home Diseases Open heart surgery complications. After heart surgery. Cardiac bypass surgery: indications and performance

Open heart surgery complications. After heart surgery. Cardiac bypass surgery: indications and performance

Morning. Petroverigsky lane, house 10. At this Moscow address in the Kitay-Gorod area I arrived at the federal center for diagnostics and treatment cardiovascular diseases angiography.su, part of the state research center preventive medicine to put on a sterile suit again and visit the operating room.

Angiography is a research method blood vessels using x-rays and contrast fluid. It is used to identify damage and defects. Without it, the operation I am about to talk about—stenting—would not have been possible.

There will still be some blood. I think I should warn impressionable people about this before they open the entire post.

Who has never heard of cholesterol plaques, he didn’t watch Elena Malysheva’s show. Plaques are deposits on internal walls vessels that have been accumulating for years. Their consistency is similar to thick wax. The plaque consists not only of cholesterol, calcium in the blood sticks to it, making the deposits even denser. And this whole structure slowly but surely clogs the blood vessels, preventing our fiery motor, or rather pump, from delivering nutrients and oxygen in different organs, including into the heart itself.

Before the advent of the stenting method, about which we'll talk, doctors only had surgical method bypass surgery, who became popularly famous thanks to Boris Nikolaevich Yeltsin’s heart surgery in 1996 in a round operating room. I remember this incident vividly (a childhood memory), although a similar operation was performed on many famous people.

Bypass surgery is a cavity operation. The person is given anesthesia, the chest is sawed open (they actually saw it, it can’t be done with just a scalpel), the heart is stopped and the artificial circulation system is started. The beating heart beats very hard and interferes with the operation, so it has to be stopped. To get to all the arteries and bypass, you need to take out the heart and turn it over. A shunt is a donor artery taken from the patient himself, for example, from the arm. Quite a stress for the body.

During stenting, the patient remains conscious (everything happens under local anesthesia), can hold his breath or do deep breaths at the doctor's request. Blood loss is minimal, and the incisions are tiny, because the arteries are entered through a catheter, which is usually installed in the femoral artery. And a stent is placed - a mechanical dilator of blood vessels. All in all, an elegant operation (-:

The operation was performed on Sergei Iosifovich in three stages. I found myself on the final operation in the series. It is not possible to place all stents at once.

The surgical table and the angiograph (a semicircular device hanging over the patient) form a single mechanism that works together. The table moves back and forth, and the machine rotates around the table to make x-rays hearts from different angles.

The patient is placed on the table, fixed and connected to a cardiac monitor.

To make the device of the angiograph clear, I will show it separately. This is a small angiograph, not as big as the one in the operating room. If necessary, it can even be brought to the ward.

It works quite simply. There is an emitter installed at the bottom, and a converter at the top (a smile is glued to it), from which the signal with the image is already transmitted to the monitor. There is virtually no scattering of X-rays in space, but everyone present in the operating room is protected. About eight such operations are performed per day.

A special catheter is inserted through a vessel on the arm or thigh, as in our case.

A thin metal wire called a conductor is inserted through a catheter into the artery to deliver the stent to the site of the blockage. I was amazed at its length!

A stent - a mesh cylinder - is attached to the end of this wire in a compressed state. It is mounted on a canister, which will be inflated in right moment time to deploy the stent. Initially, this structure is no thicker than the conductor itself.

This is what the deployed stent looks like.

And this is a scale model of a different type of stent. In cases where the walls of blood vessels are damaged, those with a membrane are installed. They not only maintain the vessel in an open state, but also act as vessel walls.

All through the same catheter, iodine-containing contrast agent. With the blood flow it fills the coronary arteries. This allows the X-ray to visualize them and calculate the sites of blockage where stents will be placed.

This is what the Amazon basin looks like when you inject contrast.

All eyes on the monitors! The entire process of stent installation is observed through X-ray television.

After the stent is delivered to the site, the balloon on which it is attached must be inflated. This is done using a device with a pressure gauge (pressure meter). This device, similar to a large syringe, is visible in the photo with long conductor wires.

The stent expands and is pressed into the inner wall of the vessel. To ensure that the stent has expanded correctly, the balloon remains inflated for twenty to thirty seconds. It is then deflated and pulled out of the artery on a wire. The stent remains and maintains the lumen of the vessel.

