How are operations performed?
An operation is an intervention in the human body that violates its integrity. Each disease requires an individual approach, which naturally affects the way in which the operation will be performed.
How heart surgery is done: preparation for surgery
Heart surgery (cardiac surgery) is one of the most difficult, dangerous and responsible types of surgical intervention.
Elective surgeries are usually performed in the morning. Therefore, in the evening (8-10 hours before) the patient is not allowed to eat or drink, and immediately before the operation a cleansing enema is given. This is necessary for the anesthesia to work as it should. 
The place where operations are performed must be sterile. In medical institutions, special rooms are used for these purposes - operating rooms, which are regularly sterilized with quartz treatment and special antiseptics. In addition, all medical personnel who take part in the operation wash themselves before the procedure (you even have to rinse your mouth with an antiseptic solution), and also change into special sterile clothing and put sterile gloves on your hands.
The patient is also put on shoe covers, a cap on his head, and the surgical field is treated with an antiseptic. If necessary, the patient's hair is shaved before surgery if it covers the surgical field. All these manipulations are necessary to avoid contamination of the surgical wound with bacteria or other dangerous active microorganisms.
Anesthesia or anesthesia
Anesthesia is a general anesthesia of the body with immersion in a medicated sleep. 
For surgical interventions on the heart, general anesthesia is used, and in some cases, when performing endovideosurgical operations, spinal anesthesia is used, in which a puncture is made into the spinal cord at the lumbar level. Substances that cause pain relief can be administered in different ways - intravenously, through the respiratory tract (inhalation anesthesia), intramuscularly or in combination.
Progress of open heart surgery
After the person goes into medicated sleep and stops feeling pain, the operation itself begins. The surgeon uses a scalpel to open the skin and soft tissue on the chest. Cardiac surgery may also require “opening” the chest. To do this, the ribs are sawed using special surgical instruments. Thus, doctors “get” to the organ being operated on and place special dilators on the wound, which provide better access to the heart. Junior medical personnel use suction to remove blood from the surgical field and also cauterize the cut capillaries and vessels so that they do not bleed. 
If necessary, the patient is connected to an artificial heart machine, which will temporarily pump blood throughout the body while the organ being operated on is artificially suspended. Depending on what type of heart surgery is performed (what damage is being repaired), appropriate manipulations are performed: this could be replacing blocked coronary arteries, replacing heart valves for defects, vein bypass surgery, or replacing an entire organ.
The surgeon and all staff are required to be extremely careful, as the patient’s life depends on it. It should also be added that during the operation, blood pressure and some other indicators that indicate the patient’s condition are constantly monitored.
Endovideosurgery: stenting and angioplasty
Today, more and more often, heart surgery is performed not in an open way - with an incision in the chest, but with access through the femoral artery in the leg, under the control of an X-ray machine and a microscopic video camera. After preparing for 
operation, which is similar for all types of surgical interventions, and putting the patient into medicated sleep, access to the femoral artery is opened through an incision in the leg. A catheter and a probe with a video camera at the end are inserted into it, allowing access to the heart.
This method in cardiac surgery is used to perform angioplasty with vascular stenting, which is necessary for blockage of the coronary vessels that supply blood to the heart itself. Special stands are installed in the narrowed vessels - cylindrical implants, which prevent the arteries from becoming clogged, which prevents the possibility of developing coronary disease.
After the main part of the operation is over, and the heart is on its own again 
functions, stitching of damaged nerves, vessels and tissues is performed. The wound is again treated with an antiseptic, the surgical field is closed, and soft tissue and skin are sutured with special threads. A medical bandage is applied to the external wound. After all these procedures are completed, the patient is removed from anesthesia.
Other types of operations
In addition to the abdominal operations described above, there are also operations performed in a less traumatic way:
- Laparoscopy - performed using a laparoscope, which is inserted through 1-2 cm incisions in the skin. Most often used in gynecology, during gastric resection and other operations in the abdominal cavity. You can read more about this
- Laser surgery is performed using a special laser beam. Usually this method is used to perform operations on the eyes, when removing skin lesions, etc. You can read more about the method
Review
Open heart surgery is a surgical procedure that opens the chest and affects the muscles, valves, or arteries of the heart.
According to the US National Institute of Heart, Lung, and Hematology (NHLBI), coronary artery bypass grafting is the most common heart surgery in adults. During this surgery, a healthy artery or vein is transplanted (attached) to a blocked coronary (heart) artery. As a result, the grafted artery delivers blood to the heart bypassing the blocked artery (NHLBI).
Open heart surgery is sometimes called traditional heart surgery. Today, many new heart procedures require only small incisions rather than large incisions. That is, the concept of open heart surgery can sometimes be misleading.
Reasons
Open heart surgery allows for coronary artery bypass grafting. Coronary artery bypass grafting may be required for patients with coronary artery disease.
Coronary artery disease occurs when the vessels that carry blood and oxygen to the heart become narrow and inelastic. This disease is known as atherosclerosis.
Atherosclerosis occurs when fatty deposits create plaque on the walls of the coronary arteries. Plaques narrow the arteries, making it difficult for blood to pass through them. If blood does not flow to the heart properly, a heart attack can occur.
Open heart surgery is also performed to:
repair or replace blood vessels, allowing blood to pass through the heart; repair damaged or abnormal areas of the heart; install medical devices that will help the heart function properly; replace a damaged heart with a donor one (transplantation).
Operation
Operation
According to the National Institutes of Health, coronary artery bypass grafting takes four to six hours. Let's look at what it is, step by step.
