Cardiovascular operations. Heart surgery: necessary recommendations. What you need to know about coronary artery bypass surgery

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This is what an open stent looks like.

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

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

Here is such an Amazon basin obtained by injecting contrast.

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

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

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

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

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

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

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

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

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

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

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

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

Indications for surgical treatment

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

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

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

Heart disease

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

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

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

Operation types

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

Endovascular intervention

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

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

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

radiofrequency ablation; coronary artery bypass grafting; stenting of coronary arteries; valve prosthetics; Operation Glenn and Operation Ross.

If surgery is performed with access through a vessel or vein, endovascular surgery (stenting, angioplasty) is used. Endovascular surgery is a branch of medicine that allows for surgical intervention under X-ray 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 gives such a complication as a blood clot.

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

RF ablation

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

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

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

Coronary artery bypass grafting

Coronary artery bypass grafting (CABG) helps to restore blood supply to the heart muscle. Unlike the RFA technique, such treatment gives a high result due to the formation of a new passage for the blood flow. This is necessary in order to bypass the affected vessels with special shunts. To do this, take a vein or artery of the patient from the lower limb or arm.

Such heart surgery helps prevent the development of myocardial infarction and atherosclerotic plaques. Its essence lies in the fact that sclerosed vessels are replaced by healthy ones. Often, after shunting, an angioplasty technique is used, when a tube is inserted through the vessels (femoral artery) with a balloon into the damaged vessel. Pressurized air exerts pressure on the actorosclerotic plaques (thrombus) in the aorta or artery and assists in their removal or advancement.

Stenting of the coronary arteries

Stenting

Together with angioplasty, stenting can be performed, during which a special stent is installed. It pushes the narrowed lumen in the aorta or other vessel and helps prevent blood clots and remove atherosclerotic plaque, as well as normalize blood flow. All these manipulations can be carried out simultaneously, so that repeated surgical intervention is not prescribed.

The most common heart disease is valve narrowing or insufficiency. Treatment of such a pathology should always be radical and consist in the correction of valvular lesions. Its essence lies in the prosthetics of the mitral valve. An indication for heart valve replacement surgery may be severe valvular insufficiency or leaflet fibrosis.

With a serious violation of the heart rhythm and the presence of atrial fibrillation, there is a serious need to install a special device called a pacemaker. A pacemaker is needed to normalize the rhythm and heart rate, which can be disturbed during arrhythmias. To normalize the heart rhythm, a defibrillator can be installed, which has the same type of action as a pacemaker.

Heart valve replacement

A patient who has a pacemaker has to undergo frequent medical examinations.

During surgery, a mechanical or biological implant is placed. Patients who have a pacemaker have to adhere to certain restrictions in life. A blood clot or other complication may appear some time after the installation, so lifelong use of special medications is often prescribed.

Operation Glenn and Operation Ross

Glenn's operation is included in the stage of complex correction of children who have congenital heart disease. Its essence is to create an anastomosis connecting the superior vena cava and the right pulmonary artery. Through the time after the treatment was carried out, the patient can live a full life.

The Ross operation involves replacing the patient's damaged aortic valve with his own pulmonic valve.

Laser cautery can also be used to treat arrhythmias. Cauterization can be performed using ultrasound or high frequency current. Cauterization helps to completely eliminate the signs of arrhythmia, tachycardia and heart failure.

Thanks to modern technology and the development of medicine, it has become possible to effectively treat arrhythmia, eliminate heart disease in newborns, or cure other pathologies with heart surgery. In the time after such an operation, many people can live their usual lives, which have only some restrictions.

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

DlyaSerdca → Symptoms and treatment → Surgery and invasive heart examinations

Heart surgeries are very common these days. Modern cardiac surgery and vascular surgery are very advanced. Surgical intervention is prescribed in the case when conservative drug treatment does not help, and, accordingly, the normalization of the patient's condition is impossible without surgery.

For example, heart disease can only be cured by surgery, this is necessary in the case when blood circulation is severely disturbed due to pathology.

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

Often prescribed surgical treatment of coronary heart disease. Since it can lead to myocardial infarction. Due to a heart attack, the walls of the cavities of the heart or aorta become thinner and protrusion appears. This pathology can also be cured only by surgery. Quite often, operations are performed due to disturbed heart rhythm (RFA).

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

Operations can be carried out urgently, urgently, or a planned intervention is prescribed. It depends on the severity of the patient's condition. An emergency operation is performed immediately, immediately after the diagnosis is established. If such an intervention is not carried out, then the death of the patient may occur.

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

Urgent operations do not require fast execution. In this case, the patient is prepared for some time. As a rule, it is several days.