Depending on the size of the affected vessel, one or more stents may be used. In this case, they are placed one after another overlapping.

Here's how the stent works. Below are screenshots from the X-ray TV. In the first picture we see only one artery, a curly one. But another one should be visible, underneath it. Due to the plaque, the blood flow is completely blocked.

The thick sausage on the second one is a stent that has just been deployed. The arteries are not visible because contrast is not running in them, but the wires are clearly visible.

The third shows the result. The artery appeared, blood flowed. Now compare the first picture with the third again.

The concept of expanding the affected areas of the vessel using a certain frame was proposed forty years ago by Charles Dotter. The development of the method took long time, the first operation using this technology was performed by a group of French surgeons only in 1986. It was only in 1993 that the effectiveness of the method for restoring the patency of the coronary artery and maintaining it in a new state in the future was proven.

Currently, foreign companies have developed about 400 different models of stents. In our case, it is Cordis from Johnson & Johnson. Artem Shanoyan, head of the department of x-ray endovascular methods of diagnosis and treatment at the center, answered my question about Russian manufacturers of stents and replied that they simply do not exist.

The operation lasts about half an hour. A pressure bandage is applied to the arterial puncture site. From the operating room the patient goes to the ward intensive care, and two hours later to the general ward, from where you can write happy text messages to your family with all your might. And in a few days they will be able to see each other at home.

Lifestyle restrictions typical for heart patients are usually removed after stenting, and the person returns to ordinary life, and observation is carried out periodically by a doctor at the place of residence.

Heart surgery can cure many diseases of cardio-vascular system, which are not amenable to standard therapeutic techniques. Surgical treatment may be performed different ways, depending on the individual pathology and general condition of the patient.

Indications for surgical treatment

Cardiac surgery is a field of medicine in which doctors specialize who study, invent methods and perform operations on the heart. Heart transplantation is considered the most complex and dangerous cardiac surgery. Regardless of what type of surgery will be performed, there are general indications:

rapid progression of cardiovascular disease; inefficiency conservative therapy; failure to consult a doctor in a timely manner.

Heart surgery provides an opportunity to improve general state the patient and eliminate the symptoms that bother him. Surgical treatment is carried out after a complete medical examination and an accurate diagnosis has been established.

Heart disease

Surgeries are performed for congenital or acquired heart defects. A congenital defect is detected in a newborn immediately after birth or before birth. ultrasound examination. Thanks to modern technologies and methods in many cases manage to detect and treat heart defects in newborns in time.

An indication for surgical intervention can also be coronary disease, which is sometimes accompanied by such a serious complication as myocardial infarction. Another reason for surgical intervention may become a violation heart rate, since this disease tends to cause ventricular fibrillation (scattered contraction of fibers). The doctor should tell the patient how to properly prepare for heart surgery in order to avoid negative consequences and complications (such as blood clots).

Advice: proper preparation to heart surgery is the key to successful recovery of the patient and prevention postoperative complications, such as a blood clot or blockage of a vessel.

Types of operations

Cardiac surgeries can be performed on open heart, as well as on a beating heart. Closed heart surgery is usually performed without affecting the organ itself and its cavity. Open heart surgery involves opening chest and connecting the patient to a ventilator.

Endovascular intervention

During open heart surgery, the heart is temporarily stopped for several hours to allow the necessary manipulations to be performed. This technique makes it possible to cure complex heart defects, but is considered more traumatic.

During beating heart surgery, special equipment is used so that the heart continues to contract and pump blood during surgery. The advantages of this surgical intervention include the absence of complications such as embolism, stroke, pulmonary edema, etc.

Exist the following types heart surgeries, which are considered the most common in cardiological practice:

radiofrequency ablation; coronary artery bypass grafting; stenting of coronary arteries; valve replacement; Glenn operation and Ross operation.

If surgery is performed with access through a vessel or vein, endovascular surgery (stenting, angioplasty) is used. Endovascular surgery is a branch of medicine that allows surgical intervention under X-ray control and using miniature instruments.

Endovascular surgery makes it possible to cure the defect and avoid the complications that abdominal surgery gives, helps in the treatment of arrhythmia and rarely causes such a complication as a blood clot.

Advice: surgical treatment heart pathologies has its advantages and disadvantages, therefore, the most suitable one is selected for each patient suitable look surgery, which carries fewer complications specifically for him.

