Cardiac surgery is a branch of medicine devoted to the surgical treatment of the heart. In case of pathologies of the cardiovascular system, such intervention is a last resort. Doctors try to restore the patient’s health without surgery, but in some cases only cardiac surgery can save the patient. Today, this field of cardiology uses the latest advances in science to return the patient to health and a full life.

Indications for operations

Invasive cardiac interventions are complex and risky work; it requires skill and experience, and the patient – ​​preparation and implementation of recommendations. Because such operations involve risks, they are performed only when absolutely necessary. In most cases, they try to rehabilitate the patient with the help of medications and medical procedures. But in cases where such methods do not help, heart surgery is needed. The surgery is performed in a hospital setting and in complete sterility, the patient being operated on is under anesthesia and under the control of the surgical team.

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

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

The decision to prescribe an operation is made by a council of doctors or. The patient must be examined to establish an accurate diagnosis and type of surgical intervention. Chronic diseases and stages of the disease are identified, risks are assessed, in which case they talk about planned surgery. If emergency assistance is needed, for example, in case of a blood clot or aneurysm dissection, minimal diagnostics are performed. In any case, the function of the heart is surgically restored, its parts are rehabilitated, and blood flow and rhythm are normalized. In severe situations, the organ or its parts can no longer be corrected, then prosthetics or transplantation are prescribed.

Classification of heart operations

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

The general classification divides them into operations:

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

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

Depending on the patient’s condition, there are:

1. Planned surgery. It is carried out after a detailed examination, within a specified time frame. Planned intervention is prescribed when the pathology does not pose any particular danger, but it cannot be postponed.
2. Emergency are operations that need to be done in the next few days. During this time, the patient is prepared and all the necessary studies are carried out. The date is set immediately after receiving the necessary data.
3. Emergency. If the patient is already in serious condition, the situation can worsen at any moment - surgery is scheduled immediately. Before it, only the most important examinations and preparations are carried out.

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

How the operations are done

The course and duration of the operation depends on the pathology being treated, the patient’s condition, and the presence of concomitant diseases. The procedure may take half an hour or may take 8 hours or more. Most often, such interventions last 3 hours and are performed under general anesthesia and AI control. First, the patient is prescribed a chest ultrasound, urine and blood tests, an ECG, and consultation with specialists. After receiving all the data, the degree and location of the pathology is determined, and it is decided whether there will be an operation.

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

Heart valve surgery

The heart muscle has four valves, all of which serve as a passage for blood from one chamber to another. The most commonly operated valves are the mitral and tricuspid valves, which connect the ventricles to the atria. Stenosis of the passages occurs when the valves are insufficiently widened, and blood flows poorly from one section to another. Valve insufficiency is a poor closure of the valves of the passage, and there is an outflow of blood back.

The plastic surgery is performed openly or closed; during the operation, special rings or sutures are applied manually along the diameter of the valve, which restore normal lumen and narrowing of the passage. Manipulations last on average 3 hours; for open types, an AIK is connected. After the procedure, the patient remains under the supervision of doctors for at least a week. The result is normal blood circulation and functioning of the heart valves. In severe cases, the original valves are replaced with artificial or biological implants.

Elimination of heart defects

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

At older ages, heart defects develop due to atrial septal defects. This happens with mechanical damage to the chest, infectious diseases, or due to concomitant heart diseases. To eliminate this problem, open surgery is also needed, often with artificial cardiac arrest.

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

Bypass surgery

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

To prevent complications or alleviate the disease, use:

• coronary artery bypass grafting;
• balloon angioplasty;
• transmyocardial laser revascularization;
• coronary artery stenting.

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

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

Recovery after interventions

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

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

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

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

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

Often, in addition to surgical care, medications are prescribed. For example, when replacing valves with artificial implants, the patient takes anticoagulants for life.

In the postoperative period, it is important not to self-medicate, since the interaction of permanent medications and other medications can give a negative result. Even regular painkillers need to be discussed with. To keep fit and restore health faster, it is recommended to spend more time in the fresh air and walk.

Life after heart surgery will gradually return to normal; full recovery is predicted within a year.

Cardiac surgery offers a variety of methods for cardiac rehabilitation. Such operations are designed to restore physical and moral strength to the patient. There is no need to be afraid or avoid such procedures; on the contrary, the sooner they are carried out, the greater the chances of success.

• Heart Valve Replacement
• • Possible complications and care recommendations

Heart operations are performed only when necessary. The most common of these are heart valve replacement and coronary artery bypass surgery. The first is necessary if the patient is concerned about heart valve stenosis. It should be noted that heart operations pose a serious risk to the patient’s life; they are performed with maximum precision and care. Heart surgery sometimes leads to numerous problems and complications; to avoid this, you can use an alternative technique - valvuloplasty.

The procedure can replace replacement surgery and help normalize the activity of the heart muscles. During the process, a special balloon is inserted into the opening of the aortic valve, and at the end this balloon is inflated. It is worth considering: if a person is elderly, valvuloplasty does not have a long-term effect.

Heart Valve Replacement

To decide on such a procedure, it is necessary to establish a diagnosis.

The operation is carried out immediately or some time after the tests are completed.

In some situations, the results indicate that a person needs bypass surgery. Valve replacement is an open procedure that can be performed using minimally invasive surgery. It should be remembered that replacing a heart valve is a very complex procedure, despite this, it is performed very often.

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Stages of the procedure and further rehabilitation

First you need to open your chest. Next, the doctor connects the patient to a special machine that provides artificial blood circulation. The device temporarily replaces the heart. The patient’s circulatory system is connected to the device, after which the natural valve begins to be removed and replaced. When this manipulation is completed, the device is turned off. In most cases, heart surgery goes well, but a scar forms on the organ.

After recovery from the anesthesia state, the breathing tube is removed from the lungs. If you need to remove excess liquid, such a tube should be left for a while. After 24 hours, you are allowed to drink water and liquids; you can walk only after two days. After such an operation, pain in the chest area may be noticeable, and on the fifth day the patient is completely discharged. If there is a risk of complications, the hospital stay must be extended by 6 days.

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Can there be complications after valve replacement?

A person may encounter such problems at different stages of the disease. During the operation, there is a risk of heavy bleeding, in addition, difficulties with anesthesia may arise. Possible risk factors include internal bleeding, seizures, and possible infections. A heart attack can also happen, but this is very rare. As for the greatest danger, it lies in the appearance of tamponade of the pericardial cavity. This phenomenon occurs when blood fills its cardiac sac. This causes serious disruptions in the functioning of the heart. Heart operations cannot but affect a person’s general condition. During the rehabilitation period, strict medical supervision is required. The need to visit a surgeon arises 3-4 weeks after the operation. It is important to maintain the general well-being of the patient. The optimal dose of physical activity should be prescribed, and it is important to adhere to the diet.

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What is coronary artery bypass grafting?