The patient receives general anesthesia. He falls asleep and does not feel pain from the operation. By making a 20 to 25 centimeter incision in the chest, the surgeon cuts through all or part of the chest bone to gain access to the heart. Once the heart opens, the patient is connected to a heart-lung machine. It diverts blood away from the heart so the surgeon can operate. Some new technologies make it possible to abandon this device. The surgeon uses a healthy vein or artery to create a new path around the blocked artery. The rib cage is held together with wires that remain inside the body. The initial incision is sutured. (NIH)
A chest plate is sometimes used in high-risk patients, especially in the elderly and in those who have had multiple surgeries. In this case, the breast bone is connected after surgery with small titanium plates.
Risks
Risks of coronary artery bypass grafting:
wound infection of the chest (most common in obesity, diabetes, repeated bypass operations); heart attack or stroke; heart rhythm disturbance; damage to the lungs or kidneys; chest pain, low-grade body temperature; memory loss or blurred memories; blood clots; blood loss; difficulty breathing.
According to the University of Chicago Medical Center (UCM), using a heart-lung machine increases the risks. These risks will include stroke and memory problems (UCM).
Preparation
Preparation
Tell your doctor about all the medications you take, including over-the-counter drugs, vitamins, and herbs. Report any health problems, including herpes, infection, colds, flu, fever.
Two weeks before surgery, your doctor may ask you to avoid smoking and stop taking vasoconstrictor medications such as aspirin, ibuprofen, or naproxen.
On the eve of the operation, you will be asked to wash yourself with special soap. It kills bacteria on the skin and reduces the chance of infection after surgery. You may be asked not to eat or drink anything after midnight.
You will receive further instructions when you arrive at the hospital for surgery.
Rehabilitation
Rehabilitation
When you wake up after surgery, you will have two or three tubes in your chest. They are necessary to remove fluid from the area around the heart.
You may have intravenous tubes that will give you fluids.
You may have a catheter (thin tube) placed in your bladder to drain urine.
You may also have machines connected to you to monitor your heart function. Nurses will be nearby to help you if necessary.
You will most likely spend the first night in the intensive care unit. After three to seven days you will be transferred to a regular ward.
Long
Long
You must be prepared for gradual recovery. Improvement will occur in about six weeks, and after about six months you will feel the full benefits of the operation. So, the outlook is optimistic for many people, the shunt can work for many years.
However, the operation does not exclude re-occlusion of the vessels. The following measures will help maintain your health:
proper nutrition; limiting salty, fatty and sweet foods; maintaining physical activity; quitting smoking; control high blood pressure and cholesterol levels.
Heart operations are performed very often today. Modern cardiac and vascular surgery are very developed. Surgical intervention is prescribed when conservative drug treatment does not help, and accordingly, normalization of the patient’s condition is impossible without surgery.
For example, a heart defect can only be cured surgically; this is necessary when blood circulation is severely impaired due to pathology.
And as a result, the person feels unwell and serious complications begin to develop. These complications can lead not only to disability, but also to death.
Surgical treatment of coronary heart disease is often prescribed. Since it can lead to myocardial infarction. As a result of 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. Surgeries are often performed due to abnormal heart rhythm (RFA).
They also perform heart transplantation, that is, transplantation. This is necessary in the case when there is a complex of pathologies due to which the myocardium is not able to function. Today, such an operation prolongs the patient’s life by an average of 5 years. After such an operation, the patient is entitled to disability.
Operations can be performed urgently, urgently, or scheduled intervention. This depends on the severity of the patient's condition. Emergency surgery is performed immediately, immediately after diagnosis. If such intervention is not carried out, the patient may die.
Such operations are often performed on newborns immediately after birth with congenital heart disease. In this case, even minutes matter.
Emergency operations do not require quick implementation. In this case, the patient is prepared for some time. As a rule, this is several days.
A planned operation is prescribed if there is no danger to life at this time, but it must be carried out in order to prevent complications. Doctors prescribe myocardial surgery only if it is necessary.
Invasive research
Invasive methods for examining the heart involve catheterization. That is, the study is carried out through a catheter, which can be installed either in the heart cavity or in a vessel. Using these studies, you can determine some indicators of heart function.
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.
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 arrhythmia, heart failure, atherosclerosis, ischemic heart disease, myocardial infarction, and many other diseases. Only natural ingredients are used, no chemicals or hormones!
Invasive methods make it possible to study the pathology of the valves, their size and the 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.
Such studies include:
Angiography. This is a method for which a contrast agent is used. It is injected into the heart cavity or vessel for accurate visualization and determination 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 necessary, and if not, what therapy is suitable for a given patient. Ventriculography. This is a study using X-ray contrast, which will determine the condition of the ventricles and the presence of pathology. All ventricular parameters can be studied, such as cavity volume measurements, cardiac output, measurements of cardiac relaxation and excitability.
In selective coronary angiography, contrast is injected into one of the coronary arteries (right or left).
Having studied Elena Malysheva’s methods in the treatment of HEART DISEASE, as well as restoration and cleansing of VESSELS, we decided to bring it to your attention...
Coronary angiography is often performed in patients with angina pectoris of functional class 3-4. In this case, it is resistant to drug therapy. Doctors need to decide what kind of surgical treatment is needed. It is also important to carry out this procedure for unstable angina.
Invasive procedures also include punctures and probing of the heart cavities. Using sounding, you can diagnose heart defects and pathologies in the left ventricle, for example, these could be tumors or thrombosis. To do this, use the femoral vein (right), a needle is inserted into it through which a conductor passes. The needle diameter becomes about 2 mm.