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

Invasive Research

Invasive methods for examining the heart are to conduct catheterization. That is, the study is carried out through a catheter, which can be installed both in the cavity of the heart and in the vessel. With the help of these studies, you can determine some indicators of the work of the heart.

For example, blood pressure in any part of the myocardium, as well as determine how much oxygen is in the blood, evaluate cardiac output, vascular resistance.

Invasive methods allow you to study the pathology of the valves, their size and degree of damage. This study takes place without opening the chest. Cardiac catheterization allows you to take an intracardiac electrocardiogram and phonocardiogram. This method is also used to monitor the effectiveness of drug therapy.

For the treatment of cardiovascular diseases, Elena Malysheva recommends a new method based on Monastic tea.

It contains 8 useful medicinal plants that are extremely effective in the treatment and prevention of arrhythmias, heart failure, atherosclerosis, coronary artery disease, myocardial infarction, and many other diseases. In this case, only natural ingredients are used, no chemicals and hormones!

Such studies include:

Angiography. This is a method for which a contrast agent is used. It is injected into the cavity of the heart or vessel for accurate visualization and detection 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 needed, and if not, what therapy is suitable for this patient. Ventriculography. This is a radiopaque study that will determine the condition of the ventricles, the presence of pathology. All ventricular parameters can be studied, such as cavity volume, cardiac output, cardiac relaxation and excitability measurements.

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

Coronary angiography is often performed in patients with angina pectoris 3-4 functional class. In this case, it is resistant to drug therapy. Doctors need to decide what type of surgical treatment is needed. It is also important to carry out this procedure for unstable angina.

Also, invasive procedures include punctures and probing of the heart cavities. With the help of probing, it is possible to diagnose heart defects and pathologies in the LV, for example, it can be tumors, or thrombosis. To do this, use the femoral vein (right), a needle is inserted into it through which the conductor passes. The needle diameter becomes about 2 mm.

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

Having studied the methods of Elena Malysheva in the treatment of HEART DISEASE, as well as the restoration and cleaning of VESSELS - we decided to bring it to your attention ...

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

Surgery for heart disease

Heart defects include

stenosis of the heart valves; insufficiency of heart valves; septal defects (interventricular, interatrial).

valve stenosis

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

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

Valve replacement (prosthetics)

Feedback from our reader Victoria Mirnova

I recently read an article that talks about Monastic tea for the treatment of heart disease. With the help of this tea, you can FOREVER cure arrhythmia, heart failure, atherosclerosis, coronary heart disease, myocardial infarction and many other diseases of the heart and blood vessels at home.

I was not used to trusting any information, but I decided to check and ordered a bag. I noticed the changes within a week: the constant pain and tingling in my heart that had tormented me before receded, and after 2 weeks they disappeared completely. Try it and you, and if anyone is interested, then below is a link to the article.

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

Valve implant placement

Plastic defects of partitions

It can be carried out in 2 options, for example, suturing a defect or its plastic. Suturing is carried out if the size of the hole is less than 3 cm. Plastic surgery is performed using synthetic tissue or autopericardium.

Valvuloplasty

With this type of operation, implants are not used, but simply expand the lumen of the affected valve. At the same time, a balloon is introduced into the lumen of the valve, which is inflated. It should be noted that such an operation is carried out only for young people, as for the elderly, they are only entitled to intervention on the open heart.

Balloon valvuloplasty

Often, after heart disease surgery, a person is given a disability.

Operations on the aorta

Open surgeries include:

Prosthetics of the ascending aorta. At the same time, a valve-containing conduit is installed; this prosthesis has a mechanical aortic valve. Prosthetics of the ascending aorta, while the aortic valve is not implanted. Prosthetics of the ascending artery and its arch. Surgery to implant a stent graft in the ascending aorta. This is an endovascular intervention.

Prosthetics of the ascending aorta is the replacement of this section of the artery. This is necessary in order to prevent serious consequences, for example, a break. To do this, prosthetics are used by opening the chest, and endovascular or intravascular interventions are also performed. In this case, a special stent is installed in the affected area.

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

Aortic dissection

When prosthetics of the aortic arch are used:

Open distal anastomosis. This is when the prosthesis is installed, so that it does not affect its branches; Arc semi-replacement. This operation consists in replacing the artery where the ascending aorta passes into the arch and, if required, replacing the concave surface of the arch; Subtotal prosthetics. This is when the replacement of branches (1 or 2) is required during prosthetics of the arterial arch; Complete prosthetics. In this case, the arch is prosthetized together with all supra-aortic vessels. This is a complex intervention that can cause neurological complications. After such an intervention, a person is given a disability.

Coronary artery bypass grafting (ACS)

CABG is open-heart surgery that uses a patient's vessel as a shunt. This heart operation is needed in order to create a bypass for the blood, which will not affect the occlusive section of the coronary artery.