Coronary artery bypass grafting is a type of surgery that restores blood flow in the arteries. The procedure is necessary to eliminate coronary heart disease. The disease manifests itself when the lumen of the coronary vessels narrows, resulting in an insufficient amount of oxygen entering the heart muscle. Coronary artery bypass surgery aims to prevent changes in the myocardium (heart muscle). After surgery, it should recover completely and contract better. It is necessary to restore the affected area of ​​the muscle; for this, the following procedure is performed: everyday shunts are placed between the aorta and the coronary vessel that is affected. In this way, new coronary arteries are formed. They are designed to replace narrowed ones. After a shunt is placed, blood from the aorta flows through a healthy vessel, thanks to which the heart produces normal blood flow.

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Why is surgery necessary?

This procedure will be required if the left coronary artery of the vessel that provides flow to the heart is affected. It is also needed if all coronary vessels are damaged. The procedure can be double, triple, single - it all depends on how many shunts the doctor needs. With coronary heart disease, a patient may need one shunt, in some cases two or three. Bypass surgery is a procedure that is often used for atherosclerosis of the heart vessels. This occurs when angioplasty cannot be performed. As a rule, the shunt can serve for a long time, its functional suitability is 12-14 years.

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Carrying out coronary artery bypass grafting

The duration of the operation is 3-4 hours. The procedure requires maximum concentration and attention. The doctor needs to gain access to the heart, this requires cutting the soft tissue, then opening the sternum and performing a stenotomy. During the operation, a procedure is performed that is necessary for temporary, it is called cardioplegia. The heart must be cooled with very cold water, then a special solution must be injected into the arteries. To attach the shunts, the aorta must be temporarily blocked. To do this, you need to clamp it and connect the heart-lung machine for 90 minutes. Plastic tubes should be placed in the right atrium. Next, the doctor carries out procedures that promote the flow of blood into the body.

What is conventional vascular bypass surgery? This method involves the implantation of special implants into the coronary vessels beyond the blockage, the end of the shunt is sutured to the aorta. To be able to use the internal mammary arteries, the procedure must take more time. This is due to the need to separate the arteries from the chest walls. At the end of the operation, the doctor carefully fastens the chest together using a special wire. With its help, the soft tissue incision is sutured, then drainage tubes are applied to remove residual blood.

Sometimes bleeding occurs after surgery and continues throughout the day. Installed drainage tubes should be removed 12-17 hours after the procedure. Upon completion of the operation, the breathing tube must be removed. On the second day, the patient can get out of bed and move around. Heart rate recovery occurs in 25% of patients. As a rule, it lasts for five days. As for arrhythmia, this disease can be eliminated within 30 days after surgery, using conservative methods of therapy.

Heart surgery is performed only when other methods of therapy cannot help the patient's condition. Heart surgery can prevent death in a patient, but the risk of an unfavorable outcome remains quite high.

Despite the fact that cardiac surgery does not stand still and is developing, heart surgery is very difficult to perform. It is performed by the best cardiac surgery specialists. But even this important fact cannot protect the operated patient from complex consequences.

Complications in the postoperative period can even lead to death.

Indications for surgery

As mentioned earlier, cardiac surgery is used in cases where there are no other options to save the patient’s life. Heart surgery requires a very serious approach.

Heart transplantation is considered the most complex and serious surgical procedure. The operation is carried out under the strict supervision of highly qualified specialists.

Indications for cardiac surgery of any complexity are as follows:

• rapid development of diseases of the cardiovascular system;
• in case of lack of results with drug treatment;
• late contact with a medical institution.

Heart surgery helps improve the general condition of the patient and eliminate the symptoms of a painful disease.

Abdominal cardiac surgery is performed only after a complete diagnostic examination and an accurate diagnosis has been made by a cardiologist.

Methods of surgical interventions

What types of heart surgeries are there?

This is a pretty important question if you are going to have this major surgery. You will also need to know how the operation is performed and how it is done.

This is necessary in order to make, perhaps, the main decision in your life, on which your entire future fate will depend.

Closed interventions

This is a heart operation that does not affect the organ itself. It is performed without touching the heart. To carry it out, there is no need for special equipment other than surgeon's instruments.

The heart cavity does not “open”. This is why it is called “closed”.

Such an intervention is performed at the initial stage of disease development, when the patient’s condition can only be improved by surgery.

Open interventions

There is also open surgery. This type of operation requires opening the heart cavities in order to eradicate the existing pathology.

Open heart surgeries are performed using a special device - heart-lung or heart-lung equipment.

With open intervention, the cavities are open, the heart and pulmonary organs are disconnected from the blood circulation. This makes it possible to intervene on a “dry” organ.

All blood goes through a vein to specialized surgical equipment. There they pass through artificial lungs, are enriched with oxygen and release carbon dioxide, transforming from vein blood to arterial blood. Then it is driven with a special pump into the aorta of the person being operated on, in other words, into the systemic circulation.

Innovative techniques help make all the “insides” of the equipment (also an artificial lung), with which the patient’s blood comes into contact, “disposable,” that is, once for one person. This will reduce possible disastrous consequences.

Today, a heart-lung machine helps stop the functioning of the heart and lungs for several hours. Thus allowing the most difficult open operations to be carried out.

X-ray surgical interventions

This type of intervention began to be used quite recently. But thanks to innovative equipment, they occupy an important place in heart surgery.

Using a special catheter, surgical instruments are inserted into a strip section of the heart organ or into the opening of a vessel. Next, using the pressure created by the device, the valves of the cavity incisions are opened. They enhance or distort the partitions, or vice versa, using a device to eliminate the distortion.

Special tubes are inserted into the lumen of the required vessel, thereby helping to open it slightly.

The process of such operations is carefully monitored by a special computer and every action is monitored. Thanks to this, operations are performed with less risk of injury and a greater likelihood of a favorable outcome.

If you have undergone X-ray surgery, it is more effective.

Action plan before surgery

Before surgery on a heart organ, preparation is necessary. If you have enough time, at least a few days or weeks, you need to take care of your body. Eat healthy, nutrient-rich foods.

Get plenty of rest, walk in the fresh air, and do physical exercises recommended by your treating specialist.

Proper nutrition

Try to eat only natural foods every day and more than once, even if you have no appetite. Your body needs to consume plenty of proteins, vitamins and minerals.

Thanks to a healthy diet, the surgical intervention itself and the rehabilitation period are more favorable.

Rest

Don't overwork your body before surgery. The more you rest, the stronger and stronger your body will become.

If your loved ones want to visit you or invite you to visit, say that you need to gain strength before a difficult process. Your family will always understand you and will not be offended.

Nicotine use

It has long been no secret to everyone that smoking has a negative effect even on the body of a completely healthy person. What can we say about patients with cardiac pathology?

Nicotine affects the heart in the following negative way: it develops arteriosclerosis, increases pressure in the blood vessels, and causes the heart vessels to strain. It also narrows the blood-forming arteries and increases the concentration of mucous fluid in the pulmonary organs.

