Best Clinics for Open Heart Surgery Worldwide

Modern cardiac surgery is a minimally invasive operation that practically leaves no scars, does not require long-term rehabilitation, and is completely safe. But there are clinical cases when it is impossible to carry out the operation minimally invasively and access to an open heart is required.

Open surgery is any surgical intervention in which the operation is performed on an open area of an internal organ. As for the heart, it can be an intervention on working or artificially stopped organ. For example, coronary artery bypass grafting, valve replacement, or repair of a heart defect.

These are quite complex, many hours of operation, so all manipulations are performed under strict control of the vital signs of the operated person and using the latest equipment.

Types of open-heart surgery

Coronary artery bypass grafting is a necessary manipulation to restore the correct functioning of the blood supply and is performed on open areas of the heart.

Bypass surgery is:

• Traditional - when the intervention is carried out in conditions of artificial circulation,
• On a beating heart without the use of a heart-lung machine,
• Minimally invasive - the operation is performed without opening the chest. It is used when an intervention is required to bypass the anterior left descending artery.

Diagnostics and indications for surgery

Indications for coronary artery bypass grafting can be:

• severe, drug-resistant angina pectoris,
• stenosis of three coronary arteries,
• severe left ventricular failure,
• acquired and congenital heart defects.

For diagnostics before the operation, many studies are carried out: laboratory tests, ECG, coronary angiography, echocardiogram, chest X-ray, daily Holter monitoring. The diagnosis is made by the doctors collectively, and depending on it, the patient receives a referral for surgery.

Preparing for open-heart surgery

Open heart surgery, bypass surgery, or valve replacement is planned. General preparation for the operation is as follows:

The day before the upcoming operation, the patient is examined by the operating surgeon, the anesthesiologist, and the details of the upcoming operation are discussed.

In the evening before the operation, the last medication is taken and a light dinner is allowed, after 23:00 it is prohibited to eat or drink water. In the morning, the patient takes a shower, and manipulations are performed to cleanse the intestines. In places where there will be cuts, it is necessary to remove the hair.

How is coronary artery bypass grafting performed?

After all the preparatory stages, the patient is sent to the operating room, where he receives general anesthesia. As soon as the patient falls asleep, doctors secrete those veins that will be used as shunts.

There are several types of transplants in total, and only the surgeon will determine which one is suitable for the patient's case. Most often these are the internal thoracic or radial arteries.

• This type of surgery lasts from 3 to 6 hours, depending on the planned volume of interventions.
• In case of artificial cardiac arrest, blood is removed by a heart-lung machine. In this case, the blood enters the body being enriched with oxygen through the apparatus, excluding the heart muscle.
• To carry out surgery in this case, the doctor cuts the midline of the chest and almost completely opens it.
• When all surgical manipulations on an open heart are over, the patient is disconnected from the heart-lung machine - his heart enters the body's work and returns to normal blood circulation.
• Before stitching the sternum to the heart, special electrodes are temporarily sutured to stimulate the organ's work and drainage is installed to eliminate the excess accumulation of fluid around the heart.
• After that, the skin is sutured and the patient is transferred to the intensive care unit, where he spends 2 or more days under close supervision.
• Patients are transferred to the intensive care unit for continuous observation for an average of 2 days.

A little about the principle of operation of the heart-lung machine

The venous blood of the operated person is sent to the apparatus. There it passes through an oxygen generator, becomes saturated with oxygen, and gets rid of carbon dioxide (just like in the lungs), where it becomes arterial.

This blood is pumped into the aorta of the operated patient and enters the systemic circulation. This technology allows the patient's heart and lungs to be safely stopped for several hours, giving surgeons an advantage in, particularly difficult areas. Now technologies make it possible to make all parts of the contact disposable for each patient, eliminating the risk of complications from infections.

Beating heart coronary artery bypass grafting

In the case when a beating heart is operated on, this happens through a small incision between the ribs. This type of bypass surgery is performed without connecting to a heart-to-lung machine. cue ".

To carry out the operation between the ribs without damaging them, an expander is installed. Because the area of the surgical intervention is small, healing is also easier and faster. As with artificial cardiac arrest, the patient's veins are used to correct the pathology.

What complications can there be after coronary artery bypass grafting?

Complications from coronary artery bypass grafting are minimal. Only patients with bleeding disorders, inflammation or renal failure, and poor left ventricular function are at increased risk of complications.

Open heart surgery - valve replacement

Valve replacement is performed on a stopped heart with connection to a heart-lung machine. The process takes place under ultrasound control for the most accurate assessment of the valve's performance.

It can be an artificial implant or a biological one. The difference in them is not only in material but also in durability. The operation time is approximately 5-6 hours.

For diagnosis before surgery, the patient is assigned a chest x-ray, ECG, echocardiogram, and many laboratory tests, as well as coronary angiography of the heart.

What other techniques are there for surgical valve replacement, their advantages?

The Ozaki method allows you to create an aortic valve created directly during surgery from the heart tissue of the operated patient. Thanks to this method of surgical intervention, the patient does not need to take anticoagulants for life, the valve takes root quickly and the risk of pressure drops in the operated person decreases.

