000 rub. 137,000 rub. 50,000 rub. 140,000 rub. 110000-130000 rub.
Research Institute of SP named after. I.I. Dzhanelidze	St. Petersburg, st. Budapestskaya, 3	Angioplasty and stenting of coronary arteries Aortic stenting Valve replacement Valvoplasty Multivalve replacement Probing of the heart cavities	60,000 rub. 134400 rub. 25,000 rub. 60,000 rub. 50,000 rub. 75,000 rub. 17,000 rub.
St. Petersburg State Medical University named after. I.P. Pavlova	St. Petersburg, st. L. Tolstoy, 6/8	Angioplasty and stenting of coronary arteries Valve replacement Multivalve replacement	187000-220000 rub. 33,000 rub. 198000-220000 rub. 330,000 rub. 33,000 rub.
Sheba MC	Derech Shiba 2, Tel Hashomer, Ramat Gan	Valve replacement	30000 dollars 29600 dollars

This kind of surgical manipulation falls within the competence of cardiac surgeons, and is one of the most complex in nature. Heart surgery is a last resort for treating serious cardiovascular diseases, which is used to improve the patient’s quality of life, and sometimes even save his life.

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

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

When is heart surgery performed - indications and timing

The main pathologies that may require surgical intervention are:

Poor blood supply to the myocardium. This condition is called coronary heart disease in medical circles. IHD can lead to the formation of an aneurysm and extensive thrombus formation. For all the described ailments, certain surgical procedures on the heart may be required.
Heart defects, which have both congenital and acquired nature. Many defects in the structure of the heart valve are incompatible with life. Therefore, such pathologies are diagnosed in the prenatal period, and the operation itself is performed in the first days of the baby’s life.
Disturbances in the frequency, sequence and rhythm of heart contraction, - arrhythmias.

The following pathological conditions are general indications for heart surgery:

Active deterioration of vital signs against the background of the development of underlying heart disease.
The inability of drug therapy to cope with the manifestations of the disease.
Noticeable deterioration in the functioning of the heart muscle that cannot be eliminated with medications.
Advanced stage of the disease. This happens when the patient fails to seek qualified help in a timely manner.

It is also necessary to take into account that any surgical manipulation of the heart carries a risk and is fraught with the development of a number of exacerbations in rehabilitation period. TO similar treatment Doctors turn to us when other measures do not bring the desired effect.

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

Based on the patient’s condition, the type of surgical intervention in question is:

Emergency. In such a situation, examination and preparation are carried out to a minimum extent, and the operation itself is carried out as quickly as possible. This type of manipulation is prescribed for life-threatening conditions, when every minute counts: with a ruptured aneurysm, extensive myocardial infarction. Often emergency interventions on the heart is performed in newborns with complex heart defects.
Urgent. There is time for diagnostic and preparatory measures, but not much of it. After receiving the examination results, surgical treatment is performed. heart disease.
Planned. In some medical sources, this type of surgery is called elective. After detailed study Based on the patient’s condition, the cardiac surgeon finally makes a decision on the need for surgical intervention. Together with the patient or his parents (when operating on a child), the exact date of the operation is negotiated.

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

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

Note!

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

The progress of the entire procedure is monitored through a monitor screen - this ensures the effectiveness of the operation, as well as its safety for the patient. In addition, when carrying out the manipulation in question, general anesthesia is not used: the doctor confines himself to anesthetizing mini-approaches.

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

The most popular types of heart surgery

Today, the following operations are used in cardiac surgery practice:

1. For coronary heart disease:

2. If a heart defect is diagnosed:

3. In the presence of arrhythmia:

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

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

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

Review

Open heart surgery is a surgical procedure that opens the chest and affects the muscles, valves, or arteries of the heart.

According to the US National Institute of Heart, Pulmonology, and Hematology (NHLBI), coronary artery bypass grafting is the most common heart surgery in adults. During this surgery, a healthy artery or vein is transplanted (attached) to a blocked coronary (heart) artery. As a result, the grafted artery delivers blood to the heart bypassing the blocked artery (NHLBI).

Open heart surgery is sometimes called traditional heart surgery. Today, many new heart procedures require only small incisions rather than large incisions. That is, the concept of open heart surgery can sometimes be misleading.

Causes

Open heart surgery allows for coronary artery bypass grafting. Coronary artery bypass grafting may be required in patients with coronary artery disease.

Coronary artery disease occurs when the vessels that carry blood and oxygen to the heart become narrow and inelastic. This disease is known as atherosclerosis.

Atherosclerosis occurs when fatty deposits create plaque on the walls of the coronary arteries. Plaques narrow the arteries, making it difficult for blood to pass through them. If blood does not flow to the heart properly, a heart attack can occur.

Open heart surgery is also performed to:

repair or replace blood vessels, allowing blood to pass through the heart; repair damaged or abnormal areas of the heart; install medical devices that will help the heart function properly; replace a damaged heart with a donor one (transplantation).

Operation

According to the National Institutes of Health, coronary artery bypass grafting takes four to six hours. Let's look at what it is, step by step.

The patient receives general anesthesia. He falls asleep and does not feel pain from the operation. By making a 20 to 25 centimeter incision in the chest, the surgeon cuts through all or part of the chest bone to gain access to the heart. Once the heart opens, the patient is connected to a heart-lung machine. It diverts blood away from the heart so the surgeon can operate. Some new technologies make it possible to abandon this device. The surgeon uses a healthy vein or artery to create a new path around the blocked artery. The rib cage is held together with wires that remain inside the body. The initial incision is sutured. (NIH)

A chest plate is sometimes used in high-risk patients, especially in the elderly and in those who have had multiple surgeries. In this case, the breast bone is connected after surgery with small titanium plates.

Risks

Risks of coronary artery bypass grafting:

wound infection of the chest (most common in obesity, diabetes, repeated bypass operations); heart attack or stroke; heart rhythm disturbance; damage to the lungs or kidneys; chest pain, low-grade fever bodies; memory loss or blurred memories; blood clots; blood loss; difficulty breathing.

According to the University Medical center Chicago (UCM), using a heart-lung machine increases risks. These risks will include stroke and memory problems (UCM).

Preparation

Tell your doctor about all the medications you take, including over-the-counter drugs, vitamins and herbs. Report any health problems, including herpes, infection, colds, flu, fever.