Radiofrequency ablation

Radiofrequency or catheter ablation (RFA) is a minimally invasive surgical intervention that has a high therapeutic effect and has a minimal number of side effects. This treatment is indicated for atrial fibrillation, tachycardia, heart failure and other cardiac pathologies.

Arrhythmia itself is not a serious pathology requiring surgical intervention, but can lead to serious complications. Thanks to RFA, it is possible to restore normal heart rhythm and eliminate main reason his violations.

RFA is performed using catheter technology and under X-ray control. Heart surgery is performed under local anesthesia and involves inserting a catheter into the required area organ that sets the wrong rhythm. Through an electrical impulse under the influence of RFA, the normal rhythm of the heart is restored.

Coronary artery bypass grafting

Coronary artery bypass grafting (CABG) helps restore blood supply to the heart muscle. Unlike the RFA technique, this treatment gives a high result due to the formation of a new passage for blood flow. This is necessary in order to bypass the affected vessels using special shunts. To do this, take a vein or artery from the patient lower limb or hands.

This type of heart surgery helps prevent the development of myocardial infarction and atherosclerotic plaques. Its essence lies in the fact that sclerotic vessels are replaced with healthy ones. Often, after bypass surgery, an angioplasty technique is used, when a tube is inserted with a balloon into the damaged vessel through the vessels (femoral artery). Pressurized air puts pressure on the plaques (thrombus) in the aorta or artery and helps remove or promote them.

Stenting of coronary arteries

Stenting

Together with angioplasty, stenting can be performed, during which a special stent is installed. It expands the narrowed lumen in the aorta or other vessel and helps prevent blood clots and remove atherosclerotic plaque, as well as normalize blood flow. All these manipulations can be carried out simultaneously, so that repeated surgery is not prescribed.

Most common vice heart disease is a narrowing of the valve or its insufficiency. Treatment of such a pathology should always be radical and consist of correction of valvular lesions. Its essence lies in prosthetics mitral valve. Indication for replacement surgery heart valve there may be severe valve insufficiency or fibrosis of the leaflets.

In case of serious heart rhythm disturbances and the presence of atrial fibrillation, there is a serious need for installation special device called a pacemaker. A pacemaker is necessary to normalize the rhythm and heart rate, which can be disturbed by arrhythmia. To normalize the heart rhythm, a defibrillator may be installed, which has the same type of effect as a pacemaker.

Heart valve replacement

A patient who has a pacemaker should undergo frequent medical examinations.

During surgery, a mechanical or biological implant is installed. Patients who have a pacemaker must adhere to certain restrictions in their lives. Some time after installation, a blood clot or other complication may appear, so lifelong use of special medications is often prescribed.

Glenn operation and Ross operation

Glenn's operation is part of the complex correction stage for children who have a congenital heart defect. Its essence is to create an anastomosis connecting the superior vena cava and the right pulmonary artery. After the treatment has been carried out, the patient can live a full life.

Ross's procedure involves replacing a patient's damaged aortic valve with his own pulmonary valve.

Laser cauterization can also be used to treat arrhythmia. Cauterization can be performed using ultrasound or high frequency current. Cauterization helps to completely eliminate the signs of arrhythmia, tachycardia and heart failure.

Thanks to modern technologies and the development of medicine, it has become possible to carry out effective treatment arrhythmias, eliminate heart defects in newborns, or cure other pathologies with heart surgery. Some time after such an operation, many people can live their normal lives, with only some restrictions.

Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for self-treatment. Be sure to consult your doctor!

DlyaSerdca → Symptoms and treatment → Surgeries and invasive studies of the heart

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 of this, the person feels unwell and begins to develop severe complications. These complications can lead not only to disability, but also to death.

Surgery is often prescribed coronary disease hearts. 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 carried out 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 given time There is no danger to life, but it must be carried out 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 both in the heart cavity and in a vessel. Using these studies, you can determine some indicators of heart function.

For example, blood pressure in any part of the myocardium, and also 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 drug therapy.

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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 extent of damage coronary vessels, it helps doctors understand whether they need surgery, and if not, what therapy is suitable for of this patient. Ventriculography. This is a study using an x-ray contrast method, 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).

Coronary angiography is often performed in patients with angina 3-4 functional class. In this case, it is resistant to drug therapy. Doctors need to decide which method surgical treatment needed. It is also important to carry out this procedure in case of 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 studies, use local anesthesia. The incision is small, about 1-2 cm. This is necessary to expose the desired vein for installing the catheter.