This leads to more difficult adaptation after surgery.

Rehabilitation period

After surgery on a cardiac organ, if not enough time has passed, it is forbidden to even get out of the ward bed. During the entire rehabilitation period, the patient is in the intensive care unit.

This department is intended for patients who are at risk of death.

A special diet plays a huge role in rehabilitation. The treating specialist prescribes it individually for each patient. You can start eating only with lean porridges and vegetable broths, but after a few days the diet increases significantly.

After the patient is transferred to a regular ward, as a rule, the attending physician will allow the use of the following products:

• coarse porridge (barley, barley, unpolished rice). You can also include oatmeal in your diet 2-3 times a week;
• dairy production: low-fat curd mass, cheese with a fat content of no more than 20%;
• vegetable and fruit crops: fresh, steamed and in various salads;
• small pieces of boiled chicken, turkey and rabbit. As well as homemade steamed cutlets;
• various varieties of fish: herring, salmon, capelin, etc.;
• All soups are free of fried ingredients and contain no fat.

The following foods should not be consumed under any circumstances.

Heart valve replacement has been carried out everywhere for many years and has proven itself to be a safe and very effective operation for restoring normal hemodynamics in the heart and the body as a whole.

Throughout life, valves are in constant operation, opening and closing billions of times. By old age, some wear and tear of their tissues may occur, but the degree does not reach critical levels. Much greater damage to the condition of the valve apparatus is caused by various diseases - atherosclerosis, rheumatic endocarditis, bacterial damage to the valves.

age-related changes in the aortic valve

Valvular lesions are most common among older people, the reason for which is atherosclerosis, accompanied by the deposition of fat and protein masses in the valves, their compaction, and calcification. The continuously relapsing nature of the pathology causes periods of exacerbations with damage to valve tissue, microthrombosis, ulceration, which are followed by subsidence and sclerosis. The proliferation of connective tissue ultimately leads to deformation, shortening, thickening and decreased mobility of the valve leaflets - a defect is formed.

Among young patients requiring artificial valve transplantation, mainly patients rheumatism. The infectious and inflammatory process on the valves is accompanied by ulceration, local thrombosis (warty endocarditis), and necrosis of the connective tissue that forms the basis of the valve. As a result of irreversible sclerosis, the valve changes its anatomical configuration and becomes unable to perform its function.

Defects of the valvular apparatus of the heart lead to a total disruption of hemodynamics in one or both circulation circles. When these openings are narrowed (stenosis), the cavities of the heart do not fully empty, which are forced to work in an intensive mode, hypertrophying, then depleting and expanding. In case of valve insufficiency, when the valve flaps do not close completely, part of the blood returns in the opposite direction and also overloads the myocardium.

The increase in heart failure, stagnation in the large or small circle of blood flow provoke secondary changes in the internal organs, and are also dangerous for acute heart failure, therefore, if measures are not taken in time to normalize intracardiac blood flow, the patient will be doomed to death from decompensated heart failure.

The traditional valve replacement technique involves open access to the heart and temporarily removing it from circulation. Today in cardiac surgery, more gentle, minimally invasive methods of surgical correction are widely used, which are less risky and just as effective as open intervention.

Modern medicine offers not only alternative methods of operations, but also more modern designs of the valves themselves, and also guarantees their safety, durability and full compliance with the requirements of the patient’s body.

Heart operations, no matter how they are performed, carry certain risks, are technically complex and require the participation of highly qualified cardiac surgeons working in a well-equipped operating room, so they are not simply performed. In case of heart disease, the organ itself copes with the increased load for some time; as its functional abilities weaken, drug therapy is prescribed, and only if conservative measures are ineffective does the need for surgery arise. Indications for heart valve replacement include:

• Severe stenosis (narrowing) of the valve opening, which cannot be eliminated by simple dissection of the leaflets;
• Valve stenosis or insufficiency due to sclerosis, fibrosis, deposition of calcium salts, ulceration, shortening of the valves, their wrinkling, limited mobility for the above reasons;
• Sclerosis of the tendinous chords, disrupting the movement of the valves.

Thus, the reason for surgical correction is any irreversible structural change in the components of the valve, making correct unidirectional blood flow impossible.

There are also contraindications to heart valve replacement surgery. Among them are the patient’s serious condition, pathology of other internal organs that make the operation life-threatening for the patient, and severe blood clotting disorders. An obstacle to surgical treatment may be the patient’s refusal to undergo surgery, as well as the neglect of the defect, when intervention is inappropriate.

The mitral and aortic valves are most often replaced; they are also usually affected by atherosclerosis, rheumatism, and bacterial inflammation.

Depending on the composition, the heart valve prosthesis can be mechanical or biological. Mechanical valves made entirely of synthetic materials, they are metal structures with semicircular doors moving in one direction.

The advantages of mechanical valves are considered to be their strength, durability and wear resistance; the disadvantages are the need for lifelong anticoagulant therapy and the possibility of implantation only with open access to the heart.

Biological valves consist of animal tissues - elements of the bovine pericardium, pig valves, which are fixed on a synthetic ring that is installed at the attachment point of the heart valve. When making biological prostheses, animal tissues are treated with special compounds that prevent immune rejection after implantation.

The advantages of a biological artificial valve are the possibility of implantation during endovascular intervention, limiting the period of taking anticoagulants within three months. A significant disadvantage is considered to be rapid wear, especially if the mitral valve is replaced with such a prosthesis. On average, a biological valve lasts about 12-15 years.

The aortic valve is easier to replace with any type of prosthesis than the mitral valve, therefore, if the mitral valve is damaged, they first resort to various types of plastic surgery (commissurotomy), and only if they are ineffective or impossible is the possibility of a total valve replacement considered.

Preparing for valve replacement surgery

Preparation for surgery begins with a thorough examination, including:

1. General and biochemical blood tests;
2. Urine examination;
3. Determination of blood clotting;
4. Electrocardiography;
5. Ultrasound examination of the heart;
6. Chest X-ray.

Depending on the accompanying changes, the list of diagnostic procedures may include coronary angiography, vascular ultrasound, and others. Consultations with narrow specialists, opinions of a cardiologist and a therapist are required.

On the eve of the operation, the patient talks with the surgeon, anesthesiologist, takes a shower, has dinner - no later than 8 hours before the start of the intervention. It is advisable to calm down and get some sleep; many patients benefit from talking with the attending physician, clarifying all questions of interest, knowing the technique of the upcoming operation and getting to know the staff.

Technique for heart valve replacement surgery

Heart valve replacement can be performed through an open approach and in a minimally invasive manner without an incision in the sternum. Open surgery performed under general anesthesia. After immersing the patient in anesthesia, the surgeon processes the surgical field - the anterior surface of the chest, dissects the sternum in the longitudinal direction, opens the pericardial cavity, followed by manipulations on the heart.

heart valve replacement

To disconnect the organ from the bloodstream, a heart-lung machine is used, which allows valves to be implanted on a non-working heart. In order to prevent hypoxic damage to the myocardium, it is treated with cold saline throughout the entire operation.

