In what year to do heart surgery. How is heart surgery done using stenosis? With ischemic heart disease

Operations on the heart and blood vessels are performed by such a branch of medicine as cardiac surgery.

With the help of cardiac surgeons, many vascular and cardiac diseases can be effectively treated, thereby significantly prolonging the life of the patient.

Operations on the heart and blood vessels can significantly improve the general well-being of the patient.

They should be performed only after a thorough diagnosis and preparation of the patient.

It is very important to follow all the instructions of the specialist exactly.

Regardless of what kind of disease was detected in a person, there are the following general indications for operations on the heart and blood vessels:

Rapid deterioration of the patient's condition and progression of the underlying disease of the heart or blood vessels.
The lack of positive dynamics from the use of traditional drug therapy, that is, when taking pills no longer helps a person to maintain his condition in a normal way.
The presence of acute signs of deterioration of the underlying myocardial disease, which cannot be eliminated by conventional analgesics or antispasmodics.
The neglect of the underlying disease, in which the patient hesitated to contact the doctor, which led to very severe symptoms of the disease.

These procedures are indicated for patients with heart defects (regardless of whether they are congenital or acquired). Moreover, thanks to current techniques, this disease can be treated even in newborn babies, thereby providing them with a healthy life.

The next common indication is myocardial ischemia. In this case, surgery may be required when the underlying disease is aggravated by a heart attack. In this condition, the sooner surgery is performed, the greater the chance that the person will survive.

A significant indication for the need for surgical intervention can be acute heart failure, which provokes abnormal contraction of the myocardial ventricles. At the same time, it is important that the patient prepares for the operation in advance (to avoid postoperative complications in the form of a blood clot).

Often, surgery is required for myocardial valve disease, which was triggered by trauma or an inflammatory process. Rarely, other causes contribute to its appearance.

A serious reason for the urgent intervention of surgeons is the diagnosis of narrowing of the coronary valve of the artery, as well as endocarditis of infectious origin.

Additional conditions that may require a person to have myocardial surgery include:

Severe aortic aneurysm, which may result from trauma or be congenital.
Rupture of the ventricle of the heart, because of which the blood flow was disturbed.
Various types of arrhythmias that can be eliminated by inserting or replacing an already installed pacemaker. They are commonly used for atrial fibrillation and bradycardia.
Diagnosis of an obstruction in the myocardium in the form of tamponade, due to which the heart cannot pump the required volume of blood normally. This condition can occur under the influence of viral infections, acute tuberculosis and heart attack.
Acute insufficiency of the left ventricles of the myocardium.

Cardiac surgery is not always necessary for the above indications. Each case is individual and only the attending physician can decide what is best for a particular patient - traditional drug therapy or a planned (urgent) operation.

In addition, it should be noted that heart surgery may be required in case of exacerbation of the underlying disease, as well as if the first surgical intervention did not give the expected results. In this case, the patient may need to repeat manipulation. Its cost and preparation features (diet, medication) depend on the complexity of the operation.

Surgical interventions can be practiced both on the open myocardium and on the closed one, when the heart and its cavity are not completely affected. The first type of operations involves dissection of the chest and connecting the patient to artificial respiration equipment.

During open-type operations, surgeons artificially stop the heart for a while, so that within a few hours they can perform the necessary surgical procedures on the organ. These interventions are considered very dangerous and traumatic, but even very complex myocardial diseases can be eliminated with their help.

Closed type operations are more secure. They are usually used to correct minor heart and vascular defects.

There are the following most common types of myocardial operations, which are most often practiced in cardiac surgery:

Installation of artificial valves.
Operations according to the method of Glenn and Ross.
Coronary artery bypass grafting and stenting of arteries.
Ablation of radiofrequency type.

An operation called radiofrequency ablation is a low-traumatic procedure that allows you to achieve significant improvements in heart failure and various types of arrhythmias. It rarely causes side effects and is well tolerated by patients.

RA is performed using special catheters that are inserted under X-ray control. The patient is then given local anesthesia. During this operation, a catheter is inserted into the organ and, thanks to electrical impulses, the normal heart rhythm is restored to the person.

The next type of surgery is prosthetic heart valves. This intervention is very often practiced, since such a pathology as myocardial valve insufficiency is extremely common.

It should be noted that in the event of a severe failure in the patient's heart rhythm, he may need to install a special device - a pacemaker. It is needed to normalize the rhythm of the heart.