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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 and restore normal functioning ventricle, as well as restoration of contractile function and reduction of pressure in the cavities of the heart.

To eliminate these defects, the following surgical interventions are performed:

Valve replacement (prosthetics)

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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 of biological material animals).

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 interventions include:

Prosthetics of the ascending aorta. In this case, a valve-containing conduit is installed; this prosthesis has a mechanical aortic valve. Prosthetic replacement of the ascending aorta, without the aortic valve being implanted. 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 involves replacing the artery where ascending aorta goes into the arc and, if required, replaces the concave surface of the arc; Subtotal prosthetics. This is when, when replacing an 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 one is also used thoracic vein, radial artery.

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 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 electricity. 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 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

These types of operations are distinguished into 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. More often under general anesthesia, since the procedure is performed in the neck area and there are discomfort.

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 inner shell, they do it special seams. 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.

Also, the bandage will help prevent swelling and hematomas, promotes correct location 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 an increased arterial pressure, then appoint ACE inhibitors and beta-blockers, as well as drugs to lower blood cholesterol (statins). 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 necessarily given 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 problems coronary insufficiency 3 degrees or suffered a myocardial infarction, disability is also required.

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

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Endovascular surgery is a set of techniques that make it possible to perform heart surgery with minimal risk for the patient's health.

They do not require large incisions, but a highly qualified surgeon and the availability of appropriate equipment are required. The recovery period after such operations is much shorter than after thoracotomy.

Endovascular surgery is a low-traumatic intervention

A number of surgical interventions are combined under the name “endovascular operations”. Their common feature in that access to the heart, coronary vessels and aorta is carried out through one of the peripheral vessels, most often the femoral vein.

It is low-traumatic and can significantly reduce the recovery period. It can be performed under both general and local anesthesia, which is important if the patient cannot tolerate certain anesthetic drugs.

The essence of the method

The operation is carried out as follows:

The doctor determines the vessel through which access will be achieved:

Femoral vein
Femoral artery
Subclavian vein

A puncture of the selected vessel is performed, a catheter is installed
Instruments for surgery are inserted through a catheter
Surgery is being performed
Instruments and catheter are removed
The puncture site is sutured

Mechanism of coronary artery stenting

Immediately after the operation, the patient can be transferred to the cardiology department, bypassing the intensive care ward. When carrying out such manipulations in adults, local anesthesia is used, which allows the doctor to contact the patient.

General anesthesia is used in children for congenital defects heart and in mentally ill patients.

The range of operations that are performed using the endovascular method is quite wide. The most famous of them is coronary artery stenting.

This is the installation of a special device (stent), which does not allow the artery to collapse, and can also destroy it, restoring the patency of the vessel.

Other operations performed using the endovascular method:

Balloon dilatation – restoration of the lumen of the vessel
Occlusion - installation of devices that close pathological messages in the chambers of the heart
Perforation – restoration of blood flow during atresia
Atrioseptostomy is an operation for severe congenital vascular anomalies

As can be seen from the list, these manipulations can be performed even in children from the first days of life with congenital heart defects - transposition of the great vessels, absence of physiological anastomoses, presence of pathological messages.

Indications

The list of indications for endovascular operations varies depending on the diagnosis. Among them are:

Attacks of angina according to the results stress tests, as well as angina pectoris and rest
Previous myocardial infarction
Coronary artery stenosis confirmed by echocardiography
Stenosis of the aorta, pulmonary trunk and other large vessels
Congenital heart defects in children

The advantages of endovascular surgery are that these techniques can be used in elderly people without the risk of complications from general anesthesia (can be performed under local anesthesia), and in young children.

The operation can be performed under local anesthesia

The operation is low-traumatic and does not require cardiac arrest or the use of a heart-lung machine.

However, there are also disadvantages - some types of interventions are only possible openly with access through the chest.

In addition, sometimes these operations (like any heart interventions) turn out to be impossible due to the lack of special equipment or surgeons in the hospital who know this method.

Contraindications

List of contraindications for this species The operations are quite long, although less than for open heart surgery.

Thrombus - a blood clot that interferes with normal blood flow in the vessels

No types of endovascular operations can be performed if there is a tendency to thrombosis, tortuous arteries in the area before the intervention site, or a high risk of branches further along the bloodstream after the intervention site.

