Named the percentage of complications in heart surgery

— Andrei Nikolaevich, cardiovascular diseases remain leaders in the list of causes of death in the population. Why?

— Diseases of the cardiovascular system, unfortunately, are still the main cause of death among adults worldwide. Of course, a lot is being done to increase the life expectancy of the population: a healthy lifestyle is being popularized, medicine is developing, and its accessibility is increasing. But modern society, due to the development of various technologies, basically leads a hypodynamic lifestyle, which is superimposed on the quality of food, stress, ecology, and general aging of the population. All this leads not only to the growth of cardiovascular diseases, but also to their rejuvenation. If ten years ago a patient at the age of 40 came for coronary artery bypass grafting and it was nonsense, today it is not surprising.

What pathologies do you most often encounter as a practicing physician?

– The heart is a muscle that contracts throughout a person’s life: from the first to the last day. If an insufficient amount of blood flow comes through one of the large arteries, then a heart attack can occur – the death of the heart muscle. And on how much a large part of the heart died, either a person’s life or the quality of his life depends.

Ischemic heart disease is the most common disease of the cardiovascular system. It lies in the fact that atherosclerotic plaques are deposited in the vessels that feed the heart muscle. Depending on how much this artery is blocked, a person develops angina pectoris, which is accompanied by pressing or nagging pain in the sternum. These are the first signs of coronary disease.

To ensure normal blood flow to the heart muscle, either bypass or stenting is performed. As a result, the nutrition of the heart muscle is restored – the risk of developing a heart attack is reduced, and the person returns to his usual way of life.

In the elderly, ischemic heart disease often coexists with valvular disease. In this case, one-stage shunting and valve prosthetics is performed, or stenting of several pools of heart vessels and blood vessels that feed the brain is performed.

A large proportion is occupied by patients with cardiac arrhythmias. Arrhythmogenic deaths are always sudden, including in young people. To maintain normal contraction of the heart muscle, we install pacemakers, cardioverter-defibrillators.

— What techniques are currently used for the surgical treatment of patients with cardiovascular pathologies?

— Today there are different areas of cardiovascular surgery: cardiac surgery, X-ray endovascular surgery, arrhythmology, phlebology, cardiooncology. Each of the diseases of the cardiovascular system can be successfully treated by two main methods: classical cardiac surgery (open method) and minimally invasive – X-ray endovascular (when operations are performed through microscopic incisions on the skin). To choose a treatment method, we are going to Cardio Team – “team of the heart”. It includes a cardiac surgeon, an X-ray endovascular surgeon, a cardiologist, an anesthesiologist, who determine the optimal method of treatment for a given patient. If we see a complex lesion that cannot be treated with endovascular methods, then the patient goes for classical cardiac surgery. If the patient can be treated with minimally invasive techniques, then the patient undergoes stenting.

— Are there any new, unique methods of treatment invented by our doctors?

— We have outstanding cardiac surgeons in our country who have presented unique techniques to the whole world. For example, the honorary president of our institute is an academician of the Russian Academy of Sciences, head of the department of interventional cardioangiology of the First Moscow State Medical University named after I.I. I.M. Sechenov David Georgievich Ioseliani. He was one of the first in our country to perform endovascular aortic valve replacement in combination with stenting of the affected arteries of other organs. Today, mini-invasive coronary artery bypass grafting, mini-invasive operations on valvular structures are actively developing in our country. Unfortunately, coronary artery bypass grafting is performed through a small incision between the ribs, and our institute is one of them so far, only in a few medical centers in the country. Also, endoscopic vein sampling for shunting is performed, when the patient has only a small incision on the leg instead of a suture along the entire length of the lower leg. Or, for example, there is a minimally invasive aortic valve treatment TAVI (transcatheter aortic valve implantation): when a new valve is delivered to the patient’s site through a puncture in the femoral artery, it opens and replaces the damaged one. Such operations are performed on severe patients who have two or more chronic diseases. They may not be able to tolerate classic heart valve replacement surgery. Ten years ago, such patients were doomed, and today, on the third day after the operation, they are discharged home.

In recent years, such a direction as cardiooncology has been developing significantly. Sometimes a patient is denied an oncological operation due to heart problems – the risk of death is high. We take such patients to either simultaneously perform cardiovascular and oncological operations, or to remove the tumor under the cover of the cardiovascular team. We make every effort to make modern treatment methods available to patients throughout the country.

— Andrey Nikolaevich, which of the operations do you remember the most?

“A patient in the region underwent coronary artery bypass grafting, and five years later he developed mitral insufficiency, due to which severe pulmonary hypertension developed. The patient may not have undergone repeated cardiac surgery. For this reason, he was denied surgery in other medical institutions. When he came to us, he had a very low ejection fraction, high pulmonary hypertension, a constant form of atrial fibrillation – the heart was beating chaotically, unevenly. It is this factor that is the risk of a thrombus formation, which can “fly away” and cause either a stroke or severe damage to internal organs (blood clots form in the left atrial appendage). We performed the patient’s simultaneous clipping of the mitral valve and closed the left atrial appendage with a special device – an occluder. Such an operation was performed for the first time in Russia. Thanks to the endovascular technique, we not only brought the patient back to life, but also prevented the risk of intraoperative complications, which are very susceptible to patients with numerous pathologies. Six months after the operation, we saw a completely different person. He lives a full life, works again, engages in physical activity.

– Can we say that heart surgery is a chance for a second life?

“Heart surgery is done for two reasons: to eliminate the risk of fatal complications and to return a person to a full-fledged lifestyle. Many patients, coming to classical cardiac surgery, are afraid. After all, “heart surgery” already sounds scary. But this is the trail of a historical myth and the lack of enlightenment in this area. Cardiac surgery today is one of the most developed areas of medicine. The capabilities of modern Russian cardiac surgery make it possible to reduce heart surgery to minimal risks, which just recently seemed unrealistic. In large centers, the complication rate is less than 1%. The quality of hardware equipment, suture material, the level of technology – all this reduces the risks of elective surgical interventions to zero. Today’s capabilities of cardiac surgery make it possible to transfer the patient to the ward on the second day, and on the fifth or seventh day the patient is discharged for rehabilitation. After the operation, the patient is limited only by a surgical injury – a fastened sternum and a special corset (only a month). There are no restrictions for a normal lifestyle. Of course, after heart surgery, you should not forget about the diet, a more active lifestyle, and categorically stop smoking.

But cardiac surgeons believe that the best operation is not an operation. And if the patient can be effectively treated with medication, then that is what we are doing.

What is the future of cardiovascular surgery?

— First of all, mini-invasive, hybrid surgeries are becoming widespread — the result of the teamwork of classical cardiac and X-ray surgeons. By taking advantage of the two directions, surgeons will be able to obtain the optimal result: the maximum effect of treatment combined with minimal trauma.

Rapidly developing X-ray endovascular surgery. So, in addition to the aortic valve, the mitral and tricuspid valves are now being replaced – and all this is done through punctures.

Hybrid operations are actively used in the treatment of patients with atherosclerosis of the lower extremities, with aortic dissection, a severe pathology.

Cardiac surgery in Russia is developing very dynamically; new technologies and surgical practices are introduced here every year. Therefore, every year patients have more and more opportunities to keep their heart healthy.