Treatments & Therapies

Cardiac Surgery – Treatment, Effect & Risks

Cardiac surgery

Cardiac surgery has been an independent medical specialty since 1993 . The primary specialty is thoracic and cardiovascular surgery, which evolved from general surgery . Cardiac surgeons treat acquired and congenital heart disease and injuries to the heart and surrounding vessels. Cardiac surgery works closely with vascular surgery and cardiology .

What is cardiac surgery?

The public perceives heart surgery primarily in the field of heart transplants . However, these complicated and sometimes life-threatening operations are by no means the most common operations.

Cardiac surgeons primarily perform heart valve surgery and coronary artery bypass grafts. Cardiac Surgery includes six focus groups: Coronary Surgery, Mitral Valve Surgery, Aortic Valve Surgery, Aortic Surgery, Heart Failure , and Pacemakers .

Treatments & Therapies

During surgical revascularization, the heart specialists use bypasses as a highly effective long-term therapy for coronary heart disease. This procedure is particularly suitable for patients who have multivessel coronary disease including the large anterior wall artery (ramus interventricularis).

Surgical revascularization is also induced in the presence of reduced left ventricular heart function with parallel diseases, e.g. of the heart valve. Cardiac patients benefit to the same extent when the diagnosis is main stem stenosis.

The heart specialists are guided by the national care guidelines, which specify when a bypass operation should be given preference over balloon dilatation or drug therapy. Patients benefit from a minimally invasive bypass transfer that occurs without the use of a heart-lung machine, OPCAB. The arterial bypass vessels are removed from the patient endoscopically.

Automated instruments are used to perform the anastomotic suture. Operations on the mitral valve are among the most common interventions in the field of heart valve reconstruction, which is carried out using minimally invasive interventions. Diseases of the aortic valve particularly affect older patients over the age of 70. Various heart valves are available for replacing the aortic valve, with a distinction being made between biological and mechanical heart valves. If there is a regular heart (sinus) rhythm, the relocation of a biological valve is induced, since lifelong anticoagulant therapy with Marcumar is not necessary.

Biological heart valves are mainly implanted in patients over the age of 65. These heart valves are now also being increasingly used in younger patients. These innovative models have a shelf life of 15 years. The good experiences regarding recurrence operations of degenerated biological aortic valves have confirmed the high expectations of this procedure.

A contraindication in patients under the age of 65 is a second operation in old age, since the biological heart valves only have a limited durability. Calcified heart valves can also be regenerated in this way. A mechanical heart valve and blood coagulation planning can be avoided.

Catheter-based aortic valve surgeries are performed either transfemorally (via the leg artery) or transapically (via the apex of the heart). Operations on the aortic valve combined with coronary revascularization are complex operations that involve an increased risk for elderly patients. Frequent interventions take place on the ascending aorta (aorta ascendens). This intervention places high demands on the heart surgeons, since the main artery and the aortic roots are exchanged up to the carotid arteries. Doctors use different techniques to protect the brain from embolism and circulatory disorders .

In the majority of cases, there are dilatations due to an aneurysm , which occurs as a result of progressive degeneration in old age. Younger heart patients often have a disturbed strength of the aortic wall ( Marfan syndrome ). An emergency indication is aortic dissection. During the operation, the valves are sewn into a vascular prosthesis. In commercially manufactured vascular prostheses, the artificial heart valves are already sewn in.

Cardiac surgeons prefer the first method, however, because it allows some flexibility, since larger heart valves can also be sewn in, which significantly improve hemodynamics. In the case of these biological conduits, the administration of anticoagulation with Macumar becomes obsolete, which is a decisive advantage.

Doctors prefer the stentless valve, which is sewn into the vascular prosthesis . This newly manufactured aortic root shows above-average performance (hemodynamics). Reconstruction of the aortic valve is preferred to replacement because medicine has now developed various innovative techniques that enable patients to live a carefree post-operative life.

In this regard, operations are performed on the aortic arch and eliminate the life-threatening aortic dissection, which in the absence of timely therapy inevitably leads to death. Heart failure is the most common heart disease. This disease can occur in the form of a heart attack, severe inflammation or during heart surgery.

However, chronic heart failure is by far the most common coronary disease. In some patients, this condition can be controlled with drug therapy. If this is not the case, only the implantation of an artificial heart or a heart transplant is possible . In most cases, there is a need to treat the patient with an artificial heart system until a suitable donor heart is available.

However, the risks involved are high as the waiting times are long and there is a risk that the body will reject the implanted donor organ. Defibrillator and pacemaker technology has experienced significant technical innovations in recent years, since various computer-controlled algorithms simulate the natural heartbeat under rest and stress conditions almost exactly.

Diagnosis & examination methods

Anticoagulants, which help blood to clot , are the most common . Most patients are given Godamed, Marcumar , Colfarit, Aspirin , Asasantin, ASS , Plavix, Iscover, or Tiklyd. These drugs must be discontinued before an operation due to the risk of bleeding.

However, this withdrawal does not take place on one’s own responsibility, but under medical supervision, since the regulated blood flow is not guaranteed without these anticoagulants . Under certain circumstances, the doctors use a replacement medication. If there is coronary heart disease or a bypass operation to be performed, the patients take the drug ASA until they are admitted to the hospital. If a coronary stent was placed within the last 12 months, Iscover or Plavix will continue to be taken. Tests are carried out in the laboratory and tests are carried out in the following areas: hepatitis and HIV serology, lung function, blood group, coronary angiography, echo, duplex carotids, abdominal sonography to clarify whether there is an infection or an abdominal aortic aneurysm, chest x -ray and calculation of the Euroscore for risk patients.

In the case of valve surgery, X-ray OPG, X-ray paranasal sinuses , dental presentation, ENT presentation and 3D-TEE (morphological assessment of the mitral valve) are made before reconstructions. In the case of elective valve surgery, an infection focus must be eliminated in order to avoid or minimize endocarditis . Postoperatively in the intensive care unit: ECG , blood pressure control, blood analysis, ventilation, PiCCO (monitoring of cardiovascular data), pulmonary artery catheter, IABP (intra-aortic balloon pump), SpO² (blood oxygen, oxygen saturation), CVP (measurement of central venous pressure), ECMO (extracorporeal membrane oxygenation, intensive care technology for ventilation).

Medication includes Cordarex (antiarrhythmic), vasopressin , dobutamine, adrenaline , noradrenaline , and corotrop. The patients are first extubated and mobilized the day after the operation and transferred to the normal ward.

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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.