That is, this shunt is installed on the aorta and brought to the area of the coronary artery not affected by atherosclerosis.

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

CABG is prescribed if there is angina pectoris, in which even the smallest loads cause seizures. Also, indications for CABG are lesions of all coronary arteries, and if an aneurysm of the heart has formed.

Coronary artery bypass grafting

During CABG, the patient is put into general anesthesia, and then, after opening the chest, all manipulations are performed. This operation can be performed with or without cardiac arrest. And also, depending on the severity of the pathology, the doctor decides whether it is necessary to connect the patient to a heart-lung machine. The duration of CABG can be 3-6 hours, it all depends on the number of shunts, that is, on the number of anastomoses.

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

Today, CABG is performed, which is performed with minimal access to the heart, while the heart continues to work. Such an intervention is considered not as traumatic as the others. In this case, the chest is not opened, the incision is made between the ribs and a special expander is also used so as not to affect the bones. This type of CABG lasts 1 to 2 hours.

The operation is performed by 2 surgeons, while one makes an incision and opens the sternum, the other operates on the limb to take a vein.

After carrying out all the necessary manipulations, the doctor installs drains and closes the chest.

CABG significantly reduces the likelihood of a heart attack. Angina pectoris does not appear after surgery, which means that the quality and duration of the patient's life increase.

Radiofrequency ablation (RFA)

RFA is a procedure that is performed under local anesthesia, since the basis is catheterization. Such a procedure is carried out in order to exfoliate the cells that cause arrhythmia, that is, the focus. This happens through a catheter-conductor, which conducts an electric current. As a result, tissue formations are removed by RFA.

RF catheter ablation

After conducting an electrophysical study, the doctor determines where the source is located, which causes a rapid heartbeat. These sources can be formed along the conducting paths, as a result of which an anomaly of the rhythm manifests itself. It is RFA that neutralizes this anomaly.

RFA is carried out in case of:

when drug therapy does not affect the arrhythmia, and also if such therapy causes side effects. If the patient has Wolff-Parkinson-White syndrome. This pathology is perfectly neutralized by RFA. If a complication may occur, such as cardiac arrest.

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

The catheter is inserted through a puncture in the thigh. Only the area through which the catheter is inserted is anesthetized.

The guide catheter reaches the myocardium, and then a contrast agent is injected. With the help of contrast, the affected areas become visible, and the doctor directs the electrode to them. After the electrode acted on the source, the tissues are scarred, which means that they will not be able to conduct the impulse. After RFA, a bandage is not needed.

Carotid surgery

There are such types of operations on the carotid artery:

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

These operations are performed under both general and local anesthesia. More often under general anesthesia, as the procedure is performed in the neck and there are discomfort.

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

Classical endarterectomy is done if long plaque lesions are diagnosed. During this operation, the plaque is peeled off and removed. Next, the vessel is washed. Sometimes it is still necessary to fix the inner shell, this is done with special seams. At the end, the artery is sutured with a special synthetic medical material.

Endarterectomy of the carotid arteries

Eversion endartectomy is performed in such a way that the inner layer of the carotid artery at the site of the plaque is removed. And after that they fix, that is, sew. For this operation, the plaque should be no more than 2.5 cm.

Stenting is performed using a balloon catheter. This is a minimally invasive procedure. When the catheter is located at the site of stenosis, it inflates and thereby expands the lumen.

Rehabilitation

The period after heart surgery is no less important than the operation itself. At this time, the patient's condition is monitored by doctors, and in some cases, cardio training, therapeutic diets, etc. are prescribed.

Other recovery measures are also needed, such as wearing a bandage. The bandage at the same time fixes the seam after the operation, and of course the entire chest, which is very important. Such a bandage should be worn only if the operation is performed on the open heart. The cost of these items may vary.

The bandage that is worn after heart surgery looks like a T-shirt with tightness clamps. You can purchase male and female versions of this bandage. The bandage is important to prevent lung congestion by coughing regularly.

Such prevention of stagnation is quite dangerous because the seams can disperse, the bandage in this case will protect the seams and contribute to strong scarring.

Also, the bandage will help prevent swelling and bruising, promotes the correct location of organs after heart surgery. And the bandage helps to relieve the load from the organs.

After heart surgery, the patient needs rehabilitation. How long it will last depends on the severity of the lesion and the severity of the operation. For example, after CABG, immediately after heart surgery, you need to start rehabilitation, this is a simple exercise therapy and massage.

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

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

Disability

It should be noted that disability is given to people with diseases of the cardiovascular system even before surgery. There must be evidence for this. From medical practice, it can be noted that they necessarily give disability after coronary artery bypass grafting. Moreover, there may be a disability of both 1 and 3 groups. It all depends on the severity of the pathology.