Two weeks before surgery, your doctor may ask you to refrain from smoking and stop taking vasoconstrictor drugs medications such as aspirin, ibuprofen, or naproxen.

On the eve of the operation, you will be asked to wash yourself with special soap. It kills bacteria on the skin and reduces the chance of infection after surgery. You may be asked not to eat or drink anything after midnight.

You will receive further instructions when you arrive at the hospital for surgery.

Rehabilitation

When you wake up after surgery, you will have two or three tubes in your chest. They are necessary to remove fluid from the area around the heart.

You may have intravenous tubes that will give you fluids.

You may have a catheter (thin tube) placed in your bladder to remove urine.

You may also have machines connected to you to monitor your heart function. Nurses will be nearby to help you if necessary.

Most likely, you will spend the first night in the department intensive care. After three to seven days you will be transferred to a regular ward.

Long

You must be prepared for gradual recovery. Improvement will occur in about six weeks, and after about six months you will feel the full benefits of the operation. So, the outlook is optimistic for many people, the shunt can work for many years.

However, the operation does not exclude re-occlusion of the vessels. The following measures will help maintain your health:

proper nutrition; restriction of salty, fatty and sweet food; maintaining physical activity; to give up smoking; control high pressure and cholesterol levels.

Heart operations are performed very often today. Modern cardiac and vascular surgery are very developed. Surgical intervention is prescribed when conservative drug treatment does not help, and accordingly, normalization of the patient’s condition is impossible without surgery.

For example, a heart defect can only be cured surgically; this is necessary when blood circulation is severely impaired due to pathology.

And as a result, the person feels unwell and serious complications begin to develop. These complications can lead not only to disability, but also to death.

Surgical treatment of coronary heart disease is often prescribed. Since it can lead to myocardial infarction. As a result of a heart attack, the walls of the cavities of the heart or aorta become thinner and protrusion appears. This pathology can also only be cured surgically. Surgeries are often performed due to abnormal heart rhythm (RFA).

Operations can be performed urgently, urgently, or scheduled intervention. This depends on the severity of the patient's condition. Emergency surgery is performed immediately, immediately after diagnosis. If such intervention is not carried out, the patient may die.

Such operations are often performed on newborns immediately after birth with congenital heart disease. In this case, even minutes matter.

Emergency operations do not require quick implementation. In this case, the patient is prepared for some time. As a rule, this is several days.

Invasive research

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.

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Invasive methods make it possible to study the pathology of the valves, their size and the 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:

Angiography. This is a method for which a contrast agent is used. It is injected into the heart cavity or vessel for accurate visualization and determination of pathologies. Coronary angiography. This study allows you to assess the degree of damage to the coronary vessels, it helps doctors understand whether surgery is necessary, and if not, what therapy is suitable for a given patient. Ventriculography. This is a study using an x-ray contrast method, which will determine the condition of the ventricles and the presence of pathology. All ventricular parameters can be studied, such as cavity volume measurements, cardiac output, measurements of cardiac relaxation and excitability.

In selective coronary angiography, contrast is injected into one of the coronary arteries (right or left).

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When performing invasive examinations, local anesthesia is used. The incision is small, about 1-2 cm. This is necessary to expose the desired vein for installing the catheter.

These studies are carried out in different clinics and their cost is quite high.

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Surgery for heart disease

Heart defects include

heart valve stenosis; heart valve insufficiency; septal defects (interventricular, interatrial).

Valve stenosis

To eliminate these defects, the following surgical interventions are performed:

Valve replacement (prosthetics)

This type of operation is performed on an open heart, that is, after opening the chest. In this case, the patient is connected to a special machine for artificial blood circulation. The operation consists of replacing the damaged valve with an implant. They can be mechanical (in the form of a disk or ball in a mesh, they are made of synthetic materials) and biological (made from animal biological material).

Valve implant placement

Plastic surgery of septal defects

It can be carried out in 2 options, for example, suturing the defect or plasticizing it. Suturing is carried out if the hole size is less than 3 cm. Plastic surgery is performed using synthetic fabric or autopericardium.

Valvuloplasty

In this type of operation, implants are not used, but simply expand the lumen of the affected valve. In this case, a balloon is inserted into the lumen of the valve and inflated. It should be noted that such an operation is performed only on young people; as for older people, they are only entitled to open-heart surgery.

Balloon valvuloplasty

Often, after surgery for a heart defect, a person is given disability.

Surgeries on the aorta

Open surgical procedures include:

Prosthetics of the ascending aorta. In this case, a valve-containing conduit is installed; this prosthesis has a mechanical aortic valve. Prosthetic replacement of the ascending aorta, without the aortic valve being implanted. Prosthetics of the ascending artery and its arch. Surgery to implant a stent graft in the ascending aorta. This is an endovascular intervention.

Of course, open heart surgery is more effective, since in addition to the main pathology - aortic aneurysm, it is possible to correct the accompanying one, for example, stenosis or valve insufficiency, etc. But the endovascular procedure gives a temporary effect.

Aortic dissection

When replacing the aortic arch, the following is used:

Open distal anastomosis. This is when the prosthesis is installed so that its branches are not affected; Half-replacement of the arc. This operation consists of replacing the artery where the ascending aorta meets the arch and, if required, replacing the concave surface of the arch; Subtotal prosthetics. This is when, when replacing an artery arch, replacement of branches (1 or 2) is required; Complete prosthetics. In this case, the arch is prosthetic along with all supra-aortic vessels. This is a complex intervention that can cause neurological complications. After such an intervention, the person is entitled to disability.

Coronary artery bypass grafting (CABG)

That is, this shunt is installed on the aorta and brought to a section of the coronary artery unaffected by atherosclerosis.

This method is quite effective in the treatment of coronary heart disease. Due to the installed shunt, blood flow to the heart increases, which means ischemia and angina pectoris do not occur.

CABG is prescribed if you have angina pectoris, in which even the smallest loads cause attacks. Also, indications for CABG are lesions of all coronary arteries, and if a cardiac aneurysm has formed.

Coronary artery bypass grafting

As a rule, the role of a shunt is performed by a vein from the lower limb; sometimes a part of the internal mammary vein or radial artery is also used.

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 the patient’s quality and life expectancy increases.