When prosthetic heart valves can be used the following types of implants:

Mechanical prostheses that are made of metal or plastic. They serve for a very long time (for several decades), however, they require a person to constantly take drugs to thin the blood, because due to the introduction of a foreign object in the body, a tendency to form blood clots actively develops.
Biological implants are made from animal tissues. They are very durable and do not require special preparations. Despite this, patients after a couple of decades often require a second operation.

Glenn and Ross operations are commonly used to treat children with congenital myocardial defects. The essence of these interventions is to create a special connection for the pulmonary artery. After this operation, the child can live for a long time, with little or no need for maintenance therapy.

During the Ross operation, the patient is replaced by a diseased myocardial valve with a healthy one, which will be removed from his own pulmonary valve.

Cardiac bypass surgery: indications and conduct

Coronary artery bypass grafting is a surgical intervention on the heart, during which an additional vessel is sewn in order to restore the disturbed blood supply in the clogged blood arteries.

Cardiac bypass surgery is practiced when the narrowed vessels of the patient are no longer amenable to drug treatment and the blood cannot circulate normally in the heart, causing ischemic attacks.

A direct indication for cardiac bypass surgery is acute coronary aortic stenosis. Most often, a neglected form of atherosclerosis leads to its development, which contributes to clogging of blood vessels with cholesterol plaques.

Due to vasoconstriction, blood cannot circulate normally and deliver oxygen to myocardial cells. This leads to its defeat and the risk of a heart attack.

Today, heart vessel bypass surgery can be performed both on a beating heart and on an artificially stopped one. At the same time, it should be noted that if shunting is done on a working myocardium, then the likelihood of postoperative complications is much higher than when performing a procedure on a stopped myocardium.

The course of this operation consists in blocking the main aorta and implanting artificial vessels into the affected coronary arteries. Usually, a vessel in the leg is used for shunting. It is used as a biological implant.

Contraindications to this surgical intervention may be an existing pacemaker or an artificial valve in the heart, the functions of which may be impaired during such an operation. In general, the need for shunting is determined individually by the doctor for each individual patient, based on the diagnostic data and the patient's symptoms.

After bypass surgery, the recovery period is usually fast, especially if the patient does not have any complications after the procedure. Within a week after the operation, the patient must comply with bed rest. Until the stitches are removed, a person needs to do wound dressings daily.

After ten days, a person can get out of bed and begin to perform simple movements of physiotherapy exercises in order to restore the body.

After the wound has completely healed, the patient is advised to go swimming and walk regularly in the fresh air.

It should be noted that the wound after shunting is not sewn with threads, but with special metal staples.. This is justified by the fact that the dissection falls on a large bone, so it needs to grow together as carefully as possible and ensure peace.

To make it easier for a person to move around after the operation, he is allowed to use special medical support bandages. They look like a corset and perfectly support the seams.

After surgery, due to blood loss, a person may experience anemia, which will be accompanied by weakness and dizziness. To eliminate this condition, the patient is advised to eat right and enrich his diet with beets, nuts, apples and other fruits.

To reduce the likelihood of re-constriction of blood vessels, alcohol, fatty and fried foods should be completely excluded from the menu.

The operation of stenting of the vessels of the heart: indications and features of the conduct

Arterial stenting is a low-traumatic angioplasty procedure, which involves the imposition of a stent into the lumen of the affected vessels.

The stent itself is similar to a conventional spring. It is injected into the vessel after it has been artificially dilated.

Indications for cardiac stenting surgery are:

IHD (ischemic heart disease), which leads to impaired blood circulation and oxygen starvation of the myocardium.
Myocardial infarction.
Clogging of blood vessels with cholesterol plaques, which lead to a narrowing of their lumen.

Additional contraindications to this procedure are the patient's individual intolerance to iodine, which is invariably used during stenting, as well as the case when the total size of the diseased artery is less than 2.5 mm (in this case, the surgeon simply cannot install the stent).

An operation is performed to stent the vessels of the heart by introducing a special balloon that will expand the lumen of the diseased vessel. Further, a filter is installed in this place, which prevents subsequent blood clots and stroke.

After that, a stent is inserted into the vessel; it will support the vessel from narrowing, serving as a certain frame.

The surgeon monitors the entire course of the operation through a monitor. At the same time, he will see the stent and the vessel well, since even at the beginning of the procedure, the patient is injected with an iodine solution, which will reflect all the actions of the surgeon.

