Cardiac surgery has been an independent medical specialty since 1993. The primary specialty is toracic and cardiovascular surgery, which evolved from general surgery. Cardiac surgeons treat acquired and congenital heart disease as well as injuries to the heart and surrounding vessels. Cardiac surgery works closely with vascular surgery and cardiology.
What is cardiac surgery?
Cardiac surgeons treat acquired and congenital heart disease, as well as injuries to the heart and surrounding vessels. The public perceives cardiac surgery primarily in the area of heart transplants. However, these complicated and sometimes life-threatening procedures are far from the most common operations. Cardiac surgeons mainly perform operations on heart valves and coronary artery bypass grafting. Cardiac surgery includes six focus groups: Coronary surgery, mitral valve surgery, aortic valve surgery, aortic surgery, heart failure, and pacemaker.
Treatments and therapies
During surgical revascularization, heart specialists place bypasses as a highly effective long-term therapy for coronary artery disease. This procedure is particularly appropriate for patients who have multivessel coronary artery disease, including the great anterior wall artery (ramus interventricularis). Surgical revascularization is equally induced in the presence of reduced left ventricular heart function with parallel diseases, for example, of the heart valve. Cardiac patients benefit to the same extent when the finding is main stem stenosis. Heart specialists are guided by national care guidelines, which specify when bypass surgery is preferred over balloon dilatation or drug therapy. Patients benefit from minimally invasive bypass, which is performed without the use of a heart-lung machine, OPCAB. The arterial bypass vessels are removed from the patient endoscopically. Automated instruments are used to perform the anastomotic suture. Operations on the mitral valve are among the most common procedures in the field of heart valve reconstruction, which is performed by minimally invasive procedures. Diseases of the aortic valve particularly affect elderly patients over 70 years of age. Various heart valves are available for aortic valve replacement, with a distinction made between biological and mechanical heart valves. If a regular cardiac (sinus) rhythm is present, the transfer of a biological valve is induced, since a lifelong anticoagulation therapy with Marcumar is not necessary. Biological heart valves are implanted primarily in patients over the age of 65. These heart valves are now also increasingly used in younger patients. These innovative models have a durability of 15 years. The good experience regarding recurrent operations of degenerated biological aortic valves has confirmed the high expectations for this procedure. A contraindication in patients under 65 years of age is a second operation in old age, because the biological heart valves have a limited durability. Calcified heart valves can also be submitted to regeneration in this way. A mechanical heart valve and blood clot planning can be avoided. Catheter-based aortic valve surgery is either transfemoral (via the leg artery) or transapical (via the heart apex). Aortic valve procedures combined with coronary revascularization are complex operations that involve increased risk for the elderly patient. Frequent procedures take place on the ascending aorta (aorta ascendens). This procedure places high demands on cardiac surgeons because the aorta and aortic roots are replaced up to the cephalic arteries. The physicians use different techniques to protect the brain from embolisms and circulatory problems. In the vast majority of cases, dilations are due to aneurysm, which occurs due to progressive degeneration with age. Younger heart patients often have impaired strength of the aortic wall (Marfan syndrome). Aortic dissection is an emergency indication. During surgery, the valves are sewn into a vascular prosthesis. In commercially manufactured vascular prostheses, the artificial heart valves are already sewn in.However, cardiac surgeons prefer the first method, as it allows a certain flexibility, because larger heart valves can be sewn in, which significantly improve hemodynamics. In the case of these biological conduits, the administration of anticoagulation using Macumar becomes obsolete, which is a decisive advantage. Physicians prefer the stentless valve, which is sewn into the vascular prosthesis. This newly fabricated aortic root shows superior performance (hemodynamics). Reconstruction of the aortic valve is preferred to replacement because medical science has now developed various innovative techniques that allow patients to live a carefree, post-operative life. In this regard, operations are performed on the aortic arch and eliminate the life-threatening aortic dissection, which inevitably leads to death if not treated in time. Heart failure is the most common heart disease. This disease can occur in the form of a heart attack, severe inflammation, or during heart surgery. However, chronic heart failure is by far the most common coronary disease. In some patients, this condition can be controlled by drug therapy. If this is not the case, the only options are implantation of an artificial heart or heart transplantation. In most cases, it is necessary to provide the patient with an artificial heart system until a suitable donor heart is available. However, the risks involved are high due to long waiting times and the risk of the body rejecting the implanted donor organ. Defibrillator and pacemaker technology has undergone significant technical innovation in recent years, as various computer-controlled algorithms have come close to accurately replicating the natural heartbeat under resting and stress conditions.
Diagnosis and examination methods
Anticoagulants, which provide blood clotting, are most commonly administered. Most patients are given Godamed, Marcumar, Colfarit, aspirin, Asasantin, ASA, Plavix, Iscover, or Tiklyd. These medications must be discontinued prior to surgery due to the risk of bleeding. However, this discontinuation does not take place on the patient’s own responsibility, but under medical supervision, since the regulated blood flow is not guaranteed without these anticoagulants. Under certain circumstances, physicians will use a substitute medication. If coronary heart disease is present or bypass surgery is to be performed, patients take the medication ASA until they are admitted to the hospital. If a coronary stent has been placed within the last twelve months, Iscover or Plavix will also continue to be taken. Laboratory examinations and tests are performed in the following areas: hepatitis and HIV serology, lung function, blood group, coronary angiography, echo, carotid duplex, abdominal ultrasound to determine whether there is an infection or an abdominal aortic aneurysm, chest X-ray and calculation of the Euroscore for patients at risk. In case of valve surgery, X-ray OPG, X-ray sinuses, dental presentation, ENT presentation and 3D TEE (morphological evaluation of mitral valve) are done before reconstructions. In the case of elective valve surgery, a focus of infection must be eliminated to avoid or minimize endocarditis. Postoperatively in the ICU: ECG, blood pressure monitoring, blood analysis, ventilation, PiCCO (monitoring cardiovascular data), pulmonary catheter, IABP(intraaortic balloon pump), SpO² (blood oxygen, oxygen saturation), ZVD (measurement of central venous pressure), ECMO (extracorporeal membrane oxygenation, intensive care technique for ventilation). Medication includes Cordarex (antiarrhythmic agent), vasopressin, dobutamine, epinephrine, norepinephrine, and corotrope. Patients are extubated first and mobilized the day after surgery and transferred to the normal ward.