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

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

Clinics

NII SP im. N. V. Sklifosovsky	Moscow, Bolshaya Sukharevskaya sq., 3	CABG without IR CABG with valve replacement Angioplasty and coronary artery stenting RFA Aortic stenting Prosthetic valves Valve repair	64300 rub. 76625 rub. 27155 rub. 76625 rub. 57726 rub. 64300 rub. 76625 rub.
KB MGMU them. Sechenov	Moscow, st. B. Pirogovskaya, 6	CABG with valve replacement Angioplasty and stenting of the coronary arteries RFA Aortic stenting Prosthetic valves Valve repair Aneurysm resection	132000 rub. 185500 rub. 160000-200000 rub. 14300 rub. 132200 rub. 132200 rub. 132000-198000 rub.
FSCC FMBA	Moscow, Orekhovy Boulevard, 28	CABG Angioplasty and stenting of the coronary arteries RFA Aortic stenting Prosthetic valves Valve repair	110000-140000 rub. 50000 rub. 137000 rub. 50000 rub. 140000 rub. 110000-130000 rub.
NII SP im. I.I. Janelidze	St. Petersburg, st. Budapestskaya, 3	CABG Angioplasty and stenting of the coronary arteries Aortic stenting Prosthetic valves Valve repair Multivalvular prosthetics Probing of the heart cavities	60000 rub. 134400 rub. 25000 rub. 60000 rub. 50000 rub. 75000 rub. 17000 rub.
SPGMU them. I.P. Pavlova	St. Petersburg, st. L. Tolstoy, 6/8	CABG Angioplasty and coronary artery stenting Prosthetic valves Multivalve prosthetics RFA	187000-220000 rub. 33000 rub. 198000-220000 rub. 330000 rub. 33000 rub.
MC "Shiba"	Derech Sheba 2, Tel Hashomer, Ramat Gan	CABG Prosthetic valves	30000 USD 29600 USD
MedMira	Huttropstr. 60, 45138 Essen, Germany 49 1521 761 00 12	Angioplasty CABG Prosthetic valves Cardiac examination Coronary angiography with stenting	EUR 8000 EUR 29000 EUR 31600 EUR 800-2500 EUR 3500
Greekomed	Central Russian office: Moscow, 109240, st. Upper Radishchevskaya, house 9 A	AKSH valve replacement	20910 euros 18000 euros

Do you still think that getting rid of HEART DISEASES is impossible!?

Do you often experience discomfort in the area of the heart (pain, tingling, squeezing)? You may suddenly feel weak and tired… You constantly feel high blood pressure… There is nothing to say about shortness of breath after the slightest physical exertion… And you have been taking a bunch of medications for a long time, dieting and watching your weight…

But judging by the fact that you are reading these lines, victory is not on your side. That is why we recommend reading the story of Olga Markovich, who found an effective remedy for cardiovascular diseases. >>>

Let us know about it -

rate

Open heart surgery is one of the methods of treating cardiovascular diseases, in which special surgical procedures are performed. The general principle is that there is an intervention in the human body in order to carry out the necessary activities on the open heart. In other words, this is such an operation, during which an opening or dissection of the region of the human sternum is performed, affecting the tissues of the organ itself and its vessels.

Open heart surgery

Statistics show that the most common intervention of this type among adults is an operation in which artificial blood flow is created from the aorta to healthy areas of the coronary arteries - coronary artery bypass grafting.

This operation is performed for the treatment of severe coronary heart disease, which occurs due to the development of atherosclerosis, in which there is a narrowing of the vessels supplying blood to the myocardium, their elasticity decreases.

The general principle of the operation: the patient's own biomaterial (a fragment of an artery or vein) is taken and sutured in the area between the aorta and the coronary vessel in order to bypass the place affected by atherosclerosis, in which blood circulation is impaired. After the operation is performed, the blood supply to a certain area of the heart muscle is restored. This artery / vein supplies the heart with the necessary blood flow, while the artery in which the pathological process occurs is bypassed.

Coronary artery bypass grafting

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

Reasons for open heart surgery

The need to replace or restore the patency of blood vessels for the correct flow of blood into the heart.
The need to repair defective areas in the heart (for example, valves).
The need to place special medical devices to maintain the working capacity of the heart.
The need for transplantation operations.

What you need to know about coronary artery bypass surgery?

Time spending

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

The first night after heart surgery and all medical procedures, patients spend in the intensive care unit. After three to seven days have passed (the exact number of days is determined by the patient's well-being), the person is transferred to a regular ward.

Operation Hazards

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

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

These negative consequences, as statistics show, occur much more often when using an artificial blood supply device.