Inflammatory process, skin pathology, anatomical abnormality of the vessel or thrombus are reasons for transferring the access area.

Situations in which access is impossible through any of the above vessels are quite rare, but if they occur, endovascular intervention must be abandoned.

Possible complications

At correct implementation Operational complications are rare. However, it is possible allergic reaction for anesthesia, contrast agent and other used.

In addition, during the operation there is a risk of damage to the vascular endothelium, which can result in thrombotic and thromboembolic complications.

During surgery, complications may occur, such as cardiac arrhythmias.

If the preparation for the operation was not thorough enough, then there is a danger of infection in the area of the skin puncture. In this case, the development of various inflammatory complications is possible - phlebitis, thrombophlebitis, the appearance of foci of infection in various organs, sepsis.

Surgery on the heart and blood vessels leads to an inevitable change in blood flow, which also affects the patient’s condition.

The patient may feel weakness, pain in the heart, and possible heart rhythm disturbances. That is why, despite the fact that the operation is relatively easy to tolerate, the patient needs a rehabilitation period.

Rehabilitation

After surgery, it is important to stay hydrated

As a rule, immediately after surgery the patient is transferred to the cardiology department. In most cases, there is no need for observation in an intensive care unit or intensive care unit.

Bed rest is prescribed for several hours; if the patient feels well, physical therapy is prescribed, intended for patients on bed rest.

Walking is allowed in the evening if the operation was performed in the morning, or the next day (if the operation was in the evening or the patient feels unwell).

The range of movements is expanded gradually. Physiotherapy is a prerequisite for success.

Therapeutic diet includes limiting the amount of fluid and salt, avoiding fatty foods, consumption mainly of vegetable fats.

It is necessary to calculate the calorie content of food so that it completely covers the energy needs of the body without becoming excessive.

From this video you can learn how coronary artery stenting is performed:

Surgical interventions on the heart are necessary in the treatment of many pathologies of the cardiovascular system that are not amenable to standard drug therapy. When implementing surgical treatment, it becomes possible to improve the general condition of the patient and prolong his life. But depending on the pathology, there are different heart surgeries, which differ in their technique.

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Classification of operations

Cardiac surgery is aimed at treating cardiac pathologies by indirectly or directly affecting this organ. There are the following types of heart surgeries:

Closed, but the heart itself is not affected. Such operations are performed outside the heart, so they do not require the use of special equipment, with the exception of classical surgical instruments. The cavities of the heart remain closed, hence the name of this category.
Open, they require opening the cavities of the heart, which requires the use of special equipment, such as a heart-lung machine. At the time when such surgery is performed, the heart and lungs are not functioning, which allows the specialist to work with a stopped heart.
X-ray surgery, in which special catheters and devices attached to them are used; they are inserted into the cavity of the heart or the lumen of a vessel to correct the defect. The progress of such an operation is monitored using a monitor screen.

In addition, types of surgical interventions in cardiac surgery are classified according to the patient’s condition and type of defect, as well as the approach to treatment.

Depending on the patient’s condition and type of defect, the following are distinguished:

Emergency operations - when you need to act immediately after the diagnosis has become clear, otherwise the pathology threatens the patient’s life.
Urgent - they do not require a lightning-fast reaction and a quick start of action. They are prepared for several days, but not longer, due to the high risks of complications or death.
Planned - interventions, the implementation of which is desirable, but not essential in the near future. They are prescribed by surgeons after consultation with patients.

Depending on what approach surgical treatment requires:

Radical - they are aimed at the complete elimination of vices.
Palliative - they are additional or auxiliary, their goal is to improve the patient's condition or prepare him for radical intervention.

Radiofrequency ablation

Surgical intervention such as radiofrequency ablation refers to x-ray surgical procedures. It is carried out to improve the condition of a patient suffering from heart failure and arrhythmia, and is characterized by low rates side effects and complications.

Manipulations during the operation are carried out special catheters which are administered to the patient under local anesthesia. The catheter insertion site is distant from the heart itself, therefore local anesthesia is performed at the site where the catheter will be inserted. In most cases, it is injected into the inguinal vein or femoral artery. Once in the organ, electrical impulses are given through the catheters to restore the heart rhythm.

Because of this delivery of impulses, which eliminate a small area of cardiac tissue that causes pathological excitation of the myocardium, the technique received a second name - cauterization of the heart.