When performing invasive examinations, local anesthesia is used. The incision is small, about 1-2 cm. This is necessary to expose the desired vein for installing the catheter.
These studies are carried out in different clinics and their cost is quite high.
Review from our reader Victoria Mirnova
I recently read an article that talks about Monastic tea for treating 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’m not used to trusting any information, but I decided to check and ordered a bag. I noticed changes within a week: the constant pain and tingling in my heart that had tormented me before receded, and after 2 weeks disappeared completely. Try it too, and if anyone is interested, below is the link to the article.
Surgery for heart disease
Heart defects include
heart valve stenosis; heart valve insufficiency; septal defects (interventricular, interatrial). 
Valve stenosis
These pathologies lead to many disturbances in the functioning of the heart, that is, the goals of operations for defects are to relieve the load on the heart muscle, restore the normal functioning of the ventricle, as well as restore contractile function and reduce pressure in the cavities of the heart.
To eliminate these defects, the following surgical interventions are performed:
Valve replacement (prosthetics)
This type of operation is performed on an open heart, that is, after opening the chest. In this case, the patient is connected to a special machine for artificial blood circulation. The operation consists of replacing the damaged valve with an implant. They can be mechanical (in the form of a disk or ball in a mesh, they are made of synthetic materials) and biological (made from animal biological material).
Valve implant placement
Plastic surgery of septal defects
It can be carried out in 2 options, for example, suturing the defect or plastic surgery. Suturing is carried out if the hole size is less than 3 cm. Plastic surgery is performed using synthetic tissue or autopericardium.
Valvuloplasty
In this type of operation, implants are not used, but simply expand the lumen of the affected valve. In this case, a balloon is inserted into the lumen of the valve and inflated. It should be noted that such an operation is performed only on young people; as for older people, they are only entitled to open-heart surgery.
Balloon valvuloplasty
Often, after surgery for a heart defect, a person is given disability.
Surgeries on the aorta
Open surgical procedures include:
Prosthetics of the ascending aorta. In this case, a valve-containing conduit is installed; this prosthesis has a mechanical aortic valve. Replacement of the ascending aorta without implantation of the aortic valve. Prosthetics of the ascending artery and its arch. Surgery to implant a stent graft in the ascending aorta. This is an endovascular intervention.
Ascending aorta replacement is the replacement of this section of the artery. This is necessary in order to prevent serious consequences, such as rupture. 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, since in addition to the main pathology - aortic aneurysm, it is possible to correct the accompanying one, for example, stenosis or valve insufficiency, etc. But the endovascular procedure gives a temporary effect.
Aortic dissection
When replacing the aortic arch, the following is used:
Open distal anastomosis. This is when the prosthesis is installed so that its branches are not affected; Half-replacement of the arc. This operation consists of replacing the artery where the ascending aorta meets the arch and, if required, replacing the concave surface of the arch; Subtotal prosthetics. This is when, when replacing the artery arch, replacement of branches (1 or 2) is required; Complete prosthetics. In this case, the arch is prosthetic along with all supra-aortic vessels. This is a complex intervention that can cause neurological complications. After such an intervention, the person is entitled to disability.
Coronary artery bypass grafting (CABG)
CABG is an open-heart surgery that uses the patient's blood vessel as a shunt. This heart surgery is needed to create a bypass for blood that will not affect the occlusive portion of the coronary artery.
That is, this shunt is installed on the aorta and brought to a section of the coronary artery unaffected by atherosclerosis.
This method is quite effective in the treatment of coronary heart disease. Due to the installed shunt, blood flow to the heart increases, which means ischemia and angina pectoris do not occur.
CABG is prescribed if there is angina pectoris in which even the smallest loads cause attacks. Also, indications for CABG are lesions of all coronary arteries, and if a cardiac aneurysm has formed.
Coronary artery bypass grafting
When performing CABG, the patient is put under general anesthesia, and then after opening the chest, all manipulations are carried out. This operation can be performed with or without cardiac arrest. And also, depending on the severity of the pathology, the doctor decides whether the patient needs to be connected 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 a shunt is performed by a vein from the lower limb; sometimes a part of the internal mammary vein or radial artery is also used.
Today, CABG is performed, which is performed with minimal access to the heart and at the same time the heart continues to beat. This intervention is considered not as traumatic as others. In this case, the chest is not opened; an incision is made between the ribs and a special expander is used so as not to affect the bones. This type of CABG lasts from 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 the patient’s quality and life expectancy increases.
Radiofrequency ablation (RFA)
RFA is a procedure performed under local anesthesia, as the basis is catheterization. This procedure is carried out in order to exfoliate the cells that cause arrhythmia, that is, the focus. This occurs through a guide catheter that conducts an electrical current. As a result, tissue formations are removed using RFA.
Radiofrequency catheter ablation
After conducting an electrophysical study, the doctor determines where the source that causes the rapid heartbeat is located. These sources can be formed along pathways, resulting in a rhythm anomaly. It is RFA that neutralizes this anomaly.
RFA is performed in the following cases:
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 such as cardiac arrest may occur.
It should be noted that RFA is well tolerated by patients, since there are no large incisions or opening of the sternum.
A catheter is inserted through a puncture in the thigh. Only the area through which the catheter is inserted is numbed.
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 points an electrode at them. After the electrode has acted on the source, the tissues become scarred, which means they will not be able to conduct the impulse. After RFA, a bandage is not needed.