To install the prosthesis, the desired cavity of the heart is opened using a longitudinal incision, the altered structures of the native valve are removed, in place of which an artificial one is installed, after which the myocardium is sutured. The heart is “started” using an electrical impulse or direct massage, and artificial circulation is turned off.

After the artificial heart valve is installed and the heart is sutured, the surgeon examines the cavity of the pericardium and pleura, removes the blood and sutures the surgical wound layer by layer. Metal staples, wire, and screws can be used to connect the halves of the sternum. Regular sutures or cosmetic intradermal sutures with self-absorbable threads are applied to the skin.

Open surgery is very traumatic, so the surgical risk is high, and postoperative recovery takes a long time.

endovascular aortic valve replacement

Endovascular technique valve replacement shows very good results; it does not require general anesthesia, therefore it is quite feasible for patients with severe concomitant diseases. The absence of a large incision makes it possible to reduce hospital stay and subsequent rehabilitation to a minimum. An important advantage of endovascular prosthetics is the ability to perform surgery on a beating heart without the use of a heart-lung machine.

During endovascular prosthetics, a catheter with an implantable valve is inserted into the femoral vessels (artery or vein, depending on which cavity of the heart needs to be penetrated). After destruction and removal of fragments of the own damaged valve, a prosthesis is installed in its place, which itself straightens thanks to a flexible stent frame.

After installation of the valve, stenting of the coronary vessels can also be performed. This opportunity is very relevant for patients whose valves and vessels are affected by atherosclerosis, and in the process of one manipulation two problems can be solved at once.

The third option for prosthetics is from a mini-access. This method is also minimally invasive, but an incision of about 2-2.5 cm is made on the anterior chest wall in the projection of the apex of the heart, and a catheter is inserted through it and the apex of the organ to the affected valve. Otherwise, the technique is similar to that for endovascular prosthetics.

In many cases, heart valve transplantation is an alternative to heart transplantation, which can significantly improve well-being and increase life expectancy. The choice of one of the listed methods of surgery and the type of prosthesis depends on both the patient’s condition and the technical capabilities of the clinic.

Open surgery is the most dangerous, and the endovascular technique is the most expensive, but, having significant advantages, it is the most preferable for both young and elderly patients. Even if there are no specialists or conditions for endovascular treatment in a particular city, but the patient has the financial opportunity to go to another clinic, then it is worth taking advantage of it.

If aortic valve replacement is necessary, mini-access and endovascular surgery are preferable, while mitral valve replacement is often performed in an open manner due to its location inside the heart.

Postoperative period and rehabilitation

The operation to replace a heart valve is very painstaking and time-consuming, lasting at least two hours. After its completion, the operated patient is placed in the intensive care unit for further observation. After 24 hours and if the patient’s condition is favorable, the patient is transferred to a regular ward.

After open surgery, the sutures are processed daily and removed within 7-10 days. This entire period requires hospitalization. With endovascular surgery, you can go home within 3-4 days. Most patients note a rapid improvement in their well-being, a surge of strength and energy, and ease in performing ordinary household activities - eating, drinking, walking, showering, which previously caused shortness of breath and severe fatigue.

If during prosthetics there was an incision in the sternum area, then the pain can be felt for quite a long time - up to several weeks. If you experience severe discomfort, you can take an analgesic, but if swelling, redness, or pathological discharge appears in the suture area, then you should not hesitate to visit a doctor.

The rehabilitation period takes on average about six months, during which the patient regains strength, physical activity, gets used to taking certain medications (anticoagulants) and regular monitoring of blood clotting. It is strictly prohibited to cancel, independently prescribe or change the dosage of drugs; this should be done by a cardiologist or therapist.

Drug therapy after valve replacement includes:

• Anticoagulants (warfarin, clopidogrel) - for life with mechanical prostheses and up to three months with biological ones under constant monitoring of a coagulogram (INR);
• Antibiotics for rheumatic diseases and the risk of infectious complications;
• Treatment of concomitant angina, arrhythmia, hypertension, etc. - beta blockers, calcium antagonists, ACE inhibitors, diuretics (most of them are already familiar to the patient, and he simply continues to take them).

Anticoagulants with an implanted mechanical valve help avoid thrombus formation and embolism, which are provoked by a foreign body in the heart, but there is also a side effect of taking them - the risk of bleeding, stroke, therefore Regular monitoring of INR (2.5-3.5) is an indispensable condition for life with a prosthesis.

Among the consequences of transplantation of artificial heart valves, the greatest danger is thromboembolism, which is prevented by taking anticoagulants, as well as bacterial endocarditis - inflammation of the inner layer of the heart, when the prescription of antibiotics is mandatory.

During the rehabilitation stage, some disturbances in well-being are possible, which usually disappear after several months - six months. These include depression and emotional lability, insomnia, temporary visual disturbances, discomfort in the chest and postoperative suture area.

Life after surgery, subject to successful recovery, is no different from that of other people: the valve works well, the heart too, there are no signs of its failure. However, having a prosthesis in the heart will require changes in lifestyle, habits, regular visits to a cardiologist and monitoring of hemostasis.

The first follow-up examination by a cardiologist is carried out approximately a month after prosthetics. At the same time, blood and urine tests are taken, and an ECG is taken. If the patient’s condition is good, then in the future the doctor should be visited once a year, in other cases – more often, depending on the patient’s condition. If you need to undergo other types of treatment or examinations, you should always warn in advance about the presence of a prosthetic valve.

Lifestyle after valve replacement requires giving up bad habits. First of all, you should stop smoking, and it is better to do this even before surgery. The diet does not dictate significant restrictions, but it is better to reduce the amount of salt and liquid consumed so as not to increase the load on the heart. In addition, you should reduce the proportion of foods containing calcium, as well as the amount of animal fats, fried foods, and smoked foods in favor of vegetables, lean meats and fish.

High-quality rehabilitation after heart valve replacement is impossible without adequate physical activity. Exercises help improve overall tone and train the cardiovascular system. In the first weeks, you should not be too zealous. It is better to start with feasible exercises that will prevent complications without overloading the heart. Gradually the volume of loads can be increased.

To prevent physical activity from being harmful, experts recommend undergoing rehabilitation in sanatoriums, where exercise therapy instructors will help create an individual physical education program. If this is not possible, then all questions regarding sports activities will be explained by a cardiologist at your place of residence.

The prognosis after artificial valve transplantation is favorable. Within a few weeks, health is restored and patients return to normal life and work. If work activity involves intense workload, a transfer to lighter work may be required. In some cases, the patient receives a disability group, but it is not related to the operation itself, but to the functioning of the heart as a whole and the ability to perform one or another type of activity.