Radiofrequency ablation (RFA)

Radiofrequency catheter ablation

RFA is performed in the following cases:

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 such as cardiac arrest may occur.

It should be noted that RFA is well tolerated by patients, since there are no large incisions or opening of the sternum.

A catheter is inserted through a puncture in the thigh. Only the area through which the catheter is inserted is numbed.

Carotid artery surgery

There are the following types of operations on the carotid artery:

Prosthetics (used for large lesions); Stenting is performed if stenosis is diagnosed. In this case, the lumen is increased by installing a stent; Eversion endarterectomy - in this case, atherosclerotic plaques are removed along with the inner lining of the carotid artery; Carotid endarectomy.

Such operations are performed under both general and local anesthesia. Most often under general anesthesia, since the procedure is performed in the neck area and there are unpleasant sensations.

The carotid artery is pinched, and in order for the blood supply to continue, shunts are installed, which are bypass routes.

Carotid endarterectomy

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 bandage worn after heart surgery looks like a T-shirt with tightness fixers. You can purchase male and female versions of this headband. The bandage is important because it is necessary to prevent congestion of the lungs, for this you need to cough regularly.

Such prevention of stagnation is quite dangerous because the seams can come apart; in this case, the bandage will protect the seams and promote durable scarring.

The bandage will also help prevent swelling and hematomas, and promote the correct location of organs after heart surgery. And the bandage helps relieve stress on the organs.

After all types of heart surgery, drug rehabilitation is needed, that is, maintenance therapy. In almost all situations, the use of antiplatelet agents is mandatory.

If there is high blood pressure, then ACE inhibitors and beta-blockers, as well as drugs to lower blood cholesterol (statins), are prescribed. Sometimes the patient is prescribed physical therapy.

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 disability is necessarily given after coronary artery bypass surgery. Moreover, there may be a disability of both groups 1 and 3. It all depends on the severity of the pathology.

People who have circulatory disorders, stage 3 coronary insufficiency, or have suffered a myocardial infarction are also entitled to disability.

Clinics

Name of the clinic Address and telephone Type of service Cost

Research Institute of SP named after. N.V. Sklifosovsky	Moscow, Bolshaya Sukharevskaya square, 3	CABG without IR CABG with valve replacement Angioplasty and stenting of coronary arteries RFA Aortic stenting Valve replacement Valve plastic surgery	64300 rub. 76625 rub. 27155 rub. 76625 rub. 57726 rub. 64300 rub. 76625 rub.
KB MSMU im. Sechenov	Moscow, st. B. Pirogovskaya, 6	CABG with valve replacement Angioplasty and stenting of coronary arteries RFA Aortic stenting Valve replacement Valvoplasty Aneurysm resection	132,000 rub. 185500 rub. 160,000-200,000 rub. 14300 rub. 132200 rub. 132200 rub. 132000-198000 rub.
FSCC FMBA	Moscow, Orekhovy Boulevard, 28	CABG Angioplasty and stenting of coronary arteries RFA Aortic stenting Valve replacement Valve plastic surgery	110000-140000 rub. 50,000 rub. 137,000 rub. 50,000 rub. 140,000 rub. 110000-130000 rub.
Research Institute of SP named after. I.I. Dzhanelidze	St. Petersburg, st. Budapestskaya, 3	CABG Angioplasty and stenting of coronary arteries Aortic stenting Valve replacement Valve plastics Multivalve replacement Probing of cardiac cavities	60,000 rub. 134400 rub. 25,000 rub. 60,000 rub. 50,000 rub. 75,000 rub. 17,000 rub.
St. Petersburg State Medical University named after. I.P. Pavlova	St. Petersburg, st. L. Tolstoy, 6/8	CABG Angioplasty and stenting of coronary arteries Valve replacement Multivalve replacement RFA	187000-220000 rub. 33,000 rub. 198000-220000 rub. 330,000 rub. 33,000 rub.
Sheba MC	Derech Shiba 2, Tel Hashomer, Ramat Gan	CABG Valve replacement	$30,000 $29,600
MedMira	Huttropstr. 60, 45138 Essen, Germany 49 1521 761 00 12	Angioplasty CABG Valve replacement Cardiac examination Coronary angiography with stenting	8000 euros 29000 euros 31600 euros 800-2500 euros 3500 euros
Greekomed	Central Russian office: Moscow, 109240, st. Verkhnyaya Radishchevskaya, house 9 A	CABG valve replacement	20910 euros 18000 euros

Do you still think that it is impossible to get rid of HEART DISEASES!?

Do you often experience discomfort in the heart area (pain, tingling, squeezing)? You may suddenly feel weak and tired... Constantly felt high blood pressure... There’s nothing to say about shortness of breath after the slightest physical exertion... And you’ve been taking a bunch of medications for a long time, going on a diet and watching your weight...

Bondarenko Tatyana

Project expert DlyaSerdca.ru

Heart surgery helps cure many diseases of the cardiovascular system that do not respond to standard therapeutic methods. Surgical treatment may be performed different ways, depending on the individual pathology and general condition of the patient.

Indications for surgical treatment

Cardiac surgery is a field of medicine in which doctors specialize who study, invent methods and perform operations on the heart. Heart transplantation is considered the most complex and dangerous cardiac surgery. Regardless of what type of surgery will be performed, there are general indications:

rapid progression of cardiovascular disease;
ineffectiveness of conservative therapy;
failure to consult a doctor in a timely manner.

Heart surgery provides an opportunity to improve general state the patient and eliminate the symptoms that bother him. Surgical treatment is performed after complete medical examination and establishing an accurate diagnosis.

They perform operations when congenital defects hearts or acquired. A congenital defect is detected in a newborn immediately after birth or before birth. ultrasound examination. Thanks to modern technologies and techniques, in many cases it is possible to detect and treat heart defects in newborns in a timely manner.

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

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

Types of operations

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

During open heart surgery, the heart is temporarily stopped for several hours to allow the necessary manipulations to be performed. This technique makes it possible to cure complex heart defects, but is considered more traumatic.

During beating heart surgery, special equipment is used so that the heart continues to contract and pump blood during surgery. The advantages of this surgical intervention include the absence of complications such as embolism, stroke, pulmonary edema, etc.