The risk of unpleasant consequences is always present

Preparation period

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

About medications that are currently being used. These may include medications prescribed by another doctor, or those that the patient purchases himself, including dietary supplements, vitamins, etc. This is important information and should be announced before surgery.
About all chronic and past diseases, health deviations that are currently available (runny nose, herpes on the lips, indigestion, fever, sore throat, fluctuations in blood pressure, etc.).

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

On the day of the operation, the patient will be asked to use a special antibacterial soap, which significantly reduces the risk of infection during the operation. In addition, a few hours before the intervention, you can not eat food and drink water.

Operation

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

The patient is placed on the operating table.
He is given general anesthesia.
When the anesthesia begins to take effect and the patient falls asleep, the doctor opens the chest. To do this, he makes an incision in the appropriate area (usually it is no more than 25 sentiments in length).
The doctor dissects the sternum, partially or completely. This allows access to the heart and aorta.
Once access is secured, the patient's heart is stopped and connected to a heart-lung machine. This allows the surgeon to calmly perform all manipulations. Today, technologies are used that allow in some cases to perform this operation without stopping the heartbeat, while the number of complications is lower. than traditional intervention.
The doctor creates a shunt around the damaged part of the artery.
The cut part of the chest is fixed with a special material, most often with a special wire, but in some cases plates are used. These plates are often used for the elderly or for people who have had frequent surgeries.
After the operation is completed, the incision is sutured.

Postoperative period

After the operation is completed and the patient wakes up, he will find two or three tubes in his chest. The role of these tubes is to drain excess fluid from the area around the heart (drainage) into a special vessel. In addition, an intravenous tube is installed for the flow of therapeutic and nutrient solutions into the body and a catheter into the bladder to remove urine. In addition to the tubes, devices are connected to the patient to monitor the work of the heart.

The patient should not worry, in case of questions or discomfort, he can always contact the medical workers who will be assigned to monitor him and promptly respond if necessary.

The duration of the recovery period depends not only on physiology, but also on the person himself.

Each patient should understand that rehabilitation after surgery is not a quick process. After six weeks of treatment, some improvements can be observed, and only after six months will all the benefits of the operation become visible.

But each patient is able to speed up this rehabilitation process, while avoiding new heart ailments, which reduces the risk of a second operation. To do this, it is recommended to take the following measures:

follow the diet and special diet prescribed by the attending physician;
limit salty, fatty, sweet foods);
devote time to physiotherapy exercises, walks in the fresh air;
stop drinking alcohol frequently;
monitor the level of cholesterol in the blood;
track blood pressure.

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

Heart valve replacement
- Possible complications and recommendations for care

Heart surgery is performed only when necessary. The most common of these are heart valve replacement and coronary artery bypass grafting. The first is necessary if the patient is concerned about valvular stenosis. It should be noted that heart surgeries pose a serious risk to the patient's life, they are carried out with maximum precision and caution. Heart surgery sometimes leads to numerous problems and complications, in order to avoid this, you can use an alternative technique - valvuloplasty.

The procedure can replace replacement surgery, help normalize the activity of the heart muscles. In the process, a special balloon is inserted into the opening of the aortic valve, at the end this balloon is inflated. It is worth considering: if a person is in old age, valvuloplasty does not give a lasting effect.

Heart valve replacement

To decide on such a procedure, it is necessary to establish a diagnosis.

The operation is carried out immediately or some time after the test.

In some situations, the results indicate that a person needs bypass surgery. Valve replacement is an open procedure that can be performed using minimally invasive surgery. It should be remembered that heart valve replacement is a very complicated procedure, despite this, it is carried out very often.

Back to index

Stages of the procedure and further rehabilitation

First you need to open the chest. Next, the doctor connects the patient to a special apparatus that provides artificial circulation. The device temporarily replaces the heart. The patient's circulatory system is connected to the device, after which the natural valve is removed and replaced. When this manipulation is completed, the device is turned off. In most cases, heart surgery goes well, but a scar forms on the organ.

After recovery from anesthesia, the breathing tube is removed from the lungs. If you want to remove excess fluid, such a tube should be left for a while. After a day, it is allowed to drink water and liquid, you can walk only after two days. After such an operation, pain in the chest area can be felt, and on the fifth day the patient is completely discharged. If there is a risk of complications, the hospital stay must be extended by 6 days.

Back to index

Can there be complications after valve replacement?

A person can face such problems at different stages of the disease. During the operation, there is a risk of heavy bleeding, in addition, difficulties with anesthesia may arise. Possible risk factors include internal bleeding, seizures, possible infections. A heart attack can also happen, but this happens very rarely. As for the greatest danger, it lies in the appearance of tamponade of the pericardial cavity. This phenomenon occurs when blood fills its heart sac. This causes serious malfunctions in the functioning of the heart. Operations on the heart cannot but affect the general condition of a person. During the rehabilitation period, strict medical supervision is required. The need to visit the surgeon arises after 3-4 weeks after the operation. It is important to maintain the general well-being of the patient. An optimal dose of physical activity should be prescribed, it is important to stick to a diet.

