Cardiovascular Surgery - Frequently Asked Questions (FAQ)

What are the treatment methods applied after a heart attack?  

Heart attack is a clinical picture that occurs as a result of critical narrowing of the coronary vessels feeding the heart or complete occlusion of the coronary vessel. In patients who have a heart attack or have had a heart attack before, the diagnosis is made by coronary angiography. In a patient diagnosed with coronary angiography, the treatment method changes according to the degree of narrowing in the coronary vessel, the location of the narrowing, and the clinical condition of the patient. Drug treatment is preferred in patients who do not have severe coronary artery stenosis (only calcification, plaque or narrowing of less than 50% in coronary vessels).

Balloon and stent placement is a method used to open stenosis and complete occlusions in the coronary vessels. The narrowed coronary vessel is entered with the help of special guide wires, the narrowed area is widened with a balloon, and then a stent suitable for the diameter of the vessel is placed. 
The other treatment method is 'Coronary Bypass Surgery'. Providing blood flow by forming a bridge with veins taken from other parts of the body (vein or artery) beyond the critical narrowing of the coronary vessels or the heart region that cannot receive enough blood due to complete occlusion is called coronary bypass surgery. Coronary bypass surgeries are performed with a risk rate as low as 1%, with the improvements in surgical techniques and the increase in the quality of patient care.

What should be paid attention to after a bypass surgery?

For some metabolic disorders that cause a disease after the surgery, the treatment method recommended by your doctor should be followed regularly and the drugs given should be used without skipping. It would be best for the patient to avoid smoking and other tobacco products and alcohol use. Exercising regularly is also important for heart health. Heavy exercise is not recommended in the early period. You may prefer brisk walking or light jogging, especially after the healing of the sternum.  Other sports such as swimming can also be done in the future. 
At least 45 minutes to 1 hour of exercise a day, four days a week is sufficient. However, there are some points to be considered while exercising. If you have complaints such as fatigue, shortness of breath, chest pain, headache, dizziness, nausea, vomiting that occur during exercise and these complaints recur or persist, you should immediately go to the hospital. It is recommended not to walk in extremely hot or cold weather, right after a meal or when hungry.

What should patients pay attention to in nutrition after bypass surgery?

After the surgery, attention should be paid to weight and, if necessary, dietitian support should be taken to get down to the ideal weight. Daily fat consumption should be reduced, fatty foods should be avoided, and a diet based on vegetables and fruits should be adopted. Lean meats should be chosen in meat selection, fish, chicken and turkey should be given priority by reducing red meat consumption, and methods such as boiling, grilling and steaming should be preferred as cooking methods. 
Sugar and salt consumption should also be limited. In the consumption of milk and dairy products, fat-free products should be preferred. It should also be noted that offal and fried foods are prohibited and the contents of packaged ready-to-eat foods should be read before consumption. 
Patients should be followed regularly in terms of blood sugar and cholesterol values; Patients with a high course despite appropriate diet and exercise should be supported with appropriate drug therapy.

Can heart surgery be performed without cutting the chest bones?

Yes, heart surgery can be performed without cutting the sternum. Thanks to the developing medical technology, heart surgeries are performed with a method called minimally invasive. Unlike open surgeries, which are accepted as standard and are performed by cutting the chest bones, small incisions are sufficient in these operations. With the help of small incisions (on armpits, or under the breasts), heart valve replacement, repair of congenital holes in the heart and coronary bypass surgeries are performed successfully. 
Although not widely applied yet, robotic surgery also allows the operation to be performed by opening only small incisions, together with the minimally invasive method. Both of these methods allow surgeons to reach the heart without any problems. Thanks to the small incisions after the surgery, it is seen that the patient heals faster. 
In the application of these methods, the suitability of the patients and the condition of the disease for the operation is an important criterion.

Is bypass surgery performed on a working/beating heart?

Coronary bypass surgery has been performed on the working heart for many years. Elderly patients, patients with severe calcification in the aorta, patients with severely impaired kidney and lung functions, and patients with a previous heart attack and severely weakened heart contraction are the patient groups in which bypass surgery in the working heart is most frequently applied. 
In the bypass surgery on the working heart, the heart area that is planned to be bypassed is fixed, while the heart continues to work. While the heart is working, a bypass is made to the coronary artery that is completely blocked or has severe narrowing. After the surgeries on the beating heart, the duration of intensive care and hospital stay is shortened, and the number of blood products used is also reduced.

What are the risks of heart surgery?

As with any surgery, there are some risks in heart surgery. However, thanks to the developing medical technology, the probability of successful operations is increasing day by day. The risk of coronary by-pass surgeries, which are commonly performed in the world and in our country, is around 1%. However, the general health status of the patients, their age and other accompanying health problems affect the risk of developing complications. The risk of developing complications is higher in patients with advanced age and loss of function in organs such as kidneys, lungs and liver.

At the same time, the increase in these risks depends on whether or not the heart muscle is damaged. Apart from operations such as coronary bypass, the risk rate is slightly higher in operations performed on patients with bleeding due to ruptures of the main vessel, for example. Along with coronary bypass, accompanying valve disorders, valve replacement or repair surgery are also performed. The risk ratios may differ from patient to patient and according to the surgical intervention to be applied.

The risk ratio, benefit and harm ratio may vary for each patient. The risks that will arise in the absence of surgery may be much more than the possible risks in the surgery.

How long do you need to stay in hospital after heart surgery?

Patients usually go to hospital one day before the surgery. All surgical preparations are completed while the patient is hospitalized. If the patient does not have a medical problem that prevents surgery, surgery is planned. The patient, who enters the operating room, is taken to the intensive care unit after the operation, which lasts for an average of 4-5 hours including all the preparations. Patients who have not yet woken up from the anesthesia are followed up on a ventilator. Respiratory support is gradually reduced as the effect of anesthesia decreases and the patient wakes up and all vital signs of the patient are stable. They leave the ventilator after it is seen that the patient is fully awake, muscle strength is restored and can continue breathing without support. 
Patients spend the night of the operation in the intensive care unit. The patients who are checked the next morning are taken to the standard service room if deemed appropriate. Depending on the general condition of the patients who are taken to the service, they are followed up for an average of 3 to 4 days if no problems develop. Patients stay in the hospital for an average of 5-6 days, including one or two days in the intensive care unit and three or four days of service care. During this time, patients do walking and breathing exercises. Along with the admission of the patient to the hospital, the patients and their relatives are informed in detail about the health status of their patients at all steps of the treatment processes.

Can I have heart disease even if I have no complaints?

Even if you have no complaints, you may have heart disease. Vascular diseases generally show late symptoms. In vascular diseases, the degree of narrowing of the vessels may not show symptoms before reaching a certain level. As the degree of narrowing increases, the patient's complaints begin to appear. Sometimes the first sign can be a serious heart attack. 
The patient groups without any symptoms are mostly diabetic patients. The most important reason for this is that diabetes simultaneously damages nerve endings. If you have heart disease and diabetes, you can have a silent heart attack without any symptoms. The absence of complaints does not mean that you do not have a problem with your heart. If you have a family history of heart disease, diabetes and high blood pressure, and if you smoke, you should not neglect your regular check-ups.