Heart surgery – Wikipedia

The heart surgery or cardiovascular surgery is a surgical specialty dealing with the affections of the heart and large chest vessels.

Originally, this specialty required the implementation of an extra-corporeal circulation (CEC): the heart having to be stopped to be immobilized during the intervention, the infusion of the tissues was maintained during the duration of the operation by an artificial pump . This is no longer necessary for some ^{[ first ]} Interventions on the coronary arteries. The surgeon of this specialty is called heart surgeon or cardiovascular surgeon.

Surgical techniques to achieve the heart [ modifier | Modifier and code ]

The heart being protected by the rib cage, it is actually located just below the sternum. To reach it and operate, the surgeon must conventionally practice a median sternotomy. The rib cage is therefore open, then closed at the end of the intervention.

Mini-invasive cardiac surgery (without total sternotomy) allows since its appearance in the 2000s to introduce instruments into the chest via an incision under the right breast or by a partial sternotomy (only part of the sternum is open). These new methods require only a limited opening of the mediastin and lead to better recovery from the patient and the decrease in post-operative pain ^{[ 2 ]} .

Coronary [ modifier | Modifier and code ]

• Coronary puncture in the event of the narrowing of a coronary artery. This intervention, even if it retains specific indications, is strongly competed with angioplasty techniques, carried out by the cardiologist.

Heart valve [ modifier | Modifier and code ]

• Valvular replacement with a prosthesis, either in synthetic material (mechanical valve), or in biological material (for example bioprosthesis).
• Valvular plasty: the surgeon then repairs the valve without changing it.

Congenital Heart [ modifier | Modifier and code ]

Repairs can be complete or partial and are done earlier and earlier. This is a “specialization” of cardiac surgery.

Heart failure surgery [ modifier | Modifier and code ]

Many corrective interventions have been proposed with various efficiency. Currently it is essentially:

Thoracic aorte surgery [ modifier | Modifier and code ]

• Replacement of all or part of the aorta, with possibly reimplantation of coronaries.

The abdominal aorta traditionally remains the spring of the vascular surgeon and not the heart surgeon.

Pericardium [ modifier | Modifier and code ]

The drainage of a threatening pericardial effusion can be carried out by a surgeon not specialized in cardiac surgery, even by a cardiologist (percutaneous drainage), because of the risk of rapid evolution towards a cardiac arrest and the relative simplicity of the gesture. The use of a specialized surgeon, however, has two advantages: the realization of a pericardial sample to make a more precise diagnosis of effusion and the possibility of carrying out a window between pericardium and pleura or between pericardium and peritoneum allowing much easier drainage In the event of a recurrence.

In cases of constrictive pericarditis, one may have to remove almost all of the pericardium.

Rhythm disturbance surgery [ modifier | Modifier and code ]

Again, cardiac surgery is greatly competed by interventional electrophysiology techniques, the surgeon intervening only in very rare cases.

It is also noted that the installation of a simple cardiac stimulator or an implantable automatic defibrillator is done by a cardiologist and not by a heart surgeon, with exceptions.

Divers [ modifier | Modifier and code ]

It is not negligible and depends on both the type of intervention and the terrain.

A number of scores have been developed to take into account several parameters in the calculation of the risk ^{[ 3 ]} . One of the oldest is the Parsonnet score, published in 1989 ^{[ 4 ]} . That of the Euroscore ^{[ 5 ]} has been widely used since 2003, followed by that of Society of Thoracic Surgeons dating from 2008 ^{[ 6 ]} .

Heart surgery is increasingly benefiting from the use of virtual reality headset ^{[ 7 ]} . This technique is already deployed in France in several hospitals and clinics (Les Franciscan Hospital in Nîmes, Claude-Bernard-Bernard hospital in Metz, …) ^{[ 8 ]} .

Related articles [ modifier | Modifier and code ]

external links [ modifier | Modifier and code ]

• Risk calculators: