Table of Contents
- Who undergoes heart surgery?
- What are the types of heart surgery?
- What is the main benefit of heart surgery?
- What are the risks (complications) of heart surgery?
- How long does it take to recover from heart surgery?
- How many years do people with heart surgery live?
- What are the conditions that require a doctor to be informed after heart surgery?
- Are there alternatives to heart surgery?
- References
Who undergoes heart surgery?
Heart surgery may be needed for many heart diseases, but is most commonly performed for the following problems
- Stenosis or blockage of the vessels that supply the heart: Bypass surgery (CABG)
- Stenosis or leakage of heart valves: Heart valve surgery (Cover replacement or repair)
- Congenital heart problems: Congenital heart surgery
Video 1: Bypass surgery
Video 2: Mitral valve surgery
Video 3: Aortic valve surgery
What are the types of heart surgery?
- Open heart surgery: For many people, open heart surgery is what comes to mind when they think of heart surgery. In this classical method, the surgeon makes a 15-20 cm long vertical incision in the patient's breastbone, the so-called "faith board", and pulls the ribs sideways to reach the heart. The heart is stopped for the intervention. The patient is then connected to a device called a heart-lung pump. The duration of the operation depends on the type of surgery. For example, bypass surgery, which is the most common surgery, takes 3-4 hours on average.
- Bypass surgery on a beating heart: This surgery is similar to conventional heart surgery, but the patient is not connected to a heart-lung pump. The whole surgery is performed while the heart continues to work. Therefore, it is also called "off-pump" surgery. Only bypass surgery can be performed with this method. It can be performed for one or two vessels.
- Minimally invasive surgery: Although it is popularly known as "closed" heart surgery, it is actually an "open" type of surgery. In contrast to the conventional method, a much smaller incision is made in the chest. This small incision can be in the area of the faith (mini-sternotomy) or between the ribs (mini-thoracotomy). One type of minimally invasive surgery is robotic surgery. Here, several small holes are made in the chest through which the robot's rods are inserted into the chest. The surgeon does not touch the patient directly; he or she performs the operation by remote controlling the robot's arms from a corner of the operating room. Minimally invasive surgery results in less aesthetic scarring and a shorter recovery time.
What is the main benefit of heart surgery?
The aim is to solve the problem in the heart so that the patient can live a longer life. At the end of the healing process, the patient feels fitter and healthier.
What are the risks (complications) of heart surgery?
- Bleeding during or after surgery
- Disruption of heart rhythm
- Infection at the chest incision site (skin or bone)
- Infection inside the rib cage
- Pneumonia
- Kidney failure
- Heart attack
- Lung clotting (pulmonary embolism)
- Inflammation of the pericardium (acute pericarditis; early or late type)
- Permanent impairment of the elasticity of the pericardium (constrictive pericarditis)
- Heart failure
- If a vein is removed from the leg, significant edema in that leg
- Stenosis of the artificial heart valve (valve degeneration)
- Infection of the artificial heart valve (infective endocarditis)
- Artificial heart valve suture breakdown and development of blood leakage (paravalvular leakage)
- Postoperative depression or anxiety disorder
- Forgetfulness or difficulty thinking clearly
- Paralysis (stroke)
- Death
How long does it take to recover from heart surgery?
This period varies depending on the type of surgery performed and the general health status of the patient. Most patients recover within 1.5-2 months.
How many years do people with heart surgery live?
This can usually be answered as "very many years". However, the number of years the patient will live depends on the patient's general health, the presence of other serious diseases, the type of surgery performed and the age of the patient.
What are the conditions that require a doctor to be informed after heart surgery?
It is normal to feel a little restless and unhappy after surgery. During the healing process, it can be difficult for the patient to understand what is normal and what is abnormal. If in doubt, it is best to call the doctor to confirm. However, the following is not normal:
- Increasing chest pain
- Fire
- Nausea or vomiting
- Shortness of breath
- Bleeding
- Purulent discharge or increasing redness at the incision site
- Speech impairment or similar stroke symptoms
Are there alternatives to heart surgery?
Ameliyat önerilen kalp hastalıklarının büyük çoğunluğu ameliyatsız yöntemlerle de tedavi edilebilir. Bu yöntemlerin “ameliyatsız” olarak adlandırılma nedeni, ameliyatın aksine göğüs kafesinin kesilmesine ve kalbin durdurulmasına ihtiyaç duyulmamasıdır. Yani, tüm aşamalar kalp çalışmaya devam ederken yapılır. Kalbin durdurulmaması ve dolayısıyla kalp-akciğer pompasına bağlanma ihtiyacının olmaması sayesinde bu işlemlerdeki riskler genel olarak ameliyata kıyasla daha azdır. Göğüste kesi yapılmadığından iyileşme süreci, ağrı ve stres daha az olur. Göğüste yara izi olmadığından estetik sorun da olmaz. Genellikle kasıktan, kalemden daha ince küçük bir damar girişi yoluyla kalbe gönderilen uzun, esnek borular (kateter) yardımıyla bu işlemler yapılır. En tipik örnek, bypass ameliyatı yerine damarların kompleks teknikler ve malzemeler kullanarak stents opening of the aortic valve. Also, non-surgical replacement of the aortic valve of the heart (TAVI)Balloon dilatation of mitral valve stenosis (mitral balloon) ve mitral kapak kaçağının mandal ile tedavisi (MitraClip) de diğer sık uygulanan ameliyatsız yöntemlerdendir. Tüm bu ameliyatsız yöntemler girişimsel kardiyologlar tarafından uygulanır; ameliyatlar ise cerrahlar tarafından yapılır.
Thanks to advances in technology, today, an experienced interventional cardiologist, whose professional interest is in complex procedures, can also open complex blockages in the arteries with a stent. The stent provides the same benefit as bypass surgery in most patients in whom bypass surgery is decided. So, in these patients, bypass surgery and stenting are equally effective; neither is wrong. However, some patients still require bypass surgery (see References).
For serious decisions, such as the choice of treatment, we recommend that you seek a second opinion from a different physician. It is important that you request that the most up-to-date scientific evidence for the proposed treatment is presented in understandable language, with references.
Prof. Dr. Şükrü Akyüz, girişimsel kardiyologdur. Mesleki ilgi alanı, kalp hastalıklarının ameliyatsız yöntemlerle tedavisidir. Kompleks damar tıkanıklıklarının özel stentleme yöntemleriyle ameliyatsız açılması, TAVI ve mandal yöntemi de bu tedavilere dahildir.