How heart surgery works and how safe it is

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Even though many heart surgeries are standard procedures, they arouse existential fears in many patients. (Source: Shuttermon / Getty Images)

Surgical procedures on the heart are emotionally stressful. Information and competent care help patients to better deal with their fears.

Around 100,000 heart operations are carried out in Germany every year. In addition, there are around 900,000 cardiac catheter procedures. Despite great care from specialists and good medical care, an operation on one’s own heart is still associated with fear for most people. Are they eligible?

The surgical team: Experience creates security

“The rule of thumb is: the greater the experience of the interdisciplinary treatment team, the safer the procedure is for the patients and the better and long-term the result is,” says Professor Jan Gummert, medical director of the Heart and Diabetes Center (HDZ) North Rhine-Westphalia. Westphalia in Bad Oeynhausen .

“Rehearsed processes in inpatient care as well as in the operating room as well as teamwork from a wide range of disciplines and levels are extremely important,” confirms Christian Siegling, nursing director at the HDZ.

Patient safety is essentially based on a therapy concept that is individually tailored to the severity of the disease as well as possible comorbidities and additional risk factors. This also means that questions about treatment risks are not only asked when anesthesia is initiated, but rather an assessment takes place before the operation.

Heart surgery: What procedures are there?

Depending on the underlying disease and diagnosis, there are different ways to perform heart surgery:

  • Classic surgery : The procedure in which the surgeon opens the breastbone takes place under general anesthesia and the use of a heart-lung machine. During the operation, it takes over the tasks of the heart and supplies the body with oxygen.
  • Minimally invasive technique : Here too, the patient is placed under general anesthesia. However, with this technique, in which the surgeon makes an incision just a few centimeters wide along the ribs, the physical strain on the person affected is significantly lower.
  • Catheter-assisted technique : The surgeon guides a fine tube through a blood vessel, usually from the groin, to the heart.

The time before the operation: This is how it goes

Before you are admitted to hospital, a so-called heart conference between cardiologists and heart surgeons clarifies the requirements for the procedure. Depending on the preliminary examination results, the specialists determine an individual surgical strategy.

Coordination with your family doctor’s practice is particularly advisable if certain medications are being taken and the medication dosage needs to be changed before the operation.

Risk factors such as tooth decay and inflamed tooth roots, narrowing of the carotid artery, impaired lung function or nicotine consumption can affect the result of the operation.

In order to keep the risk of circulatory problems, bacterial inflammation or a stroke as low as possible, further preliminary examinations, dental treatments or medication may be necessary in advance.

Individual risk factors are taken into account

A common and serious complication, especially in patients over 65 years of age, is postoperative delirium. It shows that patients are initially confused. Under the leadership of anesthesia and cardiac surgery, structured, multi-professional delirium management has proven successful at the HDZ.

It reduces the frequency and duration of delirium and thus reduces the risk of cognitive disorders relevant to everyday life after hospitalization.

Anesthesia: preparation and implementation

In order to discuss specific questions about anesthesia and preparation for the operation, anesthesiologists offer, in addition to educational discussions, consultation appointments and video consultations in advance. Systematic preparation for the operation begins in the clinic from the day of admission, during which all preliminary examinations are reviewed again.

Experts speak of a so-called “preoperative risk stratification and monitoring”, which is based on the guidelines of the specialist societies and, together with a care concept tailored to the needs of the patient, promises better treatment success, especially in complex operations and frail patients.

Patients who suffer from severe stress or have a mental illness should seek psychotherapeutic support.

The day of the operation: what happens now?

On the day of the operation, preparations for inducing anesthesia are made. This includes continuous blood pressure monitoring and monitoring of oxygen saturation in the blood.

Brain waves and oxygen saturation of the brain are also measured throughout the operation to avoid anesthesia that is too deep or too shallow. Thorough circulatory monitoring with all available medications ensures a high level of safety during and after the procedure.

Risks and possible complications after surgery

Despite all precautionary measures, complications can occur during cardiac surgery, as with all operations. These include infections, secondary bleeding or the development of blood clots (thrombosis). However, they are usually detected early during the operation and aftercare and are therefore usually easy to treat.

The risk of the procedure itself depends on many individual factors, especially the patient’s previous illnesses and their age. General statements cannot therefore be made. It is all the more important that a detailed discussion takes place between patient and doctor in which all relevant parameters are taken into account.

Important: Involvement of relatives

During screening after the operation, nurses, as permanent reference persons for patients and relatives, take responsibility for the further treatment process in the intensive care unit. This is particularly true for patients at risk of delirium. Among other things, intensive care nurses check the sleep-wake rhythm, communication skills and orientation after waking up from anesthesia.

Part of the recovery process in the intensive care unit is that patients can be mobilized as early as possible after the operation. The recovery progress is documented in clinical physiotherapy.

The soul also needs help

A competent surgical team and good aftercare are often not enough for patients to be able to return to their old lives in a relaxed manner after the procedure. Many also need emotional support.For this reason, psychocardiological centers, which are available at some large clinics, are becoming increasingly important. In such centers, cardiac surgeons, cardiologists and psychologists work closely together to provide patients with comprehensive care and to take into account not only the physical but also the psychological effects of the disease.

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