For many people with acquired heart defects, heart surgery is the only option. Heart surgery is used in many cases. In addition to open heart surgery, non-invasive heart surgery has also become increasingly popular in recent years.
Here you will find further information on various heart operations as well as selected specialists and centers for heart defect surgery.
Structure of the human heart © designua | AdobeStock
The coronary arteries supply the heart muscle with oxygen and nutrients. Arteriosclerosis can cause these vessels to become increasingly narrow. This means that less blood can pass through the vessels. As a result, parts of the heart muscle are insufficiently supplied with blood and can be damaged in the long term(coronary heart disease).
If the coronary arteries become completely blocked, the heart muscle dies. This is known as a heart attack.
Doctors try to avoid this life-threatening situation for the patient. For example, blood-thinning medication can be administered. Balloon dilatation is another option for widening constricted vessels.
However, if these methods no longer help, heart surgery is used. The constricted vessel sections can be bypassed using a bypass. In other words, an alternative "route" is created for the blood flow.
The procedure is performed under general anesthesia. The surgeon makes a 15 cm incision at the level of the sternum and then cuts it in the middle. The heart is now exposed.
As the operation cannot be performed on a beating heart, it must be immobilized. A heart-lung machine maintains circulation during this time.
The surgeon creates a bypass circuit in the constricted coronary arteries using a section of vein from the leg or forearm. This restores the blood supply to the heart.
At the end of the procedure, a drain is inserted to drain the wound secretions to the outside. The surgeon then drains the sternum.
The patient receives follow-up care in the intensive care unit for a few days.
Bypass surgery is one of the standard procedures in heart surgery today. However, it does not eliminate the underlying disease. It is a matter of combating the symptoms of arteriosclerosis. However, the arteriosclerosis remains and further vascular constriction can occur.
The patient must therefore also cooperate in the treatment of arteriosclerosis. This includes a healthy lifestyle with a healthy diet and sufficient exercise.
If the patient succeeds in changing their diet and lifestyle, they can prevent the progression of arteriosclerosis. Bypass surgery can then successfully alleviate the heart symptoms for several years.
If the arteriosclerosis progresses, the bypasses can also become narrower after some time. In principle, further bypass operations are also possible at a later date. However, every further open procedure harbors further possibilities of infections and complications.
Illustration of two bypasses on the coronary arteries of the heart © sakurra | AdobeStock
The heart valves are located
If they are restricted in their function, this can lead to blood shunting or congestion. This can lead to further heart damage.
The task of heart surgery for valve defects is to repair or replace the heart valves. A person can only lead a normal, safe life if the heart valves function properly.
In most cases, the surgeon can only decide during the operation whether a repair is possible. Otherwise, heart valve replacement is the better alternative.
In principle, biological or artificial heart valves are available for heart valve replacement.
A biological valve replacement is usually functional for 10 to 15 years. An artificial valve is functional for life. However, it requires the lifelong use of blood thinners.
The choice of valve type is made in close consultation between the Center for Cardiac Surgery and the patient. It depends on
In younger heart patients, doctors tend to favor an artificial heart valve. Otherwise, they would have to undergo another operation after the replacement valve fails. And possibly several times every few decades.
For older patients, the durability of the replacement valve is not as important. This means that they do not have to take blood thinning medication.
In the vast majority of cases, the patient's physical capacity improves after a successful operation. The old performance capacity returns to some extent.
The position of the human heart © SciePro | AdobeStock
The heart has independent signal transmitters that control its beating rhythm. However, these specialized cells can be disrupted by illness or infection. The heart then loses its rhythm. Pacemakers step in as soon as the heart's own beating pulse fails to occur or is triggered with a delay.
Cardiac surgery has made significant progress in the treatment of signal disturbances in the heart's excitation system. Pacemakers now work for several years before the built-in batteries run out.
The operation is standard in many heart centers and can be performed on an outpatient basis under local anesthesia.
A probe is inserted endoscopically into the ventricle and measures the heart rate there. The actual pacemaker is often located below the collarbone. It processes the signals from the probe and reacts with its own electrical impulses to synchronize the heartbeat.
In the event of sudden cardiac death, ventricular fibrillation occurs unexpectedly, especially in older people. This is followed by circulatory collapse and after a short time the patient dies. There is hardly any time to act.
People,
have an increased risk of dying from sudden cardiac death. Cardiac surgery can help to get the heart back into the right rhythm in an emergency.
A sensor and a metal coil are inserted into the ventricle during outpatient heart surgery. A pacemaker is placed below the collarbone. The procedure to insert the defibrillator is performed under local anesthesia. It is usually performed on an outpatient basis.
In the event of cardiac arrhythmia, the metal coil generates a strong electrical impulse. This forces the heart back into its normal rhythm. In this way, the defibrillator prevents circulatory collapse and thus the death of the patient.
Resynchronization therapy is currently the only possible treatment for cardiacinsufficiency.