The advantage of stenting is that this operation has a low risk of complications. Moreover, it is performed under local anesthesia and does not require a long period of hospitalization.

After stenting, the patient must remain in bed for a certain time (usually for a week). After that, if there are no complications, the person is allowed to go home.

It is very important to exercise regularly after this operation. At the same time, it is worth controlling your condition and not allowing physical overwork.

Every two weeks after the procedure, the patient must necessarily come to the doctor and undergo a follow-up examination. When pain occurs, a person should immediately report it to the doctor.

To recover faster, the patient should take all the drugs prescribed by the doctor. Sometimes drug therapy lasts a long time, more than one month in a row.

Be sure to follow a dietary diet after stenting.

It provides for the following:

Complete abstinence from alcohol and smoking.
Ban on all animal fats. Also, you can not eat caviar, chocolate, fatty meat and sweet confectionery.
The basis of the diet should be vegetable soups, fruit mousses, cereals and greens.
You need to eat at least six times a day, but at the same time, portions should not be large.
You should completely limit the consumption of salt and salted fish.
It is important to drink plenty of fluids to maintain normal water balance in the body. It is recommended to drink fruit compotes, juices and green tea. You can also use a rosehip decoction.

In addition, a person needs to control their blood pressure and blood sugar levels. This is especially important in the presence of already existing hypertension and diabetes, because these diseases can worsen the functioning of the heart.

Cardiac surgery is a branch of medicine dedicated to the surgical treatment of the heart. With pathologies of the cardiovascular system, such intervention is an extreme measure. Doctors try to restore the patient's health without surgery, but in some cases only cardiac surgery can save the patient. Today, this field of cardiology uses the latest advances in science to return the patient to health and a fulfilling life.

Indications for operations

Invasive interventions on the heart is a complex and risky job, it requires skill and experience, and the patient - preparation and implementation of recommendations. Since such operations are risky, they are carried out only when absolutely necessary. In most cases, the patient is trying to rehabilitate with the help of medicines and medical procedures. But in cases where such methods do not help, heart surgery is needed. Surgical intervention is carried out in a hospital and complete sterility, the operated is under anesthesia and the control of the surgical team.

Such interventions are needed for congenital heart defects or acquired. The former include pathologies in the anatomy of the organ: defects in valves, ventricles, impaired blood circulation. Most often they are discovered even during the bearing of a child. Heart disease is also diagnosed in newborns, often such pathologies need to be eliminated urgently in order to save the life of the baby. Among the acquired diseases, ischemic disease is in the lead, in this case, surgery is considered the most effective method of treatment. Also in the heart area there are: impaired blood circulation, stenosis or valve insufficiency, heart attack, pericardial pathology and others.

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

The decision on the appointment of the operation is made by a council of doctors or. The patient must be examined to establish an accurate diagnosis and type of surgical intervention. They identify chronic diseases, stages of the disease, assess the risks, in which case they talk about a planned operation. If emergency assistance is needed, for example, when a blood clot is torn off or an aneurysm is exfoliated, minimal diagnostics are performed. In any case, the function of the heart is restored surgically, its departments are rehabilitated, blood flow and rhythm are normalized. In severe situations, the organ or its parts are no longer amenable to correction, then prosthetics or transplantation is prescribed.

Classification of heart operations

In the area of the heart muscle, there can be dozens of different diseases, these are: insufficiency, narrowing of the lumen, ruptures of blood vessels, stretching of the ventricles or atria, purulent formations in the pericardium, and much more. To solve each problem, surgery has several types of operations. They are distinguished by urgency, effectiveness and method of influencing the heart.

The general classification divides them into operations:

Buried - used to treat arteries, large vessels, aorta. During such interventions, the chest of the operated person is not opened, the heart itself is also not affected by the surgeon. Therefore, they are called "closed" - the heart muscle remains intact. Instead of a strip opening, the doctor makes a small incision in the chest, most often between the ribs. Closed types include: shunting, balloon angioplasty, stenosis of blood vessels. All these manipulations are designed to restore blood circulation, sometimes they are prescribed to prepare for a future open operation.
Open - carried out after opening the sternum, sawing the bones. The heart itself during such manipulations can also be opened to get to the problem area. As a rule, for such operations, the heart and lungs must be stopped. To do this, connect the heart-lung machine - AIC, it compensates for the work of "disabled" organs. This allows the surgeon to accurately perform the work, in addition, the procedure under the control of AIC takes longer, which is necessary when eliminating complex pathologies. During open operations, AIC may not be connected, but only the desired zone of the heart can be stopped, for example, during coronary artery bypass grafting. Opening the chest is necessary to replace valves, prosthetics, and eliminate tumors.
X-ray surgery - similar to a closed type of operation. The essence of this method is that the doctor moves a thin catheter through the blood vessels, and gets to the very heart. The chest is not opened, the catheter is placed in the thigh or shoulder. The catheter is injected with a contrast agent that stains the vessels. The catheter is advanced under X-ray control, the video image is transmitted to the monitor. Using this method, the lumen in the vessels is restored: at the end of the catheter there is a so-called balloon and a stent. At the site of narrowing, this balloon is inflated with a stent, restoring the normal patency of the vessel.

The safest are minimally invasive methods, that is, X-ray surgery and a closed type of surgery. With such work, the risk of complications is the least, the patient recovers faster after them, but they can not always help the patient. Complex operations can be avoided with periodic inspections. The earlier the problem is identified, the easier it is for the doctor to solve it.

Depending on the condition of the patient, there are:

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

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

How operations are done

The course and duration of the operation depends on the pathology being eliminated, the patient's condition, and the presence of concomitant diseases. The procedure can take half an hour, and can stretch for 8 hours or more. Most often, such interventions last 3 hours, are carried out under general anesthesia and AIC control. First, the patient is prescribed an ultrasound of the chest, urine and blood tests, an ECG, and a consultation with specialists. After receiving all the data, they determine the degree and place of the pathology, decide whether there will be an operation.

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

Heart valve repair

There are four valves in the heart muscle, all of which serve as a passage for blood from one chamber to another. The most commonly operated valves are the mitral and tricuspid valves, which connect the ventricles to the atria. Stenosis of the passages occurs with insufficient expansion of the valves, while the blood does not flow well from one department to another. Valve insufficiency is a poor closure of the cusps of the passage, while there is an outflow of blood back.

Plastic surgery is carried out open or closed, during the operation, special rings or sutures are applied manually along the diameter of the valve, which restore the normal lumen and narrow the passage. Manipulations last an average of 3 hours; with open views, an AIC is connected. After the procedure, the patient remains under the supervision of doctors for at least a week. The result is normal blood circulation and functioning of the heart valves. In severe cases, native leaflets are replaced with artificial or biological implants.

Elimination of heart defects

In most cases, defects are congenital, the cause of this can be hereditary pathologies, bad habits of parents, infections and fever during pregnancy. At the same time, children may have various anatomical abnormalities in the region of the heart, often such anomalies are poorly compatible with life. The urgency and type of surgery depends on the condition of the child, but they are often prescribed as early as possible. For children, heart surgery is performed only under general anesthesia, and under the supervision of medical equipment.

At an older age, heart defects develop with defects in the interatrial septum. This happens with mechanical damage to the chest, infectious diseases, due to concomitant heart disease. To eliminate such a problem, an open operation is also needed, more often with artificial cardiac arrest.

During manipulations, the surgeon can “patch” the septum with a patch, or suture the defective part.

Shunting

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

To prevent complications or alleviate the disease, apply:

aorto-coronary bypass;
balloon angioplasty;
transmyocardial laser revascularization;
stenting of a coronary artery.

All these methods are aimed at restoring normal blood flow. As a result, enough oxygen is supplied to the myocardium with blood, the risk of a heart attack is reduced, and angina pectoris is eliminated.

If you need to restore normal patency, angioplasty or stenting is enough, in which the catheter is moved through the vessels to the heart. Before such an intervention, coronary angiography is performed to accurately determine the blocked area. Sometimes blood flow is restored bypassing the affected area, while a bio-shunt (often a section of the patient's own vein from the arm or leg) is sutured to the artery.

Recovery after interventions

After surgery, the patient remains in the hospital for another 1-3 weeks, all this time the doctors will assess his condition. The patient is discharged after verification and approval by the cardiologist.

The first month after surgical procedures is called the early postoperative period, at this time it is very important to follow all the doctor's recommendations: diet, calm and measured lifestyle. Nicotine, alcohol, junk food and physical activity are prohibited regardless of the type of intervention.