There are the following types of heart surgeries, which are considered the most common in cardiological practice:

radiofrequency ablation;
coronary artery bypass grafting;
valve replacement;
Glenn operation and Ross operation.

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

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

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

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

Arrhythmia itself is not a serious pathology requiring surgical intervention, but can lead to serious complications. Thanks to RFA, it is possible to restore normal heart rhythm and eliminate main reason his violations.

RFA is performed using catheter technology and under X-ray control. Heart surgery is performed under local anesthesia and involves inserting a catheter to the required area of the organ that sets the abnormal rhythm. Through an electrical impulse under the influence of RFA, the normal rhythm of the heart is restored.

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

Heart valve replacement has been carried out everywhere for many years and has proven itself to be a safe and very effective operation for restoring 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 and tear of their tissues may occur, but the degree does not reach critical levels. Much greater damage to the condition of the valve 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 older people, the reason for which is atherosclerosis, accompanied by the deposition of fat and protein masses in the valves, their compaction, and calcification. The continuously relapsing nature of the pathology causes periods of exacerbations with damage to valve tissue, microthrombosis, ulceration, which are followed by subsidence and sclerosis. Sprawl connective tissue ultimately leads to deformation, shortening, thickening and decreased mobility of the valve leaflets - a defect is formed.

Among young patients requiring transplantation artificial valves, mostly sick rheumatism. The infectious and inflammatory process on the valves is accompanied by ulceration, local thrombosis (warty endocarditis), and 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 disruption of hemodynamics in one or both circulation circles. When these openings are narrowed (stenosis), the cavities of the heart do not fully empty, which are forced to work harder, hypertrophying, then depleting and expanding. In case of valve insufficiency, when its flaps do not close completely, part of the blood returns in the opposite direction and also overloads the myocardium.

The increase in heart failure, stagnation in the 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 temporarily removing it from circulation. Today in cardiac surgery, more gentle, minimally invasive methods of surgical correction are widely used, which are less risky and just as effective as open intervention.

Modern medicine offers not only alternative ways 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 operations, 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 simply performed. In case of heart disease, for some time the organ itself copes with the increased load; as its functional abilities weaken, it is prescribed drug therapy, and only if conservative measures are ineffective does the need for surgery arise. Indications for heart valve replacement include:

Severe stenosis (narrowing) of the valve opening, which cannot be eliminated by simple dissection of the leaflets;
Valve stenosis or insufficiency due to sclerosis, fibrosis, deposition of calcium salts, ulceration, shortening of the valves, their wrinkling, limited mobility for the above reasons;
Sclerosis of the tendinous chords, disrupting the movement of the valves.

Thus, the reason for surgical correction is any irreversible structural change in the components of the valve, making correct unidirectional blood flow impossible.

There are also contraindications to heart valve replacement surgery. Among them are the patient’s serious condition, pathology of other internal organs that make the operation life-threatening for the patient, and severe blood clotting disorders. An obstacle to surgical treatment may be the patient’s refusal to undergo surgery, 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 bacterial inflammation.

Depending on the composition, the heart valve prosthesis can be mechanical or 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 considered to be 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 bovine pericardium, pig valves, which are fixed on a synthetic ring that is installed at the attachment point of the heart valve. When making biological prostheses, animal tissues 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, limiting the period of taking anticoagulants within three months. A significant disadvantage is considered to be rapid wear, especially if the mitral valve is replaced with such a prosthesis. On average, a biological valve lasts about 12-15 years.

The aortic valve is easier to replace with any type of prosthesis than the mitral valve, so if it is damaged mitral valve first resort to different types plastic surgery (commissurotomy), and only if they are ineffective or impossible is the possibility of a total valve replacement considered.

Preparing for valve replacement surgery

Preparation for surgery begins with a thorough examination, including:

General and biochemical blood tests;
Urine examination;
Determination of blood clotting;
Electrocardiography;
Ultrasound examination of the heart;
Chest X-ray.

Depending on the accompanying changes, to the list diagnostic procedures Coronary angiography, vascular ultrasound, and others may be included. Consultations required narrow specialists, conclusions of a cardiologist and therapist.

On the eve of the operation, the patient talks with the surgeon, anesthesiologist, takes a shower, has dinner - no later than 8 hours before the start of the intervention. It is advisable to calm down and get some sleep; many patients benefit from 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 an open approach and in a minimally invasive manner without an incision in the sternum. Open surgery performed under general anesthesia. After immersing the patient in anesthesia, the surgeon processes the surgical field - the anterior surface of the chest, dissects the sternum in the longitudinal direction, opens the pericardial cavity, followed by manipulations on the heart.

heart valve replacement

To disconnect the organ from the bloodstream, a heart-lung machine is used, which allows valves to be implanted on a non-working heart. In order to prevent hypoxic damage to the myocardium, it is treated with cold saline throughout the entire operation.

To install the prosthesis, the desired cavity heart, the altered structures of its own valve are removed, in its place an artificial one is installed, after which the myocardium is sutured. The heart is “started” using an electrical impulse or direct massage, and 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 the blood and sutures the surgical wound layer by layer. Metal staples, wire, and screws can be used to connect the halves of the sternum. Regular sutures or cosmetic intradermal sutures with self-absorbable threads are applied to the skin.

Open surgery is very traumatic, so the surgical 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, therefore it is quite feasible for patients with severe concomitant diseases. The absence of a large incision makes it possible to reduce hospital stay and subsequent rehabilitation to a minimum. An important advantage of endovascular prosthetics is the ability to perform surgery on a beating heart without the use of a heart-lung machine.

During 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 destruction and removal of fragments of the own damaged valve, a prosthesis is installed in its place, which itself straightens thanks to a flexible stent frame.

After valve installation, stenting can also be performed. coronary vessels. This opportunity is very relevant for patients whose 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 front 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.

In many cases, heart valve transplantation is an alternative to heart transplantation, which can significantly improve well-being and increase life expectancy. The choice of one of the listed methods of surgery and the type of prosthesis depends on both the patient’s condition and the technical capabilities of the clinic.

Open surgery is the most dangerous, and the 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 or conditions for endovascular treatment in a particular city, but the patient has the financial opportunity to go to another clinic, then it is worth taking advantage of it.

If aortic valve replacement is necessary, mini-access and endovascular surgery are preferable, while mitral valve replacement is often performed in an open manner due to its location inside the heart.