Carotid artery surgery
There are the following types of operations on the carotid artery:
Prosthetics (used for large lesions); Stenting is performed if stenosis is diagnosed. In this case, the lumen is increased by installing a stent; Eversion endarterectomy - in this case, atherosclerotic plaques are removed along with the inner lining of the carotid artery; Carotid endarectomy.
Such operations are performed under both general and local anesthesia. Most often under general anesthesia, since the procedure is performed in the neck area and there are unpleasant sensations.
The carotid artery is pinched, and in order for the blood supply to continue, shunts are installed, which are bypass routes.
Classic endarterectomy is done if long plaque lesions are diagnosed. During this operation, the plaque is detached and removed. Next, the vessel is washed. Sometimes it is still necessary to fix the inner shell; this is done with special stitches. Finally, the artery is sutured using a special synthetic medical material.
Carotid endarterectomy
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 it, that is, sew it on. To perform 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, for example, you need to wear a bandage. The bandage secures the suture after the operation, and of course the entire chest, which is very important. This type of bandage should only be worn if open heart surgery is performed. The cost of these products may vary.
The bandage worn after heart surgery looks like a T-shirt with tightness fixers. You can purchase male and female versions of this headband. The bandage is important because it is necessary to prevent congestion of the lungs, for this you need to cough regularly.
Such prevention of stagnation is quite dangerous because the seams can come apart; in this case, the bandage will protect the seams and promote durable scarring.
The bandage will also help prevent swelling and hematomas, and promote the correct positioning of organs after heart surgery. And the bandage helps relieve stress on 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 begin rehabilitation, this is simple exercise therapy and massage.
After all types of heart surgery, drug rehabilitation, that is, maintenance 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, as well as drugs to lower blood cholesterol (statins), are prescribed. Sometimes the patient is prescribed physical therapy.
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 disability is mandatory after coronary artery bypass surgery. Moreover, there may be a disability of both groups 1 and 3. It all depends on the severity of the pathology.
People who have circulatory disorders, stage 3 coronary insufficiency, or have suffered a myocardial infarction are also entitled to disability.
Regardless of whether the operation has been performed or not yet. Patients with heart defects of the 3rd degree and combined defects can apply for disability if there are persistent circulatory disorders.
Clinics
| Research Institute of SP named after. N.V. Sklifosovsky | Moscow, Bolshaya Sukharevskaya square, 3 | CABG without IR CABG with valve replacement Angioplasty and stenting of coronary arteries RFA Aortic stenting Valve replacement Valve plastic surgery | 64300 rub. 76625 rub. 27155 rub. 76625 rub. 57726 rub. 64300 rub. 76625 rub. |
| KB MSMU im. Sechenov | Moscow, st. B. Pirogovskaya, 6 | CABG with valve replacement Angioplasty and stenting of coronary arteries RFA Aortic stenting Valve replacement Valvoplasty Aneurysm resection | 132,000 rub. 185500 rub. 160,000-200,000 rub. 14300 rub. 132200 rub. 132200 rub. 132000-198000 rub. |
| FSCC FMBA | Moscow, Orekhovy Boulevard, 28 | CABG Angioplasty and stenting of coronary arteries RFA Aortic stenting Valve replacement Valve plastic surgery | 110000-140000 rub. 50,000 rub. 137,000 rub. 50,000 rub. 140,000 rub. 110000-130000 rub. |
| Research Institute of SP named after. I.I. Dzhanelidze | St. Petersburg, st. Budapestskaya, 3 | CABG Angioplasty and stenting of coronary arteries Aortic stenting Valve replacement Valve plastics Multivalve replacement Probing of cardiac cavities | 60,000 rub. 134400 rub. 25,000 rub. 60,000 rub. 50,000 rub. 75,000 rub. 17,000 rub. |
| St. Petersburg State Medical University named after. I.P. Pavlova | St. Petersburg, st. L. Tolstoy, 6/8 | CABG Angioplasty and stenting of coronary arteries Valve replacement Multivalve replacement RFA | 187000-220000 rub. 33,000 rub. 198000-220000 rub. 330,000 rub. 33,000 rub. |
| Sheba MC | Derech Shiba 2, Tel Hashomer, Ramat Gan | CABG Valve replacement | $30,000 $29,600 |
| MedMira | Huttropstr. 60, 45138 Essen, Germany 49 1521 761 00 12 |
Angioplasty CABG Valve replacement Cardiac examination Coronary angiography with stenting | 8000 euros 29000 euros 31600 euros 800-2500 euros 3500 euros |
| Greekomed | Central Russian office: Moscow, 109240, st. Verkhnyaya Radishchevskaya, house 9 A |
CABG valve replacement | 20910 euros 18000 euros |
Do you still think that it is impossible to get rid of HEART DISEASES!?
Do you often experience discomfort in the heart area (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, going on a diet and watching your weight...
Bondarenko Tatyana
Project expert DlyaSerdca.ru
The treatment of heart disease using surgery is the field of surgery and cardiology, which is called cardiac surgery. Today, cardiac surgery is the most effective method of treating certain types of heart defects, coronary heart disease and allows you to prevent the development of myocardial infarction, as well as eliminate its consequences - aneurysms.
Surgery is used only in cases where conservative treatment methods no longer help and the patient’s condition worsens. A patient’s delay in seeing a doctor can also lead to heart surgery, when the only way to help is surgical intervention.
