Cardiovascular Surgery Turkey
The cardiovascular system transports all the necessary substances that ensure the continuity of all vital functions to the necessary parts of the body, providing oxygenation, disposal of liquid waste from the body, control of the endocrine system, and body internal temperature control.
If the family doctor thinks of heart disease, the cardiologist who will refer to the cardiologist will refer to the cardiovascular surgeon if he thinks of a disorder that will require surgery.
The cardiovascular surgeon performs many operations such as heart valve repair and replacement, congenital heart defect repair, coronary artery bypass, vascular or heart ballooning (aneurysm) repair, increasing vascularization in the heart muscle with laser, malfunctions in the main vessel aorta, and heart transplantation. In recent years, ventricular assist devices are known as artificial heart namely, Ventricular Assist Device (VAD) operations are also performed by cardiovascular surgeons to ensure adequate pumping of blood to the body against heart failure.
Cardiovascular surgical methods were developed in Germany in 1896 by Dr. Ludwig Rehn opened the rib cage (thoracotomy) and reached the heart and repaired the cut as a result of a knife injury. Until the 1990s, open-heart surgery, that is, operations performed by completely evacuating the heart and connecting the patient to the heart-lung machine were successfully applied. Valve surgeries are performed with interventional methods with the techniques developed in recent years.
Coronary bypass surgery is an operation that increases blood flow to our heart. Our heart is a muscle pump and is fed by the vessels we call the coronary artery.
Why is coronary artery bypass graft surgery (CABG) needed?
Metabolic disorders such as obesity and diabetes, which increase mainly due to fatty and sugary nutrition, stress, lack of exercise, cause blood pressure and related small tears in the arteries, and as a result of the narrowing of the inner surface of the coronary arteries with the formations we call plaque, decrease in blood flow to the heart muscle As a result of the heart’s inadequate nutrition, it causes chest pain called angina. Angina is a very severe and stabbing pain, often lasting 2-3 minutes for a short time. The next stage of this situation is a heart attack. Coronary bypass surgery increases the blood flow to our heart and provides a better blood supply to our heart and thus protects our heart from a possible crisis. It also eliminates complaints such as shortness of breath and chest pain.
Is coronary bypass surgery done frequently?
Coronary artery bypass surgery is the most common type of heart surgery performed all over the world and in our country.
How is coronary artery bypass surgery performed?
This surgery is performed with various techniques, often a technique called classical coronary bypass is used. The aim is to bypass the occluded vessel and provide sufficient blood flow from the vein to the heart by suturing one end to the aorta and the other end of the stenosis.
- Classical coronary artery bypass surgery: The breastbone is opened, the heart is stopped with a special technique and connected to the machine we call the heart-lung machine, which will serve as heart and lungs during the operation. The most suitable diameter vein is taken from the leg or around the rib cage and the vein is sewn with the appropriate technique. Then the heart is started again and separated from the machine, the bones and tissues are stitched again and the operation is terminated.
The most important advantage of this surgery is that the heart has stopped, new vessels are sutured in a much more comfortable environment, which is the most important factor that increases the success of bypass surgeries. Also, with this surgical technique, you can safely bypass as many vessels as you want; This surgery can even be performed in very long strictures.
- Coronary artery surgery in the beating heart (beating heart): It is performed by opening the breastbone like classical coronary bypass surgery. However, without stopping the heart and using a heart-lung machine, new vessels in the beating heart are sutured to the vessels with stenosis.
The most important advantage of this technique is that the heart-lung machine is not used since the heart cannot be stopped. In this case, the side effects that may occur due to the machine are minimized. However, the most important disadvantage of the surgery is that it cannot be applied to every patient. In some patients, since the vascular structure is extremely calcified, the stitching of new vessels may not be healthy in the beating heart, and the possibility of stenosis subsequently increases in this procedure, which we call anastomosis. It should not be forgotten that one of the most important factors in the success of coronary bypass surgeries is the perfect anastomosis. For this reason, bypass surgery in the beating heart should be applied only to patients whose vascular structure will allow perfect anastomosis.
- Coronary artery bypass surgery performed through a small incision (minimally invasive): In this technique, without the need to open the breastbone, from the side of the chest between the ribs The heart is reached with an approximately 7-8 cm incision. This technique is a more suitable technique for bypass surgery on the veins in the anterior part of the heart. It is very difficult to reach the veins that feed the back of the heart. Therefore, it is not suitable for every patient. Again, in this surgery, the vascular structure should be suitable for bypassing the beating heart.
Small incision coronary bypass surgery is a relatively new technique. Performing this surgery has become easier with new instruments developed in recent years. However, it is still an operation that does not have long-term results yet and can be applied in a limited number of patients.
This Which vessels are used in coronary artery bypass surgery?
The arterial grafts in bypass surgeries either from the back of the breastbone (Mamarian artery) or from the arm (radial artery). We remove vein grafts from the leg. (saphenous vein) Various technical details determine which graft to use on which patient.
Who should have coronary bypass surgery?
Two coronary vessels carry blood to our heart, right and left. Side branches are originating from these two main veins. Approximately 70% of our heart is fed from the left vein. Main vessel occlusions, occlusions close to the starting point of the vessel, and stenosis that hold the vessel along its length benefit more from the bypass procedure. Also, patients with diabetes mellitus and impaired heart contraction benefit more from bypass surgery.
How long will I recover after the bypass surgery?
Coronary bypass surgeries are very promising operations due to their results. Patients are followed up in the intensive care unit for up to one day after surgery, depending on their condition. They are then discharged after being followed up in the service for 4-5 days. Recovery takes 3-4 weeks.
What should I pay attention to after coronary artery bypass surgery?
The most important thing is the healthy healing of your wound areas. Breast bone union takes about 2-3 weeks. During this time, it is important to wear your chest corset and prevent any impact on the chest area. Also, it is important to avoid crowded environments to prevent the development of infection and to keep your blood sugars under control if you have diabetes.
Will I continue to use the medication after the bypass surgery?
Yes, there will be drugs you should use. Having a bypass surgery does not prevent the underlying vascular calcification. Also, it is important to control the risk factors that cause vascular calcification for the newly stitched bypass vessels to remain open longer. For this reason, you should use your blood pressure medications, if you are diabetic, the medicines you need to use for the high levels of blood lipids and your blood thinners.
Heart Valve Diseases
Our heart is a muscle pump consisting of four chambers. Heart valves are the structures that regulate the blood flow between the vessels that we call the Aorta and the Pulmonary artery, which come out of the heart and distribute blood to our body.
How many heart valves do we have?
There are four heart valves in our bodies. Two of them are located on the left side of the heart and two on the right. On the left, the valve between the left atrium and the left ventricle is called the mitral valve, and the valve between the left ventricle and the aortic vessel is called the aortic valve. On the right side, the valve between the right atrium and the right ventricle is called the tricuspid valve, and the valve between the right ventricle and the pulmonary artery is called the pulmonary valve.
What are the symptoms of valvular heart disease?
The most important symptom of valvular heart disease is shortness of breath. This symptom, which occurs with movement in the early stages of the disease, becomes evident in the later stages. Another symptom is arrhythmia. The rhythm we call atrial fibrillation often occurs in advanced stages in heart valve diseases. There is an irregular beat in this rhythm and can lead to clot formation in the heart. This clot can manifest itself with embolism in the brain and other organs. Another symptom seen in the advanced stages of heart valve diseases is the edema table, which is more common in both legs, which occurs due to water retention.
Why does valvular heart disease develop?
Heart valve diseases occur congenitally or acquired. The most important factors are rheumatic fever, which is acquired in childhood, degenerative calcification (degenerative), and heart attack in mitral valve insufficiency. Deformation in the valves caused by heart valve disease causes valve stenosis, stenosis, or the valve’s leakage of blood back causes insufficiency.
In which valves the disease develops most frequently?
Heart valve diseases caused by age-related calcification are most common in the aortic valve. The disease we call Aortic Valve Stenosis due to calcification in the aortic valve. come out. The valvular disease that occurs as a result of a heart attack occurs in the mitral valve. In this disease, the mitral valve cannot be closed completely and some blood flows back, which is called mitral valve insufficiency.
How is the diagnosis of valvular heart diseases maintained?
The patient’s history and complaints have an important place in the diagnosis of valvular heart diseases. In terms of diagnosis, the most valuable method is Echocardiography. Echocardiography gives us valuable information about heart and valve structure via sound waves. We plan the treatment based on the information we get with echocardiography. There are two types of echocardiography: The first is the method we call “transthoracic echocardiography”, which is performed over the chest. The other is a more detailed examination, which we call “transesophageal echocardiography”, performed orally, through the esophagus. Other diagnostic methods such as angiography and tomography can be used depending on the stage of the disease.
What are the treatment methods for heart valve diseases?
The treatment of valvular heart diseases varies according to the stages of the disease. In the initial stages of the disease, the symptoms of the disease are tried to be controlled with medication. The main treatment of heart valve diseases is to repair or replace the valve. The repair method is more suitable especially for mitral valve and tricuspid valves. When the cover needs to be changed, prosthetic caps that we call mechanical or biological valves are used. Which valve type will be preferred for which patient depends on many factors. In general, mechanical valves are preferred in young patients and biological valves are preferred in elderly patients.
What is heart valve repair and how is it done?
Heart valve repair is a treatment method we use more frequently, especially for mitral and tricuspid valves. In some special cases, we can use it in the aortic valve. In the repair method, the deteriorated function of the valve is tried to be corrected by using the person’s tissues. We often use it for mitral valve insufficiency. The most important advantage is that the person’s tissues are used, so there is no need to use blood thinners after surgery and a more resistant treatment form are obtained. The most important requirement for a good repair is the long-term durability of the repair.
Valve repair surgeries are performed with open-heart surgery techniques. The surgery can be performed by opening the breastbone or using a small incision from the side of robot technology. The heart is topped with a special drug and connected to the heart-lung machine. This machine takes over the functions of the heart and lungs during the operation. After the operation is over, the heart is restarted and the machine is separated.
Depending on the characteristics of the surgery to be performed, a small incision or robot technology can be used from the side without opening the breastbone in mitral and tricuspid valve surgeries. The most important advantage of these techniques is that the patient returns to daily life in a shorter time. Also, advantageous results are obtained in terms of cosmetics.
When will I recover after heart valve surgery?
The most important factor determining the healing process after heart valve surgery is heart functions and the general condition of the body. Patients with weakened heart functions and other organ functions take longer to recover. From this point of view, early surgery in heart valve surgeries, the results of operations performed without impairment of heart functions and organ functions are better. Generally speaking, you stay in intensive care for 1-2 days after surgery. Hospital stay is 4-5 days. The full recovery period after the operation is 3-4 weeks.
Do I need to use antithrombotics after valve surgery?
Conditions in which blood thinners should be used continuously after heart valve surgeries: Patients with mechanical valves and patients with rhythm disturbances. If there is no rhythm disorder in patients undergoing biological valve and heart valve repair, blood thinners are used in the first 3 months after the operation and this treatment is discontinued afterward.
What are the non-surgical treatment methods in valvular diseases?
Non-surgical treatment methods in heart valve surgeries have become more common in recent years. Among these methods, the most commonly used method is the valves that we briefly call TAVI, which we apply in aortic valve stenosis and which we place in the heart with the help of a catheter. These caps are biological. Therefore, it is only suitable for use in patients over a certain age. Also, postoperative problems such as pacemakers and valve leakage are more common than surgical valve replacement surgeries. However, when applied in certain patients, the results are promising. The latching method used in mitral valve leaks is another catheter-based treatment method for mitraclip. It reduces leakage in certain patients. However, it is not a very successful method in terms of the long-term results of the treatment.
Heart rhythm disorders
Can surgery be done for a rhythm problem?
When rhythm disorder is mentioned in heart valve diseases, we understand the rhythm we call atrial fibrillation. Normal rhythm is the rhythm we call sinus rhythm. In atrial fibrillation, the parts of the heart that we call the auricle to grow as a result of the dysfunction caused by the heart valve, and this causes the conduction tissues in these parts of the heart to work differently. There are surgeries for rhythm disturbances in valvular patients and are performed simultaneously with heart valve surgeries under certain conditions. This surgery is called Maze surgery. Its basic principle is to create a new communication path in the heart from the auricle to the ventricle. If the auricle area of the heart is not overgrown and the emergence of atrial fibrillation rhythm in the person is short-term, it is more likely to achieve a normal sinus rhythm with this surgical technique.
Although it is rare in the heart, it can be a carcinogenic or non-carcinogenic tumor. Tumors in the heart can be in two forms;
- Primary (non-carcinogenic or cancer): Primary heart tumors originating from the heart are rare and less than 1 in 2,000. Generally, primary heart tumors are non-carcinogenic.
- Metastatic (always cancerous type): Metastatic heart tumors that develop in another organ and then spread throughout the body and settle in the heart.