Postoperative period and rehabilitation

The operation to replace a heart valve is very painstaking and time-consuming, lasting at least two hours. After its completion, the operated patient is placed in the intensive care unit for further observation. After 24 hours and if the patient’s condition is favorable, the patient is transferred to a regular ward.

After open surgery, the sutures are processed daily and removed within 7-10 days. This entire period requires a hospital stay. With endovascular surgery, you can go home within 3-4 days. Most patients note a rapid improvement in their well-being, a surge of strength and energy, and ease in performing ordinary household activities - eating, drinking, walking, showering, which previously caused shortness of breath and severe fatigue.

If during prosthetics there was an incision in the sternum area, then the pain can be felt for quite a long time - up to several weeks. If you experience severe discomfort, you can take an analgesic, but if swelling, redness, or pathological discharge appears in the suture area, then you should not hesitate to visit a 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 prohibited 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 monitoring of a coagulogram (INR);
Antibiotics for rheumatic diseases and the risk of infectious complications;
Treatment of concomitant angina, arrhythmia, hypertension, etc. - beta blockers, calcium antagonists, ACE inhibitors, diuretics (most of them are already familiar to the patient, and he simply continues to take them).

Anticoagulants with an implanted mechanical valve help avoid thrombus formation and embolism, which are provoked foreign body in the heart, but there is also by-effect taking them - there is a risk of bleeding, stroke, therefore regular control INR (2.5-3.5) is an indispensable condition for life with a prosthesis.

Among the consequences of transplantation of artificial heart valves, the greatest danger is thromboembolism, which is prevented by taking anticoagulants, as well as bacterial endocarditis - inflammation of the inner layer of the heart, when the prescription of antibiotics is mandatory.

During the rehabilitation stage, some disturbances in well-being are possible, which usually disappear after several months - six months. These include depression and emotional lability, insomnia, temporary visual disturbances, discomfort in the chest and postoperative suture area.

Life after surgery provided successful recovery no different from that of other people: the valve works well, the heart too, there are no signs of its failure. However, having a prosthesis in the heart will require changes in lifestyle, habits, regular visits to a cardiologist and monitoring of hemostasis.

The first follow-up examination by a cardiologist is carried out approximately a month after prosthetics. At the same time, blood and urine tests are taken, and 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 surgery. 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, you should reduce the proportion of foods containing calcium, as well as the amount of animal fats, fried foods, and smoked foods in favor of vegetables, lean meats and fish.

High-quality rehabilitation after heart valve replacement is impossible without adequate physical activity. Exercises help improve overall tone and train cardiovascular system. In the first weeks you should not be too zealous. It is better to start with feasible exercises that will prevent complications without overloading the heart. Gradually the volume of loads can be increased.

To prevent physical activity from being harmful, experts recommend undergoing rehabilitation in sanatoriums, where exercise therapy instructors will help form individual program physical education. If this is not possible, then all questions regarding sports activities will be explained by a cardiologist at your place of residence.

The prognosis after artificial valve transplantation is favorable. Within a few weeks, health is restored and patients return to ordinary life and work. If work activity is associated with intense loads, a transfer to lighter work may be required. In some cases, the patient receives a disability group, but it is not related to the operation itself, but to the functioning of the heart as a whole and the ability to perform one or another type of activity.

Feedback from patients after heart valve replacement surgery is often positive. The duration of recovery is different for everyone, but most note positive dynamics already in the first six months, and relatives are grateful to the surgeons for the opportunity to prolong life to a loved one. Relatively young patients feel well; some, they say, even forget about the presence of a valve prosthesis. It is more difficult for older people, but they also note significant improvement.

Heart valve transplantation can be done free of charge, at government expense. In this case, the patient is put on a waiting list, and preference is given to those who need surgery 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 starts from 20 thousand rubles. The upper threshold for the cost of the operation is difficult to determine: 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 of replacing heart valves

For certain cardiac pathologies, a person is recommended to promptly eliminate the problem. For example, taking into account individual indications, a heart valve is replaced. Surgical correction (implantation, etc.) is widespread.

When is valve replacement indicated?

It is indicated when symptoms indicating heart failure occur:

the occurrence of shortness of breath;
cardiac edema, pain;
tachycardia;
asthmatic manifestations.

If the effect therapeutic treatment is insufficient, heart surgery is recommended to restore blood circulation.

The indications for it are:

birth defects;
damage due to infection;
lack of required density;
disturbances in the valves (wrinkling, shortening, narrowing of the openings);
presence of scar tissue (fibrosis);
inability to cut adhesions.

The operation is considered effective and safe.

Aortic valve

This is an anatomical formation that contributes to the cessation of communication between the left ventricle (LV) and the aorta during the period of relaxation of the heart muscle (diastole). The flaps of this valve close tightly during the impact of the blood stream, preventing its movement from the aorta back into the ventricle. Its normal area is 3-4 cm².

Congenital or acquired defects provoke danger:

The combination of these factors causes heart defects.

Aortic heart defects

When deviations from the norm occur aortic defects: combined, stenosis, failure.

The valve flaps undergo fusion with a reduction in the opening. It becomes difficult to drain blood from the ventricle area.

LV hypertrophy when arterial hypertension is excluded and the septum size is 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 valves cannot close completely due to damage, and blood from the aorta is able to penetrate back into the ventricle.

Indicators of failure for surgery:

the volume of blood ejected into the aorta is less than 50%;
volume reverse current blood more than 60 ml during the period of cardiac contraction;
expansion of the left ventricular cavity up to 75 mm.

Practiced open method interventions with general anesthesia.

A combined defect occurs as a result of a combination of stenosis and insufficiency.

Mitral valve

It is presented in the form of two leaflets between the atrium and the LV. Blood penetrates from the first to the second. When the ventricle contracts, the valve closes. The blood at this moment is not pushed into the atrium, but through the aorta into the vascular area.

Replacing it using minimally invasive methods takes approximately three hours. Public method used in severe cases.

Correction methods

The endovascular method involves inserting a catheter with a prosthesis into the incisions of the femoral artery (or brachial artery) under local anesthesia. For dangerous defects, endovascular replacement is not applicable.

Minithoracotomy is the replacement of the mitral valve. In this case, a heart-lung machine is used. The entire chest is not opened; only a few incisions are made. General anesthesia is prescribed.