Back to index

What is coronary artery bypass grafting?

Coronary artery bypass grafting is a type of surgery that restores blood flow in the arteries. The procedure is necessary to eliminate coronary heart disease. The disease manifests itself when the lumen of the coronary vessels narrows, as a result of which an insufficient amount of oxygen enters the heart muscle. Coronary artery bypass surgery aims to prevent changes in the myocardium (heart muscle). After the operation, he should fully recover and contract better. It is necessary to restore the affected area of the muscle, for this the following procedure is carried out: everyday bypass shunts are placed between the aorta and the coronary vessel that is affected. Thus, the formation of new coronary arteries occurs. They are designed to replace the narrowed ones. After the shunt is applied, blood from the aorta flows through a healthy vessel, thanks to which the heart produces a normal blood flow.

Back to index

What is the operation for?

This procedure will be required if the left coronary artery of the vessel that provides flow to the heart is affected. It is also needed if all coronary vessels are damaged. The procedure can be double, triple, single - it all depends on how many shunts the doctor needs. With coronary heart disease, the patient may need one shunt, in some cases two or three. Bypass surgery is a procedure that is often used for atherosclerosis of the heart vessels. This happens when angioplasty is not possible. As a rule, a shunt can serve for a long time, its functional suitability is 12-14 years.

Back to index

Carrying out coronary artery bypass grafting

The duration of the operation is 3-4 hours. The procedure requires maximum concentration and attention. The doctor needs to gain access to the heart, for this it is necessary to dissect the soft tissues, then open the sternum and perform a stenotomy. During the operation, a procedure is carried out that is necessary for temporary, it is called cardioplegia. The heart must be cooled with very cold water, then a special solution should be injected into the arteries. To attach shunts, the aorta must be temporarily blocked. To do this, it is necessary to pinch it and connect the heart-lung machine for 90 minutes. Plastic tubes should be placed in the right atrium. Next, the doctor performs procedures that contribute to the flow of blood into the body.

What is routine vascular bypass surgery? This method involves the implantation of special implants into the coronary vessels outside the obstruction, the end of the shunt is sutured to the aorta. In order to be able to use the internal mammary arteries, it is necessary to carry out the procedure with the expenditure of more time. This is due to the need to separate the arteries from the chest wall. Upon completion of the operation, the doctor carefully fastens the chest, for this a special wire is used. With its help, a soft tissue incision is sutured, then drainage tubes are applied to remove residual blood.

Sometimes bleeding occurs after the operation, it continues throughout the day. The installed drainage tubes should be removed after 12-17 hours after the procedure. At the end of the operation, the breathing tube must be removed. On the second day, the patient can get out of bed and move around. Restoration of the heart rhythm takes place in 25% of patients. As a rule, it lasts for five days. As for arrhythmia, this disease can be eliminated within 30 days after surgery, for this conservative methods of therapy are used.

Cardiovascular diseases, unfortunately, occupy one of the first places in terms of mortality in our country. But cardiology does not stand still, but is constantly being improved. In this area, new methods of treatment are constantly emerging and the most modern technologies are being introduced. Naturally, people suffering from severe heart diseases are interested in all the innovations in cardiology, and therefore in various methods of surgical interventions.

When is Cardiac Surgery Used?

Absolutely not any violation in the work of cardiac activity entails surgical intervention. There are absolutely clear criteria on which the attending physician relies, recommending this or that cardiological operation. Such indications may be:

Significant and rapidly progressive deterioration of the patient's condition associated with chronic heart failure.
Acute conditions that threaten the life of the patient.
Extremely low efficiency of simple drug treatment with clear dynamics to the deterioration of the general condition.
The presence of advanced cardiac pathologies that developed against the background of a late visit to the doctor and the lack of adequate treatment.
both congenital and acquired.
Ischemic pathologies leading to the development of a heart attack.

Types of heart surgery

Today, there are many different surgical manipulations on the human heart. All these operations can be divided according to several basic principles.

Urgency.
Technique.

Operations differing in urgency

Any surgical intervention will fall into one of the following groups:

emergency operations. The surgeon performs such heart operations if there is a real threat to the patient's life. It can be a sudden thrombosis, myocardial infarction, the onset of aortic dissection, heart injury. In all these situations, the patient is sent to the operating table immediately after the diagnosis is made, usually even without further tests and examinations.
Urgent. In this situation, there is no such urgency, it is possible to conduct clarifying examinations, but it is also impossible to postpone the operation, as a critical situation may develop in the near future.
Planned. After a long observation by the attending cardiologist, the patient receives a referral to the hospital. Here he undergoes all the necessary examinations and preparation procedures before surgery. The cardiac surgeon clearly sets the time of the operation. In case of problems, for example, a cold, it can be postponed to another day or even a month. There is no threat to life in such a situation.