Today, cardiac surgery is one of the most actively developing and technically equipped branches of medicine. Open heart surgery is performed on 700 patients every year. The bulk of operations are in the United States. In Europe, the number of operations is 4 times less. In Asian countries, cardiac surgery is practically absent. In Russia, the number of heart surgeries performed is below the required minimum. These statistics are due to the fact that heart surgeries are expensive. In addition to open-heart surgery, surgery is also performed without opening the parts of the heart (for example, implantation of pacemakers, angioplasty).
Surgical intervention is required for diseases such as:
1. Coronary heart disease and its consequences (myocardial infarction);
2. Heart defects.
3. Heart rhythm disturbance.
Coronary heart disease
Coronary heart disease occurs as a result of insufficient blood supply to the working myocardium. The main cause of coronary heart disease is atherosclerosis (the formation of plaques on the walls of blood vessels). A slight narrowing of the lumen of the vessel leads to angina pectoris (a person feels pain only when the heart’s need for oxygen increases, for example, during physical activity). A strong narrowing of the lumen of the vessel causes pain even at rest, and the duration of painful attacks can also become more frequent and longer - unstable angina. If coronary blood flow is severely impaired, the muscle fibers of the heart die - this is myocardial infarction.
One of the severe complications of myocardial infarction is the formation of a post-infarction left ventricular aneurysm. An aneurysm is a bubble-like protrusion. It forms when dead tissue is replaced by scar tissue, which in turn is unable to contract. Under the pressure of healthy contracting fibers, the scar tissue bulges, and some of the blood is retained in the ventricle in the area of the aneurysmal expansion. With each contraction, organs and tissues receive less blood in an amount equal to the volume of the aneurysm. This is its main negative meaning. Very often, blood clots form in the area of the aneurysm, which can break off and be carried by the bloodstream to any organ, causing a heart attack (death of part or all of the organ). When a blood clot enters the brain, a stroke occurs.
Surgical intervention (heart surgery) for coronary heart disease is aimed at restoring normal nutrition to all parts of the heart. The degree of damage to the coronary arteries will determine what kind of surgery should be done. Analysis of the condition of the vessels is carried out using coronary angiography - this is a radiopaque research method that allows you to determine the location, nature and degree of narrowing of the coronary artery. Most often, stenting is performed on the coronary artery that causes pain. In case of severe atherosclerotic damage to the coronary vessels, the patient requires coronary artery bypass surgery.
Types of surgery for coronary heart disease
Angioplasty and stenting of coronary arteries
Angioplasty and stenting are aimed at removing obstructions to blood flow by widening the artery from the inside.
The operation is carried out as follows: using special equipment, a catheter is inserted through a puncture in the thigh area under the control of a fluorographic drug into the artery that feeds the heart. It must reach the site of narrowing of the artery, where a special balloon with a stent is inflated - a device that does not allow the artery to collapse. The stent remains in the artery, and the catheter is brought out through the same hole in the thigh.
Coronary artery bypass grafting (CABG)
Coronary artery bypass grafting is the restoration of blood supply to the heart muscle by creating a new path for blood flow bypassing the affected area of the coronary vessel using shunts - pieces of arteries or veins taken from the patient himself (for example, in the area of a limb). This operation is aimed at preventing myocardial infarction. Today, CABG operations are performed both using a heart-lung machine and on a beating heart (immobility of the heart only in the operated area).
One of the types of coronary bypass surgery is mammary coronary artery bypass grafting (MCBG). The internal mammary artery is used as a shunt. The use of this vessel is advantageous, since in this case there is no need to make additional incisions due to the close location of the thoracic artery and the heart, and also because atherosclerotic plaques do not form in the artery, and therefore the service life of such a shunt is quite long.
Repair of post-infarction left ventricular aneurysm
The essence of the intervention is to reduce the volume of the left ventricle by delineating the area of aneurysmal dilatation and the healthy part of the left ventricle. The surgeon removes the resulting blood clots in the area of the aneurysm, then sews a septum made of dense elastic human tissue across the cavity of the left ventricle. Two cavities are formed: one with normal, actively contracting walls, the other - from scar tissue that is not capable of contracting, but does not interfere with the normal functioning of the heart. Thus, blood circulation is restored and the danger of blood clot rupture is eliminated.
Heart defects
Heart defects are defects in the structure of the heart that lead to disruption of normal blood circulation, resulting in stagnation of blood in the pulmonary or systemic circulation.
The following violations are identified:
- stenosis (narrowing) of the valve apparatus;
With valve stenosis, it stops allowing the required volume of blood through the reduced opening.
- insufficiency of the valve apparatus;
The valve flaps cannot close tightly and allow blood to flow in the opposite direction to normal blood flow.
-defects of the interventricular and interatrial septum;
When these septa are defective, blood enters from a cavity with high pressure into a cavity with lower pressure, and venous blood, poor in oxygen, mixes with oxygenated arterial blood, which leads to oxygen starvation of tissues.
Heart defects can be congenital or acquired. Most of them do not require surgery. Sometimes the disease proceeds unnoticed by the patient. Congenital heart disease can improve with age, but if this does not happen and signs of heart failure increase, then surgical intervention is required.
Treatment of heart defects is aimed at correcting the existing mechanical defect in the functioning of the heart.
The following types of surgical intervention are distinguished:
Prosthetics and plastic surgery of heart valves
Operations to install prostheses are performed on an open heart, using a heart-lung machine.
Valve prostheses can be mechanical or biological.