The system consists of three probes and a pacemaker. The probes are inserted into the right atrium and the ventricles. There they control the muscle contraction of the heart.
Cardiac catheters are used to insert the probes. No open heart surgery is necessary. It is a "keyhole operation" in which the doctor opens the vessels for the catheter. This means that patients are quickly mobile again and the pain can also be limited.
This procedure is usually performed under local anesthesia and can be completed within 90 minutes.
Cardiac surgery also offers options for treating life-threatening atrial fibrillation.
Atrial fibrillation carries the risk of
Blood clots can block vessels, including the coronary arteries, which can lead to embolisms or heart attacks.
The aim of heart surgery for atrial fibrillation is therefore to eliminate the "diseased" areas of the atrium. Various procedures are available for this purpose using
The "motor cells" of the heart that are out of rhythm are specifically destroyed. This means that atrial fibrillation can no longer develop.
In some cases, normal therapy using pacemaker technology is not possible. Children and adolescents also have special requirements due to the growth processes in the body. Modern cardiac surgery has developed special cardiac arrhythmia surgery procedures for these cases.
In some patients, access cannot be created via the venous system. This means that a probe cannot be inserted into the ventricle. In this case, the probes and pacemakers can be applied to the heart muscle from the outside.
Normally, the pacemaker is placed in the shoulder area near the heart, but for some people it is too large. Children and particularly petite people are usually affected. In such cases, this leads to
In these cases, the pacemaker must be positioned in an alternative way. The pacemaker is also inserted in a minimally invasive manner.
Patients who suffer from cardiac insufficiency also benefit from a very new procedure in cardiac surgery: cardiac force augmentation using probes. During this operation, heart probes are inserted into the ventricles.
They send out an impulse that forces the heart muscle to contract more strongly. This increases the beating power of the heart and patients regain their performance in the short term.
Open heart surgery is not the only method of heart surgery. In recent years, non-invasive heart surgery has become increasingly popular. In this case, it is not necessary to open the chest; the procedure is performed endoscopically. This is useful for
possible.
The endoscope and other devices are inserted into the heart through a very small incision.
Theadvantages of this method are
Heart transplantation, i.e. the use of a donor heart, is the last option in heart surgery. It is used when no other treatment methods can save the heart.
Heart patients require a suitable donor heart for transplantation. Donor organs are rare and so the waiting time can be very long.
However, even with a "new" heart, transplant patients must adhere to certain rules for the rest of their lives. These include taking medication that suppresses the body's own immune system. Otherwise, the immune system could reject the foreign heart.
Heart transplantation is the most invasive method of heart surgery, but also the high art of the entire field.
Even though artificial hearts are now available, their use is very limited in time. They usually only support the function of one ventricle. They are particularly suitable for bridging the waiting time until the actual heart transplant.
The blood is diverted via the tip of the heart muscle through an elastic plastic tube into the pumping chamber of the artificial heart. The pumping chamber is integrated into the abdominal wall muscles below the diaphragm.
Both the filling of the pumping chamber with blood and its ejection are controlled electronically. For this purpose, a cable is fed through the subcutaneous fatty tissue from the skin and connected to a central control unit. A second plastic tube guides the blood into the large aorta.
The heart and pump work in parallel and actually completely independently of each other.
The heart only has to pump a small part of the blood into the body itself. This relieves the pressure on it. The other organs in the body receive a better blood supply and oxygen supply thanks to the additional pumping capacity.
The doctors use various examinations to assess what needs to be considered during preparation.
If heart transplantation is the only remaining option, the patient is placed on the waiting list for a donor heart. The waiting time is several months.
During the waiting period, other problems such as shortness of breath and cardiac insufficiency can set in. Close cooperation between
is vital.
A donor heart must be removed and implanted in the waiting patient within a few hours. The patient must therefore always be reachable during the waiting period.
If a suitable donor heart is available, the patient must come to the hospital as quickly as possible.
There, everything is prepared for the upcoming operation and the patient is fully anaesthetized. During the operation, a heart-lung machine takes over ventilation and circulatory control.
The diseased heart is completely removed from the bloodstream and extracted. The "new heart" is then implanted and literally connected to the body.
Aftercare for this type of heart surgery begins in the intensive care unit. The doctors monitor
During the first year after the operation, rejection reactions are monitored by means of a heart muscle biopsy. Immune and infection status must continue to be determined regularly. In an emergency, further treatment is carried out in a hospital to prevent rejection.
The heart transplant should enable the patient to return to a normal everyday life. This usually happens very slowly and can take several months. Longer walking distances without shortness of breath or heart problems are an initial start.
Gradually, the person affected will be able to take an active part in life again. Nevertheless, close monitoring is necessary, especially in the first few years after heart surgery. This is the only way to react to complications as quickly as possible.
The patient will work very closely with the hospital or heart center. Finally, starting work can round off the path to a self-determined life.
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