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

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

At scheduled examinations, the cardiologist will listen to the heartbeat, measure the pressure, and listen to complaints. To check the effectiveness of the operation, ultrasound, computed tomography, x-ray examinations are prescribed. Such visits are scheduled once a month for six months, then the doctor will see you once every 6 months.

Often, in addition to surgical care, medications are prescribed. For example, when prosthetic valves are artificially implanted, the patient drinks anticoagulants for life.

In the postoperative period, it is important not to self-medicate, since the interaction of permanent drugs and other medications can give a negative result. Even conventional painkillers need to be discussed with. To keep fit and restore health faster, it is recommended to be outdoors more often, walk on foot.

Life after heart surgery will gradually return to its previous course, a full recovery is predicted within a year.

Cardiac surgery offers many methods for the rehabilitation of the heart. Such operations are designed to restore the patient's physical and moral strength. You should not be afraid or avoid such procedures, on the contrary, the sooner they are carried out, the greater the chances of success.

May God grant everyone to live a long life so that the surgeon's scalpel never touches his heart. However, not always cardiac surgery can be replaced by therapy.

When is surgery necessary?

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

By urgency, cardiosurgical operations are emergency and planned.

Emergencies are carried out when a person's life is in serious danger. This happens when a myocardial infarction occurs, a blood clot suddenly breaks off, or aortic dissection begins. They do not tolerate delay in surgery when the heart is injured. The consequences of delay are severe.
Planned are carried out in accordance with the developed plan for the correction of the patient's health. The date of the operation may be postponed depending on the circumstances. For example: with a cold, to avoid additional stress on the heart, or when the pressure suddenly dropped.

Surgical intervention differs in the technique of execution. There are such types of heart operations:

with the opening of the chest;
without opening the chest.

open heart surgery

Chest opening operations

Such surgical intervention is used in especially severe cases, when full accessibility of the heart is required during the operation.

Opening of the chest is performed with such pathologies:

tetralogy of Fallot (the so-called congenital heart disease with four serious violations of the anatomical structure);
serious anomalies of intracardiac partitions, valves, aorta and coronary arteries;
heart tumors.

The patient arrives at the hospital one day before the operation. Passes inspection, gives written consent. Be sure to wash with antibacterial soap and shave your hair. Where do you shave your body hair? The hair will be shaved at the site of the proposed incision. If you are going to have a coronary bypass surgery, you will have to shave your legs and groin. In the case of a heart valve replacement, it is necessary to shave the hair in the lower abdomen and in the groin area.

The surgery is performed under general anesthesia. To gain access to the heart, the surgeon opens the chest of the person being operated on. The patient is connected to an artificial lung ventilation apparatus, the heart stops for a while and surgical manipulations are performed with the organ.

How long the operation takes depends on the severity of the pathology. On average, several hours.

Tetralogy of Fallot

Open heart surgery has two advantages.

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

However, there are also significant drawbacks.

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

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

A long recovery is required with significant limitations in the patient's activities.

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

What operations and under what pathologies are performed on the open heart?

Pathologies of the coronary arteries

Coronary artery bypass grafting is done in case of serious atherosclerotic lesions of the coronary arteries, which led to a severe form of coronary heart disease. The essence of shunting is to create a bypass for blood flow to the heart using a shunt, for which an artery or vein taken from the patient is used. For example: mammary coronary artery bypass grafting (MCB) is performed using the internal mammary (mammary) artery.

Operation Ross

Heart valve defects

Today, valves made from the patient's biological material are used to replace damaged valves.

The Ross procedure involves using the patient's own valvular pulmonary artery to replace a diseased aortic valve. An implant is placed in place of the pulmonary valve. Eliminates complications associated with rejection of a valve made of foreign material. Made for both adults and children.
The Ozaki operation involves the use of the patient's own tissue. Only in this case, the replacement of the aortic valve is performed with a valve made from the patient's pericardium. Complications with valve rejection are not observed for the same reason.

Such surgical manipulations are within the competence of cardiac surgeons, and are one of the most complex in nature. Heart surgery is a last resort in the treatment of serious cardiovascular diseases, which are resorted to in order to improve the quality of life of the patient, 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 myocardial blood supply. A similar condition in medical circles is called coronary heart disease. IHD can lead to the formation of an aneurysm, extensive thrombosis. With all the described ailments, certain surgical procedures on the heart may be required.
Heart defects that have both innate and acquired nature. Many defects in the structure of the heart valve are incompatible with life. Therefore, such pathologies are diagnosed even in the prenatal period, and the operation itself is carried out in the first days of the baby's life.
Failures in the frequency, sequence and rhythm of heart contraction, - arrhythmias.