TAVI operation (transcatheter aortic valve replacement)

A minimally invasive method of valve replacement using a catheter inserted into the femoral artery. The biological folding prosthesis, located in the catheter, opens in the right place and is fixed on the fibrous ring, and its rigid frame does not allow the prosthesis to move. The whole procedure is performed under local anesthesia and reduces the postoperative period to 1 day in intensive care, and 2 days in the hospital.

Treatment of heart defects

Heart defects, congenital and acquired, can be cured mainly by surgery. It will be more correct to operate congenital malformations in children as early as possible, preventing the development of changes against the background of pathology. But there are exceptions, for example, non-closure of an oval window with a defect less than 5 mm in diameter closes itself within 2 years.

What will happen after open-heart surgery?

Regardless of the type of surgery, recovery from heart surgery takes about the same time. The initial rehabilitation period takes about 4-6 weeks, during which the patient gradually returns to his usual life.

However, it should be understood that the rehabilitation period after such a complex operation will be not only with visible improvements but also with deterioration. This is to be expected, and the doctor always warns the patient about it.

For the first few weeks, patients complain of poor concentration, tearfulness, depression, and weakening of memory. It is important to know that these are the usual reactions of the body to extracorporeal circulation and after a couple of weeks everything goes away.

For patients after replacing the valve with a mechanical one, the doctor selects an anticoagulant drug, which must be taken for life. This reduces the risk of thrombotic complications.

Arrhythmia after undergoing open-heart surgery

Arrhythmia (abnormal heart rhythm) occurs as a complication after heart surgery. To identify it and prescribe the appropriate treatment, doctors conduct examinations in the first 48 hours after the operation, and if it is detected, they apply the treatment.

In general, complications are not common in the postoperative period, but to protect oneself from them, the patient needs to follow a number of doctor's recommendations. Usually, at discharge in the epicrisis, the operation is described in as much detail as possible, information about the functionality of the prosthesis (when replacing the valve) and recommendations for taking medications are indicated.

For patients with a renewed heart valve, it is necessary to undergo an echocardiogram regularly, at least 2 times a year. In case of observation of any problems with the valve, this research method is the most optimal for diagnosis.

Suture after open-heart surgery

Although in most cases, the discharge comes immediately after the removal of the stitches, and sometimes their removal is not necessary - they dissolve on their own within 2 months, all patients are given recommendations for caring for him during the healing period:

• the postoperative suture must be kept clean, use only solid, fragrance-free soap and water to maintain hygiene in the area
• without special purpose, it is prohibited to use ointments, oils, and compresses in the seam area
• follow the prescribed diet for a speedy recovery.

How to wash with a post-operative suture?

If the patient's suture heals and remains dry, then it is allowed to take a warm shower or sitz bath without submerging the seam underwater. If the stitches have not yet been removed, then you need to wash while standing with your back to the shower. The duration of water procedures should not exceed 10 minutes, and the water should be at a comfortable warm temperature.The seam should not be rubbed with a washcloth before all the crusts have fallen off. Until that time, it must be carefully moistened.

Consequences of open-heart surgery

The postoperative period is quite difficult for patients, not only from a physical point of view. Some have emotional changes: tearfulness, increased emotionality, mood swings, poor appetite. These symptoms are common and will go away over time. During this period, patients especially need the support of loved ones.

Pain after heart surgery

In the field of surgical procedures, pain is possible. They can last for several months (the sternum finally heals after 3 months). Since this is an expected reaction of the body, it should not cause panic in the patient. In this case, he has prescribed pain relievers.

All instructions for taking or canceling medication are prescribed only by the attending physician!

Sports and weight lifting after surgery can only be allowed after consultation with a cardiologist! For the first time, only walking is allowed, then, after consulting a doctor, you can gradually increase the load.

But weights will need to be avoided. In the first month after the operation, you can wear no more than 1 kg in each hand, in the second - no more than 2 kg per hand. The nose should be symmetrically distributed to avoid instability during the healing of the sternum (it heals completely in 3-4 months). Sharp climbs and heavy housework should be avoided. In the initial stages, only light loads are available.

Diet after open-heart surgery

Proper nutrition is very important during the rehabilitation period. Patients should avoid fried, fatty foods and reduce the amount of sweet and salty foods. It is recommended to eat legumes, more fresh vegetables, fruits, chicken and fish. You will also have to establish a clear meal time.

Where to get open-heart surgery?

To date, open-heart surgeries are successfully carried out in many medical centers and hospitals in

• Israel (Ichilov Medical Center)
• Spain (Quironsalud Madrid Clinic, Teknon Clinic, Quironsalud Torrevieja Clinic)
• Turkey (Memorial Medical Center, Koç University Hospital, Liv Clinic)
• Austria (Vienna Private Clinic, Vienna Central Clinical Hospital)
• South Korea (Anam Clinic, Soonchunhyang Hospital)

Open heart surgery cost

The cost of surgery varies from country to country depending on many factors. But all of them are united by a good material base of clinics, modern diagnostic equipment, and experience of the personnel.