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 are used to open stenosis and complete occlusions in coronary vessels. Special guide wires help enter the narrowed coronary vessel, which is widened with a balloon. Then, a stent suitable for the diameter of the ship is placed.
The other treatment method is Coronary Bypass Surgery. This procedure provides blood flow by forming a bridge with veins taken from different body parts (vein or artery) beyond the critical narrowing of the coronary vessels or the heart region that cannot receive enough blood due to complete occlusion. With the improvements in surgical techniques and the increase in the quality of patient care, coronary bypass surgeries are performed with a risk rate as low as 1%.

What should be paid attention to after a bypass surgery?

For some metabolic disorders that cause 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 essential for heart health. Heavy exercise is not recommended in the early period. You may prefer brisk walking or light jogging, especially after the sternum healing.  Other sports, such as swimming, can also be done.
At least 45 minutes to one hour of exercise daily, four days a week is sufficient. However, some points should be considered while exercising. Suppose you have complaints such as fatigue, shortness of breath, chest pain, headache, dizziness, nausea, or vomiting that occur during exercise and recur or persist. In that case, you should immediately go to the hospital. It is recommended that you avoid walking 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; dietitian support should be taken to achieve 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. Fish, chicken, and turkey should be given priority by reducing red meat consumption, and cooking methods such as boiling, grilling, and steaming should be preferred.
Sugar and salt consumption should also be limited. When consuming milk and dairy products, fat-free products should be preferred. Offal and fried foods are prohibited, and the contents of packaged ready-to-eat foods should be read before consumption.
Patients should be monitored regularly for blood sugar and cholesterol levels; those with high levels despite appropriate diet and exercise should be supported with proper 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 served 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, the patient heals faster.
When these methods are applied, the patient's suitability and the disease's condition for the operation are essential criteria.

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 contractions 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 daily. The risk of coronary bypass surgeries, which are commonly performed in the world and our country, is around 1%.However, the patient's general health status, age, and other accompanying health problems affect the risk of developing complications. The risk 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 and accompanying valve disorders, valve replacement or repair surgery is also performed. The risk ratios may differ from patient to patient and according to the surgical intervention to be applied.

The risk, benefit, and harm ratio may vary for each patient. The risks arising without surgery may be much greater than the possible risks.

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

Patients usually go to the 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 enters the operating room and 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, 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 the patient can continue breathing without support.
Patients spend the night of the operation in the intensive care unit. The patients checked the following day are taken to the standard service room if deemed appropriate. Depending on the general condition of the patients brought 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 patient's admission 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 process.

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 until it reaches a certain level. As the degree of narrowing increases, the patient's complaints appear. Sometimes, the first sign can be a severe 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 you have no 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.