Common indications for heart surgery are the following pathological conditions:

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 does not seek qualified help in time.

It should also be taken into account that any surgical manipulations on the heart carry a risk and are fraught with the development of a number of exacerbations in the rehabilitation period. Doctors turn to such treatment 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 of postoperative complications.

Based on the patient's condition, the type of surgical intervention under consideration is:

emergency. In such a situation, examination and preparation are carried out in a minimal amount, and the operation itself is carried out as soon as possible. This type of manipulation is prescribed for life-threatening conditions, when every minute counts: with aneurysm rupture, extensive myocardial infarction. Often, emergency interventions on the heart are performed on newborns with complex heart disease.
Urgent. There is time for diagnostic and preparatory measures, but not much. After receiving the results of the examination, surgical treatment of the heart disease is carried out.
planned. In some medical sources, this type of operation is called elective. After a detailed study of the patient's condition by a cardiac surgeon, a final decision is made 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 agreed.

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 methods of surgical intervention are used:

Note!

Not so long ago, a new direction in the treatment of heart defects began to be applied in cardiac surgery - X-ray surgery. In essence, they are minimally invasive - the doctor makes small incisions or punctures, and brings special instruments to the heart zone through the catheter. An 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 expanding tubules, vascular stenosis is eliminated.

The progress of the entire procedure is monitored through the monitor screen - this ensures the effectiveness of the operation, as well as its safety for the patient. In addition, during the manipulation under consideration, general anesthesia is not used: the doctor is limited to anesthesia with mini-accesses.

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

Most popular types of heart surgery

To date, the following operations are used in cardiac surgery practice:

1. With coronary heart disease:

2. In case of diagnosing heart disease:

3. In the presence of arrhythmia:

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

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

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

Surgical interventions on the heart are necessary in the treatment of many pathologies of the cardiovascular system that are not amenable to standard drug therapy. With the implementation of surgical treatment, it becomes possible to improve the general condition of the patient and prolong his life. But depending on the pathology, there are different heart operations, which differ in their technique.

Show all

Operations classification

Cardiac surgery is aimed at the treatment of cardiac pathologies through indirect or direct effects on this organ. There are such types of heart operations:

Closed, while the heart itself is not affected. Such operations are performed outside the heart, so they do not need to use special equipment, with the exception of classical surgical instruments. The cavities of the heart remain closed, hence the name of this category.
Open, they require opening the cavities of the heart, which requires the use of special equipment, such as a heart-lung machine. At the time when such a surgical intervention is performed, the heart and lungs are not functioning, which allows the specialist to work with a stopped heart.
X-ray surgery, in which special catheters and devices attached to them are used, they are inserted into the cavity of the heart or the lumen of the vessel to correct the defect. The progress of such an operation is controlled using the monitor screen.

In addition, the types of surgical interventions in cardiac surgery are classified according to the patient's condition and type of defect, as well as the approach to treatment.

According to the patient's condition and the type of defect, there are:

Emergency operations - when you need to act immediately after the diagnosis has become clear, otherwise the pathology threatens the patient's life.
Urgent - they do not require a lightning-fast reaction and a quick start of action. They are prepared for several days, but not longer, due to the high risks of complications or death.
Planned - interventions, the implementation of which is desirable, but not essential in the near future. They are prescribed by surgeons after consultation with patients.

Depending on what approach requires surgical treatment:

Radical - they are aimed at the complete elimination of vices.
Palliative - they are additional or auxiliary, their goal is to improve the patient's condition or prepare him for a radical intervention.

RF ablation

Such surgical intervention as radiofrequency ablation refers to X-ray surgical procedures. It is carried out to improve the condition of the patient suffering from heart failure and arrhythmia, and is characterized by low rates of side effects and complications.

Manipulations during the operation are carried out with special catheters, which are introduced to the patient under local anesthesia. The place of introduction of the catheter, remote from the heart itself, therefore, local anesthesia is carried out at the site of the future introduction of the catheter. In most cases, it is injected into the inguinal vein or femoral artery. After entering the organ, the catheters give electrical impulses to restore the heart rhythm.

Due to such a supply of impulses that eliminate a small area of cardiac tissue that causes pathological excitation of the myocardium, the technique received a second name - cauterization of the heart.