Feedback from patients after heart valve replacement surgery is often positive. The duration of recovery is different for everyone, but most note positive dynamics already in the first six months, and relatives are grateful to the surgeons for the opportunity to prolong the life of a loved one. Relatively young patients feel well; some, they say, even forget about the presence of a valve prosthesis. It is more difficult for older people, but they also note significant improvement.

Heart valve transplantation can be done free of charge, at government expense. In this case, the patient is put on a waiting list, and priority is given to those who need surgery urgently or urgently. Paid treatment is also possible, but, of course, it is not cheap. The valve itself, depending on the design, composition and manufacturer, can cost up to one and a half thousand dollars, the operation starts from 20 thousand rubles. It is difficult to determine the upper threshold for the cost of the operation: some clinics charge 150-400 thousand, in others the price of the entire treatment reaches one and a half million rubles.

Video: a new method of replacing heart valves

For certain cardiac pathologies, a person is recommended to promptly eliminate the problem. For example, taking into account individual indications, a heart valve is replaced. Surgical correction (implantation, etc.) is widespread.

When is valve replacement indicated?

It is indicated when symptoms indicating heart failure occur:

• the occurrence of shortness of breath;
• cardiac edema, pain;
• tachycardia;
• asthmatic manifestations.

If the effect of therapeutic treatment is insufficient, heart surgery is recommended to restore blood circulation.

The indications for it are:

• birth defects;
• damage due to infection;
• lack of required density;
• disturbances in the valves (wrinkling, shortening, narrowing of the openings);
• presence of scar tissue (fibrosis);
• inability to cut adhesions.

The operation is considered effective and safe.

Aortic valve

This is an anatomical formation that contributes to the cessation of communication between the left ventricle (LV) and the aorta during the period of relaxation of the heart muscle (diastole). The flaps of this valve close tightly during the impact of the blood stream, preventing its movement from the aorta back into the ventricle. Its normal area is 3-4 cm².

Congenital or acquired defects provoke danger:

The combination of these factors causes heart defects.

Aortic heart defects

When deviations from the norm occur, aortic defects occur: combined, stenosis, insufficiency.

The valve flaps undergo fusion with a reduction in the opening. It becomes difficult to drain blood from the ventricle area.

• LV hypertrophy when arterial hypertension is excluded and the septum size is 15 mm or more;
• reduction of the hole area to 1 cm or less.

The pressure in the area between the aorta and the ventricle is more than 40 units.

Failure

The valves cannot close completely due to damage, and blood from the aorta is able to penetrate back into the ventricle.

Indicators of failure for surgery:

• the volume of blood ejected into the aorta is less than 50%;
• the volume of reverse blood flow is more than 60 ml during the period of cardiac contraction;
• expansion of the left ventricular cavity up to 75 mm.

An open method of intervention with general anesthesia is practiced.

A combined defect occurs as a result of a combination of stenosis and insufficiency.

Mitral valve

It is presented in the form of two leaflets between the atrium and the LV. Blood penetrates from the first to the second. When the ventricle contracts, the valve closes. The blood at this moment is not pushed into the atrium, but through the aorta into the vascular area.

Replacing it using minimally invasive methods takes approximately three hours. The open method is used in severe cases.

Correction methods

The endovascular method involves inserting a catheter with a prosthesis into the incisions of the femoral artery (or brachial artery) under local anesthesia. For dangerous defects, endovascular replacement is not applicable.

Minithoracotomy is the replacement of the mitral valve. In this case, a heart-lung machine is used. The entire chest is not opened; only a few incisions are made. General anesthesia is prescribed.

Types of artificial valves

They differ in composition and manufacturing method.

Biological

The biological valve is made from natural tissues of pigs and other animals and is implanted for a period of up to 15 years. After this, the replacement is repeated.

Advantages: no chest opening is required, anticoagulants are prescribed for only 3 months.

Disadvantage: rapid wear and tear (12-15 years).

Mechanical

It is specially manufactured using hypoallergenic materials such as plastic and metal. Such valves are installed indefinitely.

Advantages: durability, stability.

Disadvantages: mandatory provision of open access to the heart, lifelong anticoagulant therapy.

Donor valves are rarely practiced.

Features of preparation for surgery

When preparing for surgery, you should follow the following recommendations:

1. Carry out appropriate diagnostics, which may include:
   • echocardiography;
   • laboratory tests of urine, blood (general and biochemical tests);
   • chest x-ray;
   • blood test for coagulation;
   • Ultrasound of the heart.
2. Take advantage of the consultations of specialists who will be directly involved in the operational process:
   • anesthetist;
   • cardiologist;
   • surgeon;
   • respiratory therapist;
   • nursing staff.
3. 8 hours before surgery, completely stop eating. Before this, eat light food during the day to avoid heart overload.
4. Prepare psychologically and enlist the support of relatives.

Before the operation you should rest and get enough sleep. Take a shower no later than 8 hours before the intervention.

Priority for surgery and its cost

Heart valve replacement can be done free of charge, at the expense of the state. But for this you need to register in the queue. Benefits are provided for emergency reasons.

Paid options are faster, but are more expensive.

The average cost of an implant is about one and a half thousand dollars, the operation itself is estimated from 70 to 400 thousand rubles, in some clinics or more.

Heart pathologies requiring surgical intervention are diseases subject to quotas. However, each clinic is issued by the Ministry of Health of the Russian Federation only a certain number of budget quotas, which are distributed by the commission.

Operation sequence

The operation to replace the heart valve begins after special preparation (breathing exercises, enema, etc.) and the introduction of anesthesia devices.

Difficulty in replacing the aortic valve

Aortic heart valve replacement is performed on an open organ. After opening the chest, the heart is connected to artificial blood flow. Without mandatory disclosure, the procedure is performed when the patient is in serious condition and has unstable hemodynamics.

Techniques for such surgical intervention involve access to the organ through the area of ​​the femoral vein. The process is monitored on a special screen using contrasting of the vessels.

Biological material allows, after taking anticoagulants for a three-month period after surgery, to subsequently do without them.

Operation stages

After special preparation (described above) and the introduction of general anesthesia, surgical intervention involves the following steps:

• treatment of the surgical field;
• longitudinal dissection of the sternum, opening of the pericardial cavity;
• connection of the artificial circulation mechanism;
• manipulations on the heart (removal of the affected valve);
• installation (implantation) of an artificial prosthesis;
• monitoring the functions of the implanted prosthesis, checking the seams;
• turning off artificial blood flow, “starting” the heart;
• suturing.

The procedure takes place under general anesthesia. The myocardium is treated throughout the entire operation (at least 2 hours) with cold saline solution.

At the end of the process, the operated person is sent to intensive care. He is not allowed to get up for two days. Initially, chest pain and high fatigue persist. On the fifth day the patient can be discharged. Seams are processed daily. They are removed within 7-10 days.

Recovery after surgery

Modern valve implantation operations are carried out with minimal risk. A person is discharged from the hospital on the fifth or sixth day if there are no complications. However, a person who has undergone this procedure must change his lifestyle.