Valve replacement

Heart valve replacement is used when there is insufficiency or stenosis of the valve, which prevents the normal passage of blood through it. Valve replacement can be performed during open surgery, endovascularly or with a mini-access.

In the first case, the patient is under general anesthesia the anterior surface of the chest is processed, the sternum is dissected longitudinally, and the pericardial cavity is opened. To disconnect the heart from blood circulation, the patient is connected to a heart-lung machine, and the myocardium is systematically treated with cold saline during the entire operation in order to avoid its hypoxia.

To install the prosthesis, a longitudinal incision is made, opening the heart cavity, the modified valve structures are removed, it is replaced with an artificial one, and the myocardium is sutured. After this, the surgeon “starts” the heart with an electrical impulse or by performing direct cardiac massage, and turns off the heart-lung machine.

After inspection postoperative appearance heart, pericardium and pleura, remove blood from the cavities and suture the surgical wound layer by layer.

During endovascular surgery there is no need to “disconnect” the heart from circulation. It is carried out through the leg, namely by inserting a catheter with an implantable valve into the femoral artery or vein. After the fragments of the damaged valve are destroyed and removed, a prosthesis is placed in its place, which straightens itself, having a flexible stent frame.

If the option with a mini-access was chosen, then the surgeon makes a 2–5.5 cm long incision on the anterior wall of the sternum in the area of the projection of the apex of the heart. Then a catheter is inserted into the organ through the apex of the heart, advancing it to the affected valve, and replacing it.

In the case of valve replacement, there are several types of implants:

Mechanical - they are made of metal or plastic. When choosing such an implant, the patient will need to constantly take blood thinning medications in the future.
Biological - they consist of animal tissues and do not require further use of drugs, but after several decades they need to be replaced.

Pacemaker installation

If the patient suffers from heart failure, cardiomyopathy and cardiac arrhythmias, the specialist may prescribe a minor operation to install a pacemaker.

The technique for performing such surgical intervention is simple. Local anesthesia with novocaine or lidocaine is performed on the right or left under the left clavicle, after which an incision is made in the skin and subclavian vein to insert a conductor into it, and through it into the superior vena cava and into the heart - an electrode. When the tip of the electrode enters the cavity of the right atrium, the doctor selects comfortable spot for optimal stimulation of the heart muscle, it continuously records during the search ECG changes. When the location is found, the electrode is fixed in the myocardial wall from the inside using antennae or a corkscrew-shaped fastening. After fixation, it is necessary to sew a titanium case under the patient’s arm, which is installed in the thickness pectoral muscle left. The wound is sutured and bandaged aseptic dressing.

Coronary artery bypass grafting

Coronary artery bypass grafting is a frequently performed heart surgery. It is prescribed when atherosclerotic plaques accumulate on the inner walls of the coronary vessels that supply the heart, impairing blood flow. In addition, indications may include:

Stable angina pectoris 3–4 functional class.
Acute coronary syndrome.
Acute myocardial infarction during the first 4–6 hours from the onset of pain.
Severe ischemia without pain.

Before surgery, the patient is given intravenous sedatives and tranquilizers, and the intervention itself is performed under general anesthesia. Online access done by dissecting the sternum or from a mini-access, making an incision in the intercostal space on the left in the area of the projection of the heart. The manipulation can occur either with or without connecting the patient to the artificial blood circulation machine.

The aorta is clamped and connected to the device, then a vessel is isolated that will become a shunt. This vessel is brought to the affected coronary artery and its other end is sutured to the aorta. As a result, blood will flow from the aorta, bypassing the area affected by plaques, to coronary arteries without difficulty.

Depending on how many arteries supplying the heart are affected and at what intervals, the number of shunts can vary from 2 to 5.

When the shunts are fixed, metal staples are placed on the edges of the sternum, soft fabrics sutured and applied an aseptic bandage. In addition, drainage is removed from the pericardial cavity to allow outflow of hemorrhagic fluid.

Glenn and Ross operations

Glenn's procedure is otherwise called a bidirectional cavopulmonary connection. In this case, the upper part of the superior vena cava is anastomosed with the right pulmonary artery according to the “end to side” principle.

The Ross procedure involves replacing a patient's damaged aortic valve with their pulmonary valve, and replacing the removed pulmonary valve with a prosthetic valve.