Mechanical valves
Mechanical valves are made of metal and plastic. The validity period of such prostheses is about 80 years. However, when using them, a person has to take anticoagulants daily, since blood clots easily form on prostheses, which contribute to the formation of blood clots. In rare cases, a mechanical prosthesis may break, which most often leads to the death of the patient. Mechanical valve prostheses can be in the form
- rotating disk
The disc completely covers the hole, but is secured only at one end. Blood moving in the right direction presses on the disc, rotates it on a hinge and opens the hole; when the blood flows back, the disc completely blocks the hole.
- built on the principle of a ball in a grid
The blood flow in the right direction pushes the ball out of the hole, pressing it to the bottom of the mesh and thereby creating the possibility of further passage of blood; reverse blood flow pushes the ball into the hole, which is thus closed and does not allow blood to pass through.
Biological valves
Biological prostheses are usually made from animal heart tissue and are considered more effective. After their installation, there is no need for treatment with anticoagulants, which have many contraindications. Such a prosthesis lasts from 10 to 20 years, its aging occurs gradually and you can prepare in advance for its replacement as planned. Of course, in this case a repeat operation is needed.
Biological valves do not necessarily require the use of anticoagulants (although it is often recommended), but they wear out faster than mechanical valves.
Plastic surgery of atrial and interventricular septal defects
If the structure of the septum is damaged and the size of the defect is small (the hole size is no more than 3 cm), it is sutured, and if it is large, it is repaired with a patch (synthetic tissue or autopericardium is used)
Heart rhythm disturbance
Cardiac arrhythmias are disturbances in the sequence, rhythm and frequency of contractions of the heart. Arrhythmias can occur as a result of metabolic disorders, for example, endocrine and autonomic, or the effects of certain medications. They are also often caused by heart disease, and sometimes by intoxication.
The danger of arrhythmia is that it can lead to ventricular fibrillation (disjointed contraction of fibers).
Arrhythmia is treated with drugs, catheter ablation, or a pacemaker (pacemaker) is implanted.
Surgical methods for treating arrhythmias:
Radiofrequency ablation
This is a minimally invasive surgical method that is used for:
- high heart rate with pronounced pulse deficit;
- atrial fibrillation;
- progressive heart failure;
- supraventricular tachycardia.
The radiofrequency ablation method involves passing a special catheter to the area of the heart that causes an abnormal pathological rhythm. An electrical impulse is applied to this section, which destroys the area of tissue that sets the wrong rhythm.
Thanks to ablation, normal heart rhythm is restored.
Pacemaker implantation
The operation is performed on patients with heart rhythm disturbances that are life-threatening. The purpose of a pacemaker is to control and restore normal contraction of the heart.
Doctors implant a special device under the skin or under the pectoral muscle. Two or three electrodes extend from the pacemaker and connect to the chambers of the heart to transmit an electrical impulse to them.
Defibrillator implantation
The principle of operation of a defibrillator is similar to a pacemaker. Its distinctive feature is the elimination of too fast and too slow heart rates. Heart rhythm is assessed using electrodes. Installing a defibrillator is similar to installing a pacemaker.
Installation of a defibrillator is indicated for ventricular tachycardia.
Heart transplant
In critical cases, when the heart cannot perform its function and does not respond to any treatment, a heart transplant is resorted to. Thanks to this operation, doctors prolong the patient’s life by about 5 years. Research is currently underway to extend the life of people who have had heart transplants.
Postoperative recovery period
An important stage of recovery after surgery is the postoperative recovery period. Strict monitoring of human health is necessary. This period is different and individual for each patient. Patients are prescribed special cardio training and diets. Emotional calm is necessary.
Heart surgery is dangerous due to its complications. The main signs of complications are fever, pain in the operated area, tachycardia, drop in blood pressure, and shortness of breath. The ECG shows characteristic changes. The recovery period lasts six months to a year.
An example of monitoring the health of postoperative patients is the work of Doctor of Medical Sciences, professor, arrhythmologist Andrei Vyacheslavovich Ardashev. He performs more than 200 surgeries a year. Postoperative monitoring of patients began in 2011 using the project. The doctor monitors both the cardiovisor conclusion and the ECG itself in postoperative patients. Using the website service helps monitor the recovery of the health of operated people via the Internet. This is a huge plus, since a large number of patients come to Moscow from all over Russia to undergo heart surgery. They pass the postoperative period at home. Using the Cardiovisor allows you to take ECG readings at home and send them to the doctor using the website.
Rostislav Zhadeiko, especially for the project.
Heart operations are performed very often today. Modern cardiac and vascular surgery are very developed. Surgical intervention is prescribed when conservative drug treatment does not help, and accordingly, normalization of the patient’s condition is impossible without surgery.
For example, a heart defect can only be cured surgically; this is necessary when blood circulation is severely impaired due to pathology.
And as a result, the person feels unwell and serious complications begin to develop. These complications can lead not only to disability, but also to death.
Surgical treatment of coronary heart disease is often prescribed. Since it can lead to myocardial infarction. As a result of 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. Surgeries are often performed due to abnormal heart rhythm (RFA).
They also perform heart transplantation, that is, transplantation. This is necessary in the case when there is a complex of pathologies due to which the myocardium is not able to function. Today, such an operation prolongs the patient’s life by an average of 5 years. After such an operation, the patient is entitled to disability.
Operations can be performed urgently, urgently, or scheduled intervention. This depends on the severity of the patient's condition. Emergency surgery is performed immediately, immediately after diagnosis. If such intervention is not carried out, the patient may die.
Such operations are often performed on newborns immediately after birth with congenital heart disease. In this case, even minutes matter.