Rehabilitation after surgery is important. The motor mode should be gentle:

• when sitting, keep your legs at a right angle at the knees, do not cross them;
• before getting up from the chair, you should move to the edge;
• before getting out of bed, first roll onto your side;
• To lift objects from below, do not bend over, but sit down.

New movements should be added gradually, in a gentle manner. At first, the legs may swell, sleep and appetite may be disturbed, and visual disturbances may occur.

Attacks of depression can be replaced by excessive cheerfulness. But these phenomena are temporary. Life after surgery quickly returns to normal.

With proper rehabilitation, after a few months (six months), the patient restores normal heart function and feels healthy.

It is important to undergo routine examinations and treatment annually, ensure proper dietary nutrition, and practice restorative exercise, which is important for breathing. For 2-4 weeks, you must follow the rehabilitation instructions prescribed by the doctor, monitor your fluid balance, and regularly monitor your health.

Annual examinations

They are shown to everyone who has undergone such an operation. Dispensary cardiological observation includes:

• echocardiography (EchoCG);
• blood tests (clinical, biochemical);
• X-ray.

In addition, an INR test is performed monthly, which reflects the indicators of the blood coagulation system. During the consultation, the attending physician may prescribe medications, antibiotics, and immunostimulants.

Foods and medications rich in calcium are prohibited. If you feel unwell, you should contact your doctor immediately.

Diet after surgery

There are no strict dietary restrictions, but it is not recommended to abuse certain foods.

• salt;
• coffee drinks;
• fats of animal origin;
• carbohydrates.

• vegetable oils;
• fresh fruits and vegetables;
• fish.

In general, the diet is not strict, with standard recommendations. Alcohol consumption should be reduced to a minimum. It is also advisable to limit smoking.

Physical activity

Activity during the post-rehabilitation period is practically unlimited. Only excessive loads and participation in competitive sports should be excluded.

Consultations with a doctor will help each person individually in these matters. Exercises, walking with increasing loads, and walks are recommended.

Physical activity has a positive effect on the condition of blood vessels, the heart, and strengthens the body as a whole. There are cases of returning to professional sports after surgery.

Complications and consequences of the operation

After surgical valve replacement, consequences and complications are possible. The most common are:

• instability of the surgical wound;
• migration of the implanted prosthesis;
• stroke, heart attack;
• complications due to prolonged immobility.

With any operation there is a certain risk. To prevent thromboembolic complications and bleeding, anticoagulants are prescribed with an individually selected dose.

In any case, implanted prostheses are foreign bodies that can affect blood clotting and the formation of blood clots.

About the purpose of disability and prognosis

Non-working group II is determined for a period of one year after completion of the operation to restore the myocardium. In the future, transfer to group 3 is possible.

When establishing disability, cognitive deviations (decreased mental abilities) are taken into account individually.

How long do you live with an artificial valve? The average life expectancy in this case is approximately 20 years. However, theoretically, the valve’s lifespan is much longer (up to 300 years, according to doctors).

Contraindications for surgery

There are always risks during surgery. Therefore, ailments of internal organs can become an obstacle to surgical intervention:

• severe heart pathologies;
• infection of valve tissue;
• thrombosis;
• exacerbation of rheumatism;
• complex valve deformation.

An obstacle may also be the patient’s reluctance or neglect of the pathology. The main thing is to calculate the feasibility and save life.

Surgeries to implant a heart valve are not uncommon these days. They are carried out regularly and successfully, thanks to the constant modernization of the process.

If the operation is not performed in a timely manner, there is a risk of developing pathologies due to LV enlargement. This worsens heart failure. If the operation is performed well, you will no longer have to experience pain. The forecasts are favorable. Only the scar will remind you of the procedure.

Despite the fact that medical scientists are working to improve the technique of heart valve transplantation (biological and mechanical), and are constantly creating progressive versions of artificial valves, complications sometimes occur after heart valve replacement surgery.

Postoperative complications

Complications should not be confused with the wear and tear process of an artificial valve, which becomes unusable over time. Thus, biological valves begin to function worse gradually, over 5–10 years, and mechanical valves can “work” without problems for 20–25 years, however, the person will have to constantly take anticoagulants (when transplanting biological valves, this is not required) .

Taking into account the trends described above, doctors recommend that in the process of treating heart disease, if there is a need, biological valves should be transplanted into elderly people for whom a ten-year lifespan of the valve is acceptable, and besides, they will not have to take additional medications. Young patients are offered mechanical valves that do not fail for more than 20 years, although it is necessary to prescribe medications that prevent blood clotting .

Important: heart attack and stroke are the cause of almost 70% of all deaths in the world!

Hypertension and pressure surges caused by it - in 89% of cases the patient is killed for a heart attack or stroke! Two thirds of patients die in the first 5 years of the disease!

Mortality statistics during surgery

In people under 50, heart valve replacement surgeries are usually uneventful, with a mortality rate of less than 1 percent. However, the older the patient, the higher the likelihood of dying during this heart surgery.

Mortality during heart valve replacement surgery:

Taking into account statistical data and the fact that mechanical valves fail much less frequently, doctors decide which valve (biological or mechanical) to replace the patient’s own “failed” heart valve with.

Amazing discovery in the treatment of hypertension

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Complications after surgery

Any heart surgery is a complex surgical procedure that can sometimes become complicated, causing unexpected problems.

Scar tissue growth – in some patients, at the site of valve replacement, rapid growth of fibrous scar tissue occurs. This can happen with both a implanted biological valve and a transplanted mechanical valve. This complication leads to thrombosis of the artificial valve and will require repeated urgent surgery. However, after 2008, there were no reports of this complication, that is, modern methods of performing the transplant procedure make it possible to avoid this scourge.

Bleeding as a result of taking anticoagulants – anticoagulants are popularly called drugs that “thin” the blood, but to be precise, these pharmacological agents do not make the blood more “liquid”; they prevent the formation of blood clots, increasing the clotting time of the blood. This property of anticoagulants makes it possible for blood, in any case, even if a clot has begun to form in close proximity to the valve, to “wash it off” from the valve before it turns into a thrombus.

However, it happens that people taking anticoagulants for a valve transplant begin to suffer bleeding in other organs of their body, and most often this is the stomach. Therefore, all patients are strongly advised to monitor the color of urine and stool (in case of bleeding, they darken) and, if there are any signs of gastric distress, contact their doctor.

Thromboembolism – a serious complication caused by valve thrombosis. Symptoms of thromboembolism are:

• dyspnea;
• dizziness;
• clouding of consciousness;
• loss of vision and hearing;
• numbness and weakness throughout the body.

If at least one of the above symptoms occurs, the patient should immediately consult a doctor or call an ambulance.