Valve prosthetics

Prosthetic heart valves are used when a valve is insufficiency or stenosis, which interferes with the normal passage of blood through it. Valve replacement can be performed during open surgery, endovascular or mini-access.

In the first case, the patient under general anesthesia is treated with the anterior surface of the chest, the sternum is dissected longitudinally, and the pericardial cavity is opened. To disconnect the heart from blood circulation, the patient is connected to a heart-lung machine, and the myocardium is systematically treated with cold saline during the entire operation in order to avoid its hypoxia.

To install the prosthesis, a longitudinal incision is made, opening the cavity of the heart, the modified structures of the valve are removed, it is replaced with an artificial one, and the myocardium is sutured. After that, the surgeon "starts" the heart with an electrical impulse or by performing a direct heart massage, and turns off the heart-lung machine.

After examining the postoperative view of the heart, pericardium and pleura, blood is removed from the cavities and the surgical wound is sutured in layers.

With endovascular surgery, there is no need to "disconnect" the heart from blood circulation. It is carried out through the leg, namely by introducing a catheter with implantable valves into the femoral artery or vein. After fragments of the damaged valve are destroyed and removed, a prosthesis is put in its place, which straightens itself, having a flexible stent frame.

If the option with a mini-access was chosen, then the surgeon makes an incision 2-5.5 cm long on the anterior wall of the sternum in the area of the projection of the apex of the heart. Then, through the apex of the heart, a catheter is inserted into the organ, advancing it to the affected valve, and replacing it.

In the case of valve replacement, there are several types of implants:

Mechanical - they are made of metal or plastic. When choosing such an implant, the patient in the future will need to constantly take blood thinners.
Biological - they consist of animal tissues and do not require further use of drugs, but after a few decades they need to be replaced.

Installing a pacemaker

In the event that the patient suffers from heart failure, cardiomyopathy and cardiac arrhythmias, the specialist may prescribe a minor operation to install a pacemaker.

The technique for performing such an operation is simple. On the right or left under the left clavicle, local anesthesia is performed with novocaine or lidocaine, after which an incision is made in the skin and subclavian vein to insert a conductor into it, and through it into the superior vena cava and into the heart - an electrode. When the tip of the electrode enters the cavity of the right atrium, the doctor chooses a convenient place for optimal stimulation of the heart muscle, during the search he constantly records ECG changes. When a place is found, the electrode is fixed in the myocardial wall from the inside with the help of antennae or a corkscrew-like attachment. After fixation, it is required to hem a titanium case under the patient's arm, which is installed in the thickness of the pectoral muscle on the left. The wound is sutured and an aseptic bandage is applied.

Coronary artery bypass grafting

Coronary artery bypass grafting is a common heart surgery. It is prescribed when atherosclerotic plaques accumulate on the inner walls of the coronary vessels that feed the heart, disrupting blood flow. In addition, indications can be:

Stable angina 3-4 functional class.
Acute coronary syndrome.
Acute myocardial infarction within the first 4–6 hours of onset of pain.
Severe ischemia without pain.

Before the operation, the patient is intravenously administered sedatives and tranquilizers, and the intervention itself is carried out under general anesthesia. Operative access is done by dissection of the sternum or from a mini-access, making an incision in the intercostal space on the left in the area of the projection of the heart. Manipulation can be carried out both with the connection of the patient to the heart-lung machine, and without it.

The aorta is clamped and connected to the machine, then a vessel is isolated, which will become a bypass. This vessel is brought to the affected coronary artery and its other end is sutured to the aorta. As a result, from the aorta, bypassing the area affected by plaques, the blood will go to the coronary arteries without difficulty.

Depending on how many arteries supplying the heart are affected and at what intervals, the number of shunts can vary from 2 to 5.

When the shunts are fixed, metal staples are applied to the edges of the sternum, soft tissues are sutured and an aseptic dressing is applied. In addition, drainage is removed from the pericardial cavity so that there is an outflow of hemorrhagic fluid.

Operations Glenn and Ross

The Glenn operation is otherwise known as a bidirectional cavopulmonary connection. In this case, anastomosis of the upper part of the superior vena cava with the right pulmonary artery is performed according to the "end to side" principle.

Ross surgery is the replacement of a patient's damaged aortic valve with his pulmonary valve, and the removed pulmonary valve is replaced with a prosthesis.