In recent years, with the aging of society and the accelerated pace of life, there are more and more patients with heart disease, and because of the rapid onset, critical condition, more complications and high mortality rate of patients with cardiovascular disease, it has become the number one killer of human health. Cardiac surgery is gradually developing towards better efficacy and less trauma, with an increase in the number of treatable diseases and an increasing variety of tools, playing an increasingly powerful role in the treatment of cardiovascular diseases.
Coronary artery disease is most effectively treated with bypass grafting
Coronary artery bypass surgery is an operation to establish a vascular pathway in the aorta and the distal end of the obstructed coronary artery to improve the blood supply to the myocardium, which is internationally recognized as the most effective treatment for coronary artery disease and has a history of nearly fifty years.
The outstanding advantage of surgical bypass surgery is that it can completely treat 100% of occluded coronary lesions and requires less re-blooding. At present, most of the coronary artery bypass surgery in General Hospital’s cardiac surgery department is done under general anesthesia, non-extracorporeal circulation and non-stop heartbeat, which is less traumatic, with short hospital stay and fast return to normal activities.
Reasonable choice of methods
There are three methods for treating coronary artery disease: medication, stenting and bypass, and the choice of which one needs to be judged by professional doctors according to the condition. Drug treatment is the foundation and is used throughout the other methods. It is difficult to reverse the formed plaque and vascular obstruction with medication, so for those who have frequent angina attacks and the effect of medication is not satisfactory, interventional or surgical treatment should be chosen in time.
The advantages of interventional therapy are minimally invasive and rapid, but the long-term benefit of coronary artery bypass surgery may be superior to interventional therapy in some patients with multiple branch lesions, left main lesions, stent restenosis, comorbid other structural heart disease, cardiac insufficiency, and high risk of bleeding.
Cautious evaluation in patients over 80 years of age
Coronary artery bypass grafting is an absolute indication for severe ischemic heart disease, but the perioperative risk is relatively high in patients over 80 years of age due to the aging degeneration of systemic organ function. All organs of the body need to be evaluated prior to surgery and no significant abnormalities are required before coronary artery bypass grafting can be performed.
Renal insufficiency can also be bypassed
Patients with renal insufficiency can undergo surgery under the conditions of taking measures such as keeping the heart beating during the operation, maintaining high perfusion pressure, shortening the operation time and block time, using small doses of dobutamine to dilate the renal vessels during and after the operation, increasing renal perfusion, and avoiding drugs that affect renal function.
Adherence to medication control after bypass or stenting
Coronary artery bypass or stent treatment cannot really cure coronary artery disease, but can only reduce the lesion of coronary artery and delay the progress of coronary artery disease. Therefore, after bypass or stenting, patients still suffer from coronary artery disease, and like ordinary coronary artery disease patients, they need to eat a light diet and not eat food containing too much fat and salt. At the same time, maintain a good lifestyle and do not stop medication without doctor’s permission. Patients should pay attention to the combination of work and rest and avoid stress and overwork.
Pay attention to the side effects of the medication and note any black stools, abdominal pain, etc. The use of lipid-lowering drugs may cause rhabdomyolysis, liver and kidney damage, etc. It is necessary to pay attention to regular related reexamination for any muscle pain and other conditions.
Minimally invasive treatment for valvular disease
Surgery for valve disease is like the door in our family room that does not close tightly and needs to be repaired. Currently, the General Hospital Cardiac Surgery Department uses completely thoracoscopic valve replacement surgery, which is performed with three small keyhole-like holes in the chest wall, with no large incisions in the chest wall, making it very aesthetically pleasing. There is no need to open the chest, and the postoperative pain is mild, bleeding is low, recovery time is short, and the procedure is inexpensive and meets cosmetic requirements.
Surgical treatment of atrial fibrillation
Atrial fibrillation, referred to as atrial fibrillation, is one of the most common clinical arrhythmias. In atrial fibrillation, the frequency in the atria is fast and irregular, so that the atria lose their effective contraction function. Patients have palpitations, shortness of breath, exertion, vertigo, chest discomfort, and some patients have no symptoms, but the risk of thromboembolic complications still exists.
Pharmacological treatment of atrial fibrillation: control of the ventricular rate with antiarrhythmic drugs and long-term use of anticoagulants will not eliminate atrial fibrillation per se, although they can reduce the number of episodes.
Catheter ablation: A minimally invasive catheter intervention technique that can treat paroxysmal, persistent or chronic atrial fibrillation. Catheter ablation alone is not recommended if severe structural heart abnormalities are combined with cardiac surgery. The recurrence rate is high.
Surgical treatment: including open-chest and transthoracoscopic ablation treatment. Compared with catheter ablation, surgical treatment of atrial fibrillation has a higher success rate and a lower recurrence rate. Complete removal of the left heart ear during surgery is effective in avoiding cerebral thrombosis, the most dangerous complication in patients with atrial fibrillation. Patients with atrial fibrillation in combination with valvular disease can have both procedures performed simultaneously, with complete restoration of sinus heart rate after surgery.
Thoracoscopic-assisted ablation therapy also does not require an open chest, and good AF ablation can be achieved with only 3-4 keyhole-sized incisions in the chest wall.
The best outcome of atrial fibrillation treatment is to restore sinus rhythm; for patients with atrial fibrillation who cannot restore sinus rhythm, drugs can be applied to slow down the faster ventricular rate; anticoagulants are also applied to prevent thrombosis and stroke.