Types of artificial valves

They differ in composition and manufacturing method.

Biological

The biological valve is made from natural tissues of pigs and other animals and is implanted for a period of up to 15 years. After this, the replacement is repeated.

Advantages: no chest opening is required, anticoagulants are prescribed for only 3 months.

Disadvantage: rapid wear and tear (12-15 years).

Mechanical

It is specially manufactured using hypoallergenic materials such as plastic and metal. Such valves are installed indefinitely.

Advantages: durability, stability.

Disadvantages: mandatory provision of open access to the heart, lifelong anticoagulant therapy.

Donor valves are rarely practiced.

Features of preparation for surgery

When preparing for surgery, you should follow the following recommendations:

Carry out appropriate diagnostics, which may include:
- echocardiography;
- laboratory tests of urine, blood (general and biochemical tests);
- chest x-ray;
- blood test for coagulation;
- Ultrasound of the heart.
Take advantage of the consultations of specialists who will be directly involved in the operational process:
- anesthetist;
- cardiologist;
- surgeon;
- respiratory therapist;
- nursing staff.
8 hours before surgery, completely stop eating. Before this, eat light food during the day to avoid heart overload.
Prepare psychologically and enlist the support of relatives.

Before the operation you should rest and get enough sleep. Take a shower no later than 8 hours before the intervention.

Priority for surgery and its cost

Heart valve replacement can be done free of charge, at the expense of the state. But for this you need to register in the queue. Benefits are provided for emergency reasons.

Paid options are faster, but are more 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 or more.

Heart 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

Heart valve replacement surgery begins after special preparation ( breathing exercises, enema, etc.) and the introduction of anesthesia devices.

Difficulty in replacing the aortic valve

Aortic heart valve replacement is performed on an open organ. After opening the chest, the heart is connected to artificial blood flow. Without mandatory disclosure, the procedure is carried out with in serious condition patient, unstable hemodynamics.

Techniques for such surgical intervention involve access to the organ through the area of the femoral vein. The process is monitored on a special screen using contrasting of the vessels.

Biological material allows, after taking anticoagulants for a three-month period after surgery, to subsequently do without them.

Operation stages

After special preparation (described above) and introduction general anesthesia surgical intervention involves the following stages:

treatment surgical field;
longitudinal dissection of the sternum, opening of the pericardial cavity;
connection of the artificial circulation mechanism;
manipulations on the heart (removal of the affected valve);
installation (implantation) of an artificial prosthesis;
monitoring 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. The myocardium is treated throughout the operation (at least 2 hours) with cold saline solution.

At the end of the process, the operated person is sent to intensive care. He is not allowed to get up for two days. Initially, chest pain and high fatigue persist. On the fifth day the patient can be discharged. Seams are processed daily. They are removed within 7-10 days.

Recovery after surgery

Modern valve implantation operations are carried out with minimal risk. A person is discharged from the hospital on the fifth or sixth day if there are no complications. However, a person who has undergone this procedure must change his lifestyle.

Rehabilitation after surgery is important. The motor mode should be gentle:

when sitting, keep your legs at a right angle at the knees, do not cross them;
before getting up from the 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 manner. At first, the legs may swell, sleep and appetite may be disturbed, and visual disturbances may occur.

Attacks 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 recovers normal work heart and feels healthy.

It is important to undergo routine examinations and treatment annually, to ensure proper dietary food, practice restorative exercise, important for breathing. For 2-4 weeks, you must follow the rehabilitation instructions prescribed by the doctor, monitor your fluid balance, and regularly monitor your health.

Annual examinations

They are shown to everyone who has undergone such an operation. Cardiological follow-up includes:

echocardiography (EchoCG);
blood tests (clinical, biochemical);
X-ray.

In addition, an INR test is performed monthly, which reflects the indicators of the blood coagulation system. During the consultation, the attending physician may schedule an appointment medications, antibiotics, immunostimulants.

Foods and medications rich in calcium are prohibited. If you feel unwell, you should contact your doctor immediately.

Diet after surgery

There are no strict dietary restrictions, but it is not recommended to abuse certain foods.

salt;
coffee drinks;
fats of animal origin;
carbohydrates.

vegetable oils;
fresh fruits and vegetables;
fish.

In general, the diet is not strict, with standard recommendations. Alcohol consumption should be reduced to a minimum. It is also advisable to limit smoking.

Physical exercise

Activity during the post-rehabilitation period is practically unlimited. Only excessive loads and participation in competitive sports should be excluded.

Consultations with a doctor will help each person individually in these matters. Exercises, walking with increasing loads, and walks are recommended.

Physical activity has a positive effect on the condition of blood vessels, the heart, and 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 are prescribed with an individually selected dose.

In any case, implanted prostheses are foreign bodies that can affect blood clotting and the formation of blood clots.

About the purpose of disability and prognosis

Non-working group II is determined for a period of one year after completion of the operation to restore the myocardium. In the future, transfer to group 3 is possible.

When establishing disability, cognitive deviations (decreased mental abilities) are taken into account individually.

How long do you live with an artificial valve? The average life expectancy in this case is approximately 20 years. However, theoretically, the valve’s lifespan is much longer (up to 300 years, according to doctors).

Contraindications for surgery

There are always risks during surgery. Therefore, ailments of internal organs can become an obstacle to surgical intervention:

severe heart pathologies;
infection of valve tissue;
thrombosis;
exacerbation of rheumatism;
complex valve deformation.

An obstacle may also be the patient’s reluctance or neglect of the pathology. The main thing is to calculate the feasibility and save life.

Surgeries to implant a heart valve are not uncommon these days. They are carried out regularly and successfully, thanks to the constant modernization of the process.

If the operation is not performed in a timely manner, there is a risk of developing pathologies due to LV expansion. This worsens heart failure. If the operation is performed well, you will no longer have to experience pain. The forecasts are favorable. Only the scar will remind you of the procedure.

Despite the fact that medical scientists are working to improve the technique of heart valve transplantation (biological and mechanical), and are constantly creating progressive versions of artificial valves, complications sometimes occur after heart valve replacement surgery.