Differences in technique

In this group, all operations can be divided into ongoing:

Opening the chest. This is a classic method that is used in the most severe cases. The surgeon makes an incision from the neck to the navel and opens the chest completely. Thus, the doctor gets direct access to the heart. Such manipulation is carried out under general anesthesia and the patient is transferred to the cardiopulmonary bypass system. As a result of the fact that the surgeon works with a "dry" heart, he can eliminate even the most severe pathologies with a minimal risk of complications. This method is used in the presence of problems with the coronary artery, aorta and other great vessels, with severe atrial fibrillation and other problems.
Without opening the chest. This type of surgical intervention belongs to the so-called minimally invasive techniques. There is absolutely no need for open access to the heart. These techniques are much less traumatic for the patient, but they are not suitable in all cases.
X-ray surgical technique. This method in medicine is relatively new, but it has already proven itself very well. The main advantage is that after these manipulations the patient recovers very quickly and complications are extremely rare. The essence of this technique lies in the fact that a device similar to a balloon is introduced to the patient using a catheter to expand the vessel and eliminate its defect. This whole procedure is carried out using a monitor and the progress of the probe can be clearly controlled.

The difference in the amount of assistance provided

All surgical manipulations in people with heart problems can be divided both in terms of the volume and direction of the problems to be eliminated.

Correction is palliative. Such surgical intervention can be attributed to auxiliary techniques. All manipulations will be aimed at bringing blood flow back to normal. This may be the end goal or preparation of the vessel for further surgical procedures. These procedures are not aimed at eliminating the existing pathology, but only eliminate its consequences and prepare the patient for full treatment.
radical intervention. With such manipulations, the surgeon sets himself the goal - if possible, the complete elimination of the developed pathology.

Most common heart surgeries

People with problems of the cardiovascular system are often interested in what types of heart surgeries are and how long they last. Let's look at some of them.

RF ablation

A fairly large number of people have problems with a violation in the direction of its increase - tachycardia. In difficult situations today, cardiac surgeons offer radiofrequency ablation, or "cautery of the heart." This is a minimally invasive procedure that does not require an open heart. It is performed using X-ray surgery. The pathological part of the heart is affected by radio frequency signals, which damage it, and therefore eliminate the additional path along which the impulses pass. Normal pathways are at the same time fully preserved, and the heart rate gradually returns to normal.

Coronary artery bypass grafting

With age or due to other circumstances, atherosclerotic plaques can form in the arteries, which narrow the lumen for blood flow. Thus, the flow of blood to the heart is greatly impaired, which inevitably leads to very deplorable results. In the event that the narrowing of the lumen reaches a critical state, surgery recommends that the patient undergo coronary artery bypass grafting.

This type of surgery involves creating a bypass from the aorta to the artery using a shunt. The shunt will allow blood to bypass the narrowed area and normalize blood flow to the heart. Sometimes it is required to install not one, but several shunts at once. The operation is quite traumatic, like any other, performed at the opening of the chest and lasts a long time, up to six hours. Coronary artery bypass surgery is usually performed on the open heart, but today alternative methods are gaining more and more popularity - coronary angioplasty (insertion of an expanding balloon through a vein) and stenting.

Like the previous method, it is used to increase the lumen of the arteries. It is referred to as a minimally invasive, endovascular technique.

The essence of the method lies in the introduction of an inflated balloon in a special metal frame into the artery into the pathology zone, using a special catheter. The balloon inflates and opens the stent - the vessel also expands to the desired size. Next, the surgeon removes the balloon, the metal structure remains, creating a strong skeleton of the artery. Throughout the procedure, the doctor monitors the progress of the stent on the screen of the X-ray monitor.

The operation is practically painless and does not require long and special rehabilitation.

Heart valve replacement

With congenital or acquired pathology of the heart valves, the patient is often shown their prosthetics. Regardless of what type of prosthesis will be installed, surgery most often takes place on the open heart. The patient is put to sleep under general anesthesia and transferred to the cardiopulmonary bypass system. Given this, the recovery process will be long and fraught with a number of complications.

An exception to the procedure for valvular replacement is aortic valve replacement. This procedure can be performed using a gentle endovascular technique. The surgeon inserts a biological prosthesis through the femoral vein and places it in the aorta.

Operations Ross and Glenn

Often, heart surgery is performed on children who are diagnosed with congenital heart defects. Most often, operations are performed according to the methods of Ross and Glenn.