Prosthetic valve infection – any, even the most sterile foreign object placed inside a living body can be infected. Therefore, if you have a fever, prolonged respirator problems (more than two days), or any infectious diseases, you should consult a doctor who, through tests and other tests (for example, MRI of the heart), will determine whether the artificial heart valve became infected, or whether everything turned out well.

To avoid the development of implant infection, people with artificial valves, when visiting the dentist, as well as during procedures such as colonoscopy, gastroscopy, angiography, cardiac catheterization, etc., should inform doctors that they have an artificial heart valve. .

You should also be careful about any accidental wounds, cuts, abrasions, or blisters from shoes that become infected.

Hemolytic anemia – this complication occurs extremely rarely and is expressed in damage to a large number of red blood cells upon contact with the implanted valve. Symptoms that hemolytic anemia has developed are:

• constant weakness;
• persistent fatigue and lethargy.

Although the symptoms of hemolytic anemia are similar to the symptoms of the body's reaction to anticoagulants, these complications have completely different mechanics of occurrence and development. Therefore, the patient should not figure out for himself what caused the illness, but should immediately consult a doctor, who, having made a diagnosis, will provide the correct treatment.

Which valves to install (video)

Russian industry produces many different products of the highest quality, which have no analogues in the world. Unfortunately, the same cannot be said about artificial heart valves.

Today, Carbomedics Tophead is considered one of the best mechanical heart valves. There are other excellent foreign analogues. Unfortunately, this cannot be said about Russian products - they are not so reliable, and they break down quickly. Therefore, if we are talking about a young patient, then it is better to pay more and get a European implant.

True, there is hope that soon, on the market of medical products, mechanical heart valves will appear that are not inferior and even superior in quality to foreign ones.

From this article you will learn: how a heart valve is replaced, and who is prescribed this operation. Possible complications, rehabilitation period. Life after such an operation.

Valves are structures that ensure the correct direction of blood flow. There are four valves in the human heart:

1. Aortic.
2. Pulmonary.
3. Mitral.
4. Tricuspid.

Due to various medical conditions, surgery may be required to replace one or more of them. The decision to perform surgery is made by a cardiologist, and the operation is performed by a cardiac surgeon. The patient's rehabilitation is carried out by the attending cardiologist.

Briefly about heart valves: what they are and why they are needed

All valves open during myocardial contraction and close during cardiac relaxation.

Valve location

Structure and functions

When is valve replacement necessary?

The most common indications for replacing any of the valves are:

• insufficiency (when the valve does not close completely and blood can flow in the opposite direction);
• stenosis (narrowing, due to which it is not able to open normally, and not enough blood moves in the right direction).

Most often, replacement of the aortic or mitral valve is required. Defects of the tricuspid (three-leaf) usually appear in combination with defects of other valves. This requires replacement of all valves affected by the disease.

The operation is performed when the valve is damaged to such a degree that blood circulation is significantly impaired. The following symptoms appear:

• chest pain;
• fainting;
• dyspnea.

The doctor can also inform a patient without severe symptoms about the need for surgery, based on echocardiography data.

What indications on cardiac ultrasound indicate valve replacement is necessary?

Another indication for valve replacement is infective endocarditis. With this disease, surgery is needed if:

• two weeks of antibiotic treatment had no effect;
• heart failure progresses rapidly;
• an intracardiac abscess appeared;
• Blood clots form in the heart.

Contraindications

The operation cannot be performed for the following pathologies:

• acute myocardial infarction;
• stroke;
• exacerbation of severe chronic diseases (diabetes mellitus, bronchial asthma, etc.).

Types of artificial valves, their features

They can be divided into two groups:

1. Mechanical.
2. Biological.

The latter are produced from animal tissues: pig endocardium or calf pericardium.

For aortic valve defects, the Ross operation is popular, when a pulmonary valve is installed in place of the aortic valve (it is replaced with a biological prosthesis).

Advantages and disadvantages of biological prostheses:

Advantages and disadvantages of mechanical prostheses:

The feasibility of using various valves:

How is the operation performed?

On the eve of surgery to replace the valve, the patient is prescribed sedatives.

You cannot eat 12 hours before the procedure. Also stop taking any medications.

The operation itself is performed under general anesthesia. Lasts 3–6 hours. The operation is performed on an open heart using a heart-lung machine.

Carrying out heart surgery using a heart-lung machine

The operation is performed in several stages:

• preparatory actions (putting the patient into deep sleep, preparing the surgical field, etc.);
• incision and opening of the sternum;
• connecting the patient to the artificial blood circulation machine;
• removal of the diseased valve;
• installation of a mechanical or biological prosthesis;
• disconnection from the heart-lung machine;
• sternal closure and suturing.

You will be an inpatient at the clinic for the first 2–4 weeks after surgery.

Postoperative period

For the first two days, the patient is prescribed bed rest. During this time you may have:

• chest pain;
• visual disturbances;
• poor appetite;
• insomnia and drowsiness;
• swelling of the legs.

If you experience these signs, tell your doctor, but don't panic—the symptoms usually go away within a few weeks.

Tell your doctor about any changes in how you feel.

Possible complications

The most dangerous complication is the occurrence of blood clots. The risk is higher when a mechanical prosthesis is installed, especially in place of a mitral or tricuspid valve.

To prevent this complication, constant use of anticoagulants (Aspirin, Warfarin), as well as Heparin injections in the postoperative period is necessary.

Infectious endocarditis of the installed valve is in second place in terms of frequency of occurrence. The risk is increased when installing a biological prosthesis. Endocarditis can also occur during installation of a mechanical prosthesis. In this case, microorganisms from adjacent tissues penetrate the synthetic material and become even more difficult to reach. This complication is very dangerous and often leads to death.

1. Chills.
2. Fever.
3. Malfunction of the installed valve (signs of heart failure appear again).

Treatment of this complication involves antimicrobial therapy, and if it is ineffective, repeated surgery.

To prevent endocarditis, all patients are prescribed antibiotics in the postoperative period.

The prognosis after such heart surgery is favorable. Surgery significantly reduces the risk of death from heart failure and improves quality of life.

The mortality rate after surgery is only 0.2%. Death is mainly due to thrombosis or endocarditis. Therefore, it is very important to take all preventative medications prescribed by your doctor.

Life after surgery

In the first year after valve replacement, you should go to the doctor for examination every month. In the second year - once every six months. Then - once a year.

During the examination, an ECG and EchoCG must be done.

Throughout your life you must follow these rules:

• Give up bad habits and drinking coffee.
• Take anticoagulants prescribed by your doctor.
• Follow a diet: give up fatty, fried, salty foods, eat more fruits, vegetables and dairy products.
• Work no more than 8 hours a day.
• Sleep at least 8 hours a day.
• Do not lead a sedentary lifestyle, walk more, spend at least 1-2 hours a day in the fresh air.

Physical activity

Competitive sports and hard work are contraindicated.

You can and should perform therapeutic exercises, agreed upon with your doctor.