Emergency operations do not require quick implementation. In this case, the patient is prepared for some time. As a rule, this is several days.
A planned operation is prescribed if there is no danger to life at this time, but it must be carried out in order to prevent complications. Doctors prescribe myocardial surgery only if it is necessary.
Invasive research
Invasive methods for examining the heart involve catheterization. That is, the study is carried out through a catheter, which can be installed either in the heart cavity or in a vessel. Using these studies, you can determine some indicators of heart function.
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 make it possible to study the pathology of the valves, their size and the 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.
Such studies include:
In 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 of functional class 3-4. In this case, it is resistant to drug therapy. Doctors need to decide what kind of surgical treatment is needed. It is also important to carry out this procedure for unstable angina.
Invasive procedures also include punctures and probing of the heart cavities. Using sounding, you can diagnose heart defects and pathologies in the left ventricle, for example, these could be tumors or thrombosis. To do this, use the femoral vein (right), a needle is inserted into it through which a conductor passes. The needle diameter becomes about 2 mm.
When performing invasive examinations, local anesthesia is used. The incision is small, about 1-2 cm. This is necessary to expose the desired vein for installing the catheter.
These studies are carried out in different clinics and their cost is quite high.
Surgery for heart disease
Heart defects include
- heart valve stenosis;
- heart valve insufficiency;
- septal defects (interventricular, interatrial).
Valve stenosis
These pathologies lead to many disturbances in the functioning of the heart, that is, the goals of operations for defects are to relieve the load on the heart muscle, restore the normal functioning of the ventricle, as well as restore contractile function and reduce pressure in the cavities of the heart.
To eliminate these defects, the following surgical interventions are performed:
Often, after surgery for a heart defect, a person is given disability.
Surgeries on the aorta
Open surgical procedures include:
- Prosthetics of the ascending aorta. In this case, a valve-containing conduit is installed; this prosthesis has a mechanical aortic valve.
- Replacement of the ascending aorta without implantation of the aortic valve.
- Prosthetics of the ascending artery and its arch.
- Surgery to implant a stent graft in the ascending aorta. This is an endovascular intervention.
Ascending aorta replacement is the replacement of this section of the artery. This is necessary in order to prevent serious consequences, such as rupture. 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, since in addition to the main pathology - aortic aneurysm, it is possible to correct the accompanying one, for example, stenosis or valve insufficiency, etc. But the endovascular procedure gives a temporary effect.
When replacing the aortic arch, the following is used:
- Open distal anastomosis. This is when the prosthesis is installed so that its branches are not affected;
- Half-replacement of the arc. This operation consists of replacing the artery where the ascending aorta meets the arch and, if required, replacing the concave surface of the arch;
- Subtotal prosthetics. This is when, when replacing the artery arch, replacement of branches (1 or 2) is required;
- Complete prosthetics. In this case, the arch is prosthetic along with all supra-aortic vessels. This is a complex intervention that can cause neurological complications. After such an intervention, the person is entitled to disability.
Coronary artery bypass grafting (CABG)
CABG is an open-heart surgery that uses the patient's blood vessel as a shunt. This heart surgery is needed to create a bypass for blood that will not affect the occlusive portion of the coronary artery.
That is, this shunt is installed on the aorta and brought to a section of the coronary artery unaffected by atherosclerosis.
This method is quite effective in the treatment of coronary heart disease. Due to the installed shunt, blood flow to the heart increases, which means ischemia and angina pectoris do not occur.
CABG is prescribed if there is angina pectoris in which even the smallest loads cause attacks. Also, indications for CABG are lesions of all coronary arteries, and if a cardiac aneurysm has formed.
When performing CABG, the patient is put under general anesthesia, and then after opening the chest, all manipulations are carried out. This operation can be performed with or without cardiac arrest. And also, depending on the severity of the pathology, the doctor decides whether the patient needs to be connected 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 a shunt is performed by a vein from the lower limb; sometimes a part of the internal mammary vein or radial artery is also used.
Today, CABG is performed, which is performed with minimal access to the heart and at the same time the heart continues to beat. This intervention is considered not as traumatic as others. In this case, the chest is not opened; an incision is made between the ribs and a special expander is used so as not to affect the bones. This type of CABG lasts from 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 the patient’s quality and life expectancy increases.
Radiofrequency ablation (RFA)
RFA is a procedure performed under local anesthesia, as the basis is catheterization. This procedure is carried out in order to exfoliate the cells that cause arrhythmia, that is, the focus. This occurs through a guide catheter that conducts an electrical current. As a result, tissue formations are removed using RFA.
After conducting an electrophysical study, the doctor determines where the source that causes the rapid heartbeat is located. These sources can be formed along pathways, resulting in a rhythm anomaly. It is RFA that neutralizes this anomaly.
RFA is performed in the following cases:
- 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 such as cardiac arrest may occur.
It should be noted that RFA is well tolerated by patients, since there are no large incisions or opening of the sternum.
A catheter is inserted through a puncture in the thigh. Only the area through which the catheter is inserted is numbed.
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 points an electrode at them. After the electrode has acted on the source, the tissues become scarred, which means they will not be able to conduct the impulse. After RFA, a bandage is not needed.
Carotid artery surgery
There are the following types of operations on the carotid artery:
- Prosthetics (used for large lesions);
- Stenting is performed if stenosis is diagnosed. In this case, the lumen is increased by installing a stent;
- Eversion endarterectomy - in this case, atherosclerotic plaques are removed along with the inner lining of the carotid artery;
- Carotid endarectomy.