The essence of the Ross system is to replace the aortic valve with the pulmonary valve of the patient. The biggest advantage of such a replacement can be considered that there will be no threat of rejection, like any other valve taken from a donor. In addition, the annulus will grow with the child's body and can last a lifetime. But, unfortunately, an implant must be placed in place of the removed pulmonary valve. It is important that the implant at the site of the pulmonary valve lasts much longer without replacement than the same one at the site of the aortic valve.

The Glenn technique was developed for the treatment of children with pathology of the circulatory system. This is a technology that allows you to create an anastomosis to connect the right pulmonary artery and the superior vena cava, which normalizes the movement of blood flow through the systemic and pulmonary circulation.

Despite the fact that surgical intervention significantly prolongs the life of the patient and improves its quality, it is still mostly an extreme case.

Any doctor will try to do everything possible so that the treatment is conservative, but, unfortunately, sometimes this is completely impossible. It is important to understand that any surgical intervention in the work of the heart is a very difficult procedure for the patient, and it will require high-quality rehabilitation, sometimes quite long.

Recovery time

Rehabilitation after heart surgery is a very important stage in the treatment of patients.

The success of the operation can only be judged after the end, which can last quite a long time. This is especially true for patients who underwent open heart surgery. Here it is extremely important to follow the recommendations of doctors as accurately as possible and have a positive attitude.

After surgery with an opening of the chest, the patient is discharged home in about a week or two. The doctor makes clear instructions for further treatment at home - it is especially important to follow them.

trip home

Already at this stage, it is important to take measures so that you do not have to go back to the hospital urgently. It is important to remember here that all movements should be as slow and smooth as possible. In the event that the road takes more than one hour, you need to periodically stop and get out of the car. This must be done to avoid stagnation of blood in the vessels.

Relations with relatives

Both relatives and the patient need to understand that people who have undergone major operations under general anesthesia are extremely prone to irritability and mood swings. These problems will pass with time, you just need to treat each other with maximum understanding.

Taking medications

This is one of the most important moments in life after heart surgery. It is important for the patient to always have all the necessary medicines with him. It is especially important not to show excessive self-activity and not to take drugs that are not prescribed. In addition, you should not stop taking medication prescribed by your doctor.

seam care

The patient should calmly perceive a temporary sensation of discomfort in the suture area. In the beginning, it can be pain, a feeling of tightness and itching. Painkillers can be prescribed by a doctor to relieve pain; special ointments or gels can be used to relieve other symptoms, but only after consulting a surgeon.

The seam should be dry, without excessive redness or swelling. This needs to be watched closely. The place of the seam must be constantly treated with brilliant green, and the first water procedures are allowed to be taken after about two weeks. Such patients are allowed only a shower, and taking a bath and sudden changes in temperature are contraindicated. It is recommended to wash the seam only with ordinary soap and gently blot with a towel.

In a situation where the patient's temperature rises sharply to 38 degrees, there is severe swelling with redness at the site of the suture, fluid is released or severe pain is disturbing, it is urgent to consult a doctor.

It is important for a person who has undergone heart surgery to set a goal - maximum recovery. But the main thing here is not to rush, but to do everything gradually and very carefully.

In the first days after returning home, you need to try to do everything as smoothly and slowly as possible, gradually increasing the load. For example, in the early days, you can try to walk from one hundred to five hundred meters, but if fatigue appears, you should rest. Then the distance should be gradually increased. It is best to walk outdoors and on flat terrain. After a week of walking, you should try to climb the stairs for 1-2 flights. At the same time, you can try to do simple housework.

Approximately two months later, the cardiologist will perform a stitch healing test and give permission to increase physical activity. The patient may begin to swim or play tennis. He will be allowed to work lightly in the garden with the lifting of small weights. Another test the cardiologist should conduct in three or four months. By this time, it is desirable for the patient to restore all the basic motor activity.

Diet

This aspect of rehabilitation also needs to be paid close attention.

The first time after the operation, the patient often lacks appetite and at this time any restrictions are not very relevant. But over time, a person recovers and his desire to eat familiar foods is restored. Unfortunately, there are a number of strict restrictions that will now always have to be observed. In the diet, you will have to severely limit fatty, spicy, salty and sweet. Cardiologists advise what you can eat after heart surgery - vegetables, fruits, various cereals, fish and lean meat. It is extremely important for such people to monitor their weight, and hence the caloric content of food.

Bad habits

Patients who have undergone heart surgery, of course, are strictly prohibited from smoking and using drugs. Drinking alcohol during the rehabilitation period is also prohibited.

Life after surgery can become full and rich. After a period of rehabilitation, many patients return to life without pain, shortness of breath and, most importantly, fear.