Postoperative complications

Complications should not be confused with the wear and tear process of an artificial valve, which becomes unusable over time. Thus, biological valves begin to function worse gradually, over 5–10 years, and mechanical valves can “work” without problems for 20–25 years, however, the person will have to constantly take anticoagulants (when transplanting biological valves, this is not required) .

Taking into account the trends described above, doctors recommend that, in the process of treating heart disease, if necessary, biological valves should be transplanted into elderly people for whom a ten-year lifespan of the valve is acceptable, and besides, they will not have to take additional medications. Young patients are offered mechanical valves that do not fail for more than 20 years, although it is necessary to prescribe medications 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 it - in 89% of cases the patient is killed for a heart attack or stroke! Two thirds of patients die in the first 5 years of the disease!

Mortality statistics during surgery

In people under 50, heart valve replacement surgeries are usually uneventful, with a mortality rate of less than 1 percent. However, the older the patient, the higher the likelihood of dying during this heart surgery.

Mortality during heart valve replacement surgery:

Taking into account statistical data and the fact that mechanical valves fail much less frequently, doctors decide which valve (biological or mechanical) to replace the “failed” patient’s own heart valve with.

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Complications after surgery

Any heart surgery is a complex surgical procedure that can sometimes become complicated, causing unexpected problems.

Scar tissue growth – in some patients, at the site of valve replacement, rapid growth of fibrous scar tissue occurs. This can happen with both a implanted biological valve and a transplanted mechanical valve. This complication leads to thrombosis of the artificial valve and will require repeated urgent surgery. However, after 2008, this complication has not been reported, i.e. modern techniques carrying out the transplantation procedure allows you to avoid this misfortune.

Bleeding as a result of taking anticoagulants – popularly, anticoagulants are called blood-thinning drugs, but to be precise, these pharmacological agents do not make the blood more “liquid”, they prevent the formation of blood clots, increasing the clotting time of the blood. This property of anticoagulants makes it possible for blood, in any case, even if a clot has begun to form in close proximity to the valve, to “wash it off” from the valve before it turns into a thrombus.

However, it happens that people taking anticoagulants for a valve transplant begin to suffer 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 stool (in case of bleeding, they darken) and, if there are any signs of gastric distress, contact their doctor.

Thromboembolism – a serious complication caused by valve thrombosis. Symptoms of thromboembolism are:

dyspnea;
dizziness;
clouding of consciousness;
loss of vision and hearing;
numbness and weakness throughout 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, even the most sterile foreign object placed inside a living body can be infected. Therefore, if the temperature rises, long-term respirator 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 the artificial heart valve became infected, or whether everything turned out well.

To avoid the development of implant infection, people with artificial valves should inform their doctors that they have an artificial heart valve when visiting the dentist, as well as during procedures such as colonoscopy, gastroscopy, angiography, cardiac catheterization, etc. .

You should also be careful about any accidental wounds, cuts, abrasions, or blisters from shoes that become infected.

Hemolytic anemia – this complication occurs extremely rarely and results in damage large quantity red blood cells in contact with the implanted valve. Symptoms that hemolytic anemia has developed are:

constant weakness;
persistent fatigue and lethargy.

Although the symptoms hemolytic anemia similar to the symptoms 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 illness, but should immediately consult a doctor, who, having made a diagnosis, will provide the correct treatment.

Which valves to install (video)

Russian industry produces many different products of the highest quality, which have no analogues in the world. Unfortunately, the same cannot be said about artificial heart valves.

Today, Carbomedics Tophead is considered one of the best mechanical heart valves. There are other wonderful ones foreign analogues. Unfortunately, this cannot be said about Russian products - they are not so reliable, and they break down quickly. Therefore, if we are talking about a young patient, then it is better to pay more and get 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 a heart valve is replaced, and who is prescribed 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.

Because of various diseases Surgery may be required to replace one or more of them. The decision to perform surgery is made by a cardiologist, and the operation is performed by a cardiac surgeon. The patient's rehabilitation is carried out by the attending cardiologist.

Briefly about heart valves: what they are and why they are needed

All valves open during myocardial contraction and close during cardiac relaxation.

Valve location

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. Defects of the tricuspid (three-leaf) usually appear in combination with defects of other valves. This requires replacement of all valves affected by the disease.

The operation is performed when the valve is damaged to such a degree that blood circulation is significantly impaired. The following symptoms appear:

chest pain;
fainting;
dyspnea.

The doctor can also inform a patient without severe symptoms about the need for surgery, based on echocardiography data.

What indications on cardiac ultrasound indicate valve replacement is necessary?

Another indication for valve replacement is infective endocarditis. With this disease, surgery is needed if:

two weeks of antibiotic treatment had no effect;
heart failure progresses rapidly;
an intracardiac abscess appeared;
Blood clots form in the heart.

Contraindications

The operation cannot be performed for the following 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: pig endocardium or calf pericardium.

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 various valves:

How is the operation performed?

On the eve of valve replacement surgery, the patient is prescribed sedatives.

You cannot eat 12 hours before the procedure. 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 performed in several stages:

preparatory actions (putting the patient into deep sleep, preparing the surgical field, etc.);
incision and opening of the sternum;
connecting the patient to the artificial blood circulation machine;
removal of the diseased valve;
installation of a mechanical or biological prosthesis;
disconnection from the heart-lung machine;
sternal closure and suturing.

You will be an inpatient at the clinic for the first 2–4 weeks after surgery.

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;
swelling of the legs.

If you experience these signs, tell your doctor, but don't panic—the symptoms usually go away within a few weeks.

Tell 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 when a mechanical prosthesis is installed, especially in place of a mitral or tricuspid valve.

To prevent this complication, constant use of anticoagulants (Aspirin, Warfarin), as well as Heparin injections into the postoperative period.

Infectious endocarditis of the installed valve is in second place in terms of frequency of occurrence. The risk is increased when installing a biological prosthesis. Endocarditis can also occur during 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 leads to death.

Chills.
Fever.
Malfunction of the installed valve (signs of heart failure appear again).

Treatment of this complication involves antimicrobial therapy, and if it is ineffective, repeated surgery.

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.

The mortality rate after surgery is only 0.2%. Death is mainly due to thrombosis or endocarditis. Therefore, it is very important to take all preventative medications prescribed by your doctor.

Life after surgery

In the first year after valve replacement, you should go to the doctor for examination every month. In the second year - once every six months. Then - once a year.