Precautions for future surgeries

Any surgical intervention, even dental, can provoke endocarditis. Therefore, be sure to tell your surgeon that you have undergone heart valve replacement surgery.

To prevent inflammation in the heart, you need to take an antibiotic 30-60 minutes before the surgical procedure. This may be Amoxicillin, Azithromycin, Ampicillin or Cephalexin to choose from. Please discuss this with your doctor in advance.

Hello! Last year, in October, I was diagnosed with a heart defect. Tricuspid insufficiency of the heart valve, and pulmonary hypertension, in addition, Raynaud's syndrome. They told me to have an operation, I went through all the medical examinations and tests. A few days later, the portal told me They were supposed to send me for surgery. But I refused at the last minutes, I’m very scared, I don’t know what will happen next. I also have a goiter. What should I do, please tell me, I’m completely at a loss.

Hello, Natalya. If your local doctors offer you surgery, you need to decide, because over the years there are complications, not improvements. But it's up to you to decide.

Good afternoon Please tell me what we should do! My husband is a dynamic patient and has been for 5 years. In 2013, I was diagnosed with an infection and endocorditis. I sent documents to replace the valve to the Novosibirsk clinic, but it was refused. Now he is in the hospital, pulmonary edema has occurred. The edema has now been eliminated and he was transferred from intensive care to the rheumatology department. There the Doctor said that “swelling is the beginning of the end”, that they couldn’t help and would discharge me. What should we do? HELP SAVE HUSBAND. Where can we turn for help?

Hello Veronica. I really sympathize with you, but our site has no connections with any clinics. You need to search.

5 months have passed since the operation to replace the mitral and aortic valves. I had a fever and cough for a long time, and there was congestion in the lungs and liver. After taking antibiotics for a long time, I managed to overcome these problems. Now, despite not feeling unwell, there are days when severe shortness of breath appears. The arrhythmia did not go away. I take: nebivolol, tlrosemide, lazortan and xarelto. Bio valve. Age 60 years. Periodically, a burning sensation appears throughout the body, as if under electric current. What to do? Thank you.

Lussy, our site does not prescribe treatment; this is unacceptable over the Internet. Based on your comment, you need an additional face-to-face consultation with a cardiologist about adjusting the medications you are taking.

Hello. My mother underwent heart surgery to replace the mitral valve with an artificial one. The operation took place on February 8, 2018. And the other day she began to feel very chilly. What could it be?

Hello, Nastya. This may be a circulatory disorder, vasospasm, increased blood pressure, etc. You need to consult your doctor.

Hello, in 2004 I had an operation for Tetrado fallo. Now there is insufficiency of the pulmonary valve (I don’t have one, I have a monocusp) surgery is recommended. I’m very afraid, I have two small children. They said the risk of the operation is very high, I don’t know what to do and how long can I do without it? How dangerous is this operation?

Olga, if they offer help, you need to make a decision. Any operation is a risk. However, no one can accurately judge the outcome in advance. I wish you more optimism and everything will be fine!

Hello, I had an operation and changed the valve. Thank you for your support! It’s true that my leg hurts a lot and I’m worried about bicostal neurogia.

Hello, Olga. We are very glad that you took the plunge and changed your life for the better.

There are many reasons for the development of intercostal neuralgia, these are: degenerative processes in the spinal column, especially in chronic or acute form, constant worries and stress, poisoning of the body with various toxins or chemicals, acute lack of B vitamins, which in many cases occurs due to intestinal inability suck it in, and many others. etc.

To eliminate neuralgia, you need to know the exact cause. Pain is relieved with an antispasmodic and a sedative. For example, spasmolgon plus phytosed.

Try drinking a decoction of several herbs: chamomile and lemon balm. They need to be taken in equal parts, pour boiling water over them and boil in a water bath for 15 minutes. Next you should add a teaspoon of honey. Use 2 times a day.

Good afternoon, my mother underwent mitral valve replacement with a mechanical valve and tricuspid valve repair. The area of ​​the left atrioventricular orifice was 1.2 cm2, SV = 65. She experienced restenosis. For the first time in 2007, a closed commissurotomy was performed. As the surgeons spoke after the operation. She had a big heart (there was hypertrophy). She was operated on; she spoke and walked normally. Then, after 2 days, according to the doctors, her heart stopped, and because of this, cerebral edema developed. She was immediately transferred to the intensive care unit. My dad and I are not allowed into the intensive care unit. Doctors say that Nek’s condition is stable. Tell me please. What could have caused cardiac arrest and cerebral edema? I am very worried about her, she is my life, my everything. ((((((((.

Hello Faridun. There can be many reasons for cardiac arrest and the development of cerebral edema, for example, a severe circulatory disorder. It is impossible to state such facts with precision. You need to have faith and hope that everything will work out.

The doctor replaced two valves for me, the mitral and aortic. The question in nutrition is whether you can eat spices.

I urgently need surgery to replace the valve, I’ve been living without it for a year now, I’m afraid and I have a job in 12, will I be able to work in 12? And how is the postoperative period tolerated?

Hello, Victoria. You have to choose – work or health. If you have heart disease, working 12 hours a day is contraindicated. You cannot delay the operation. If the valve stops functioning correctly, the person develops heart failure. At the same time, the cardiac muscle wears out, and blood stagnation forms in all internal organs. As a result, the human body becomes depleted. Over time, such complications lead to death. Much depends on the professionalism of the surgeons and the specific method of installing the prosthesis. The total time of stay of the patient in the cardiac surgery center: from 2 weeks to 1.5 months.
Be healthy!

My husband underwent heart surgery on January 31 to replace the meter valve with an artificial one. She was discharged after 5 days with a fever. Now the temperature is the same. They prescribed a drug for fever, Diclofenac or voltaren.
When you make candles, the temperature disappears. When will it be normal?
Maybe instead of Warfarin we need something better and inexpensive. This drug causes complications on the stomach. In short, everyone is cut down, but we are not doctors, I don’t know how to take care of them.
The most difficult thing is low blood pressure. At first it was 80/57, now it’s 100/60 and there is arrhythmia.
Help, please.

Stayed in hospital in (Sklifa)

Lyudmila, Ivanovna, blood pressure can decrease by eliminating the obstacle to normal blood flow (after mitral valve replacement), which should stabilize over time. In addition, patients after prosthetics receive a lot of drugs, and it is possible that among them there are those that lower blood pressure. Check all medications that were prescribed, and if there is an antihypertensive drug, reduce its intake by 2 times. And there can be many reasons for high body temperature after valve replacement surgery. Most often this is infective endocarditis, the addition of a respiratory infection (pleurisy, pneumonia, ARVI, etc.), exacerbation of any chronic inflammatory process existing before surgery. It is important to establish the cause. If the patient has been examined by a specialist and medications have been prescribed, do not change the medications yourself, just try to give them to your husband after meals, then the effect of irritation of the mucous membrane will be minimal.
Stay healthy.

Thank you very clearly written in ordinary words