Such operations are performed under both general and local anesthesia. Most often under general anesthesia, since the procedure is performed in the neck area and there are unpleasant sensations.
The carotid artery is pinched, and in order for the blood supply to continue, shunts are installed, which are bypass routes.
Classic endarterectomy is done if long plaque lesions are diagnosed. During this operation, the plaque is detached and removed. Next, the vessel is washed. Sometimes it is still necessary to fix the inner shell; this is done with special stitches. Finally, the artery is sutured using a special synthetic medical material.
Carotid endarterectomy
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 it, that is, sew it on. To perform 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, for example, you need to wear a bandage. The bandage secures the suture after the operation, and of course the entire chest, which is very important. This type of bandage should only be worn if open heart surgery is performed. The cost of these products may vary.
The bandage worn after heart surgery looks like a T-shirt with tightness fixers. You can purchase male and female versions of this headband. The bandage is important because it is necessary to prevent congestion of the lungs, for this you need to cough regularly.
Such prevention of stagnation is quite dangerous because the seams can come apart; in this case, the bandage will protect the seams and promote durable scarring.
The bandage will also help prevent swelling and hematomas, and promote the correct positioning of organs after heart surgery. And the bandage helps relieve stress on 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 begin rehabilitation, this is simple exercise therapy and massage.
After all types of heart surgery, drug rehabilitation, that is, maintenance 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, as well as drugs to lower blood cholesterol (statins), are prescribed. Sometimes the patient is prescribed physical therapy.
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 disability is mandatory after coronary artery bypass surgery. Moreover, there may be a disability of both groups 1 and 3. It all depends on the severity of the pathology.
People who have circulatory disorders, stage 3 coronary insufficiency, or have suffered a myocardial infarction are also entitled to disability.
Regardless of whether the operation has been performed or not yet. Patients with heart defects of the 3rd degree and combined defects can apply for disability if there are persistent circulatory disorders.
Clinics
| Clinic name | Address and telephone | Type of service | Price |
|---|---|---|---|
| Research Institute of SP named after. N.V. Sklifosovsky | Moscow, Bolshaya Sukharevskaya square, 3 |
|
|
| KB MSMU im. Sechenov | Moscow, st. B. Pirogovskaya, 6 |
|
|
| FSCC FMBA | Moscow, Orekhovy Boulevard, 28 |
|
|
| Research Institute of SP named after. I.I. Dzhanelidze | St. Petersburg, st. Budapestskaya, 3 |
|
|
| St. Petersburg State Medical University named after. I.P. Pavlova | St. Petersburg, st. L. Tolstoy, 6/8 |
|
|
| Sheba MC | Derech Shiba 2, Tel Hashomer, Ramat Gan |
|
| link to article.
May God grant everyone to live a long life so that their heart is never touched by a surgeon’s scalpel. However, cardiac surgery cannot always be replaced by therapy.
In what cases is surgery necessary?
- When conservative therapy does not give the desired result.
- When, despite all the treatment, the patient’s condition continues to deteriorate.
- When severe congenital heart defects, severe arrhythmia, cardiomyopathy are present.
Depending on the urgency, cardiac surgery can be either emergency or planned.
- Emergency calls 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 delays in surgery when the heart is wounded. The consequences of delay are severe.
- Planned ones are carried out in accordance with the developed plan for correcting 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 drops.
Surgical interventions vary in technique. There are the following types of heart surgeries:
- with opening of the chest;
- without opening the chest.
Operations with opening of the chest
This surgical intervention is used in particularly severe cases when complete accessibility of the heart is required during surgery.
The chest is opened for the following pathologies:
- tetralogy of Fallot (the so-called congenital heart defect with four serious anatomical disorders);
- serious anomalies of intracardiac septa, valves, aorta and coronary arteries;
- heart tumors.
The patient arrives at the hospital one day before the operation. He undergoes an examination and gives written consent. You will definitely have to wash with antibacterial soap and shave your hair. Where is body hair shaved? The hair will be shaved at the site of the intended incision. If you have coronary artery bypass surgery, you will have to shave your legs and groin. If you have a heart valve replacement, you will need to shave the hair in your lower abdomen and groin area.
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 device, the heart is stopped for a while and surgical manipulations are performed on the organ.
How long the operation lasts 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 surgery 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, and during the operation there is a higher probability of making an erroneous action.
- Opening the chest is fraught with various injuries.
- A noticeable scar remains after heart surgery.
- Various complications cannot be excluded:
- myocardial infarction,
- thromboembolism,
- bleeding,
- infections;
- coma after surgery.
- Long-term recovery with significant restrictions in the patient's activities is required.
In most cases, when surgery is performed by opening the chest, disability is given after heart surgery, as after a heart attack.
What operations and for what pathologies are performed on an open heart?
Pathologies of the coronary arteries
Coronary artery bypass surgery is performed in case of serious damage to the coronary arteries by atherosclerosis, leading to severe coronary heart disease. The essence of bypass surgery is to create a bypass path 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 (MCBG) is performed using the internal mammary artery.
Operation Ross Heart valve defects
These days, valves made from the patient's biological material are used to replace damaged valves.
- The Ross procedure involves using the patient's own valved pulmonary artery to replace the diseased aortic valve. An implant is installed instead of the pulmonary valve. Eliminates complications associated with rejection of a valve made of foreign material. It is done for both adults and children.
- The Ozaki procedure involves using the patient's own tissue. Only in this case, the aortic valve is replaced with a valve made from the patient's pericardium. Complications with valve rejection are not observed for the same reason.