During the examination, an ECG and EchoCG must be done.

Throughout your 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 foods, 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.

You can and should perform therapeutic exercises, agreed upon with your doctor.

Precautions for future surgeries

Any surgical intervention, even dental, can provoke endocarditis. Therefore, be sure to tell your surgeon that you have undergone heart valve replacement surgery.

To prevent inflammation in the heart, you need to take an antibiotic 30–60 minutes before the surgical procedure. This may be Amoxicillin, Azithromycin, Ampicillin or Cephalexin to choose from. Please discuss this with your doctor in advance.

Hello! Last year, in October, I was diagnosed with a heart defect. Tricuspid insufficiency of the heart valve, and pulmonary hypertension, k also, Raynaud's syndrome. They told me to have surgery, I went through all the medical examinations and tests. A few days later, I was supposed to be sent through the portal for surgery. But I refused at the last minutes, I was very scared, I don’t know what will happen next. I have a goiter. What should I do, please tell me, I’m completely confused.

Hello, Natalia. If your local doctors offer you surgery, you need to decide, because over the years there are complications, not improvements. But it's up to you to decide.

Good afternoon Please tell me what we should do! My husband is a dynamic patient and has been for 5 years. In 2013, I was diagnosed with an infection and endocorditis. I sent documents to replace the valve to the Novosibirsk clinic, but it was refused. Now he is in the hospital, pulmonary edema has occurred. The edema has now been eliminated and he was transferred from intensive care to the rheumatology department. There the Doctor said that “swelling is the beginning of the end”, that they couldn’t help and would discharge me. What should we do? HELP SAVE HUSBAND. Where can we turn for help?

Hello Veronica. I really sympathize with you, but our site has no connections with any clinics. You need to search.

5 months have passed since the operation to replace the mitral and aortic valves. I had a fever and cough for a long time, and there was congestion in the lungs and liver. After taking antibiotics for a long time, I coped with these problems. Now there is no feeling unwell There are days when severe shortness of breath appears. The arrhythmia did not go away. I take: nebivolol, tlrosemide, lazortan and xarelto. Bio valve. Age 60 years. Periodically, a burning sensation appears throughout the body, as if under electric current. What to do? Thank you.

Lussy, our site does not prescribe treatment; this is unacceptable over the Internet. Based on your comment, an additional face-to-face consultation with a cardiologist is needed to adjust the medications you are taking.

Hello. My mother underwent heart surgery to replace the mitral valve with an artificial one. The operation took place on February 8, 2018. And the other day she began to feel very chilly. What could it be?

Hello, Nastya. This may be a circulatory disorder, vasospasm, increased blood pressure, etc. You need to consult your doctor.

Hello, in 2004 I had an operation for Tetrado fallo. Now there is insufficiency of the pulmonary valve (I don’t have one, I have a monocusp) surgery 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 long can I do without it? How dangerous is this operation?

Olga, if they offer help, you need to make a decision. 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 and changed the valve. Thank you for your support! It’s true that my leg hurts a lot and I’m worried about bicostal neurogia.

Hello Olga. We are very glad that you took the plunge and changed your life for the better.

There are many reasons for the development of intercostal neuralgia, these are: degenerative processes in the spinal column, especially in chronic or acute form, constant worries and stress, poisoning of the body with various toxins or chemicals, acute lack of B vitamins, which in many cases occurs due to intestinal inability suck it in, and many others. etc.

To eliminate neuralgia, you need to know the exact cause. Pain is relieved with an antispasmodic and sedative. For example, spasmolgon 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 you should add a teaspoon of honey. Use 2 times a day.

Good afternoon, my mother underwent mitral valve replacement with a mechanical valve and tricuspid valve repair. The area of the left atrioventricular orifice was 1.2 cm2, SV = 65. She experienced restenosis. For the first time in 2007, a closed commissurotomy was performed. As the surgeons spoke after the operation. She had a big heart (there was hypertrophy). She was operated on; she spoke and walked normally. Then, after 2 days, according to the doctors, her heart stopped, and because of this, cerebral edema developed. She was immediately transferred to the intensive care unit. My dad and I are not allowed into the intensive care unit. Doctors say that Nek’s condition is stable. Tell me please. What could have caused 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 severe circulatory disorder. It is impossible to state such facts with precision. You need to have faith and hope that everything will work out.

The doctor replaced two valves for me, the mitral and aortic. The question in nutrition is whether you can eat spices.

I urgently need an operation to replace the valve, I’ve been living without it for a year now, I’m afraid and I have a job in 12, will I be able to work in 12? And how is the postoperative period tolerated?

Hello, Victoria. You have to choose – work or health. If you have heart disease, working 12 hours a day is contraindicated. You cannot delay the operation. If the valve stops functioning correctly, the person develops heart failure. At the same time, the cardiac muscle wears out, and blood stagnation forms in all internal organs. As a result, the human body becomes depleted. Over time, such complications lead to death. Much depends on the professionalism of the surgeons and the specific method of installing the prosthesis. The total time of stay of the patient 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 meter valve with an artificial one. She was discharged after 5 days with a fever. Now the temperature is the same. They prescribed a drug for fever, Diclofenac or voltaren.
When you make candles, the temperature disappears. When will it be normal?
Maybe instead of Warfarin we need something better and inexpensive. This drug causes complications on the stomach. In short, everyone is cut down, but we are not doctors, I don’t know how to take care of them.
The most difficult thing is low blood pressure. At first it was 80/57, now it’s 100/60 and there is arrhythmia.
Help, please.

Stayed in hospital in (Sklif)

Lyudmila, Ivanovna, blood pressure can decrease by eliminating the obstacle 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 those that lower blood pressure. Check all medications that were prescribed, and if there is an antihypertensive drug, reduce its intake by 2 times. And for reasons high temperature there can be a lot of body after valve replacement surgery. Most often this is infective endocarditis, joining respiratory infection(pleurisy, pneumonia, ARVI, etc.), exacerbation of any chronic inflammatory process existing before surgery. It is important to establish the cause. If the patient has been examined by a specialist and medications have been prescribed, do not change the medications yourself, just try to give them to your husband after meals, then the effect of irritation of the mucous membrane will be minimal.
Be healthy.

Thank you very clearly written in ordinary words

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