Closed Heart Surgery

Closed heart surgery, scientifically; Stopping the heart and lungs and connecting the patient to the pump that acts as the heart and lungs is considered open heart surgery. Surgeries performed while the heart and lungs are working are called working heart or closed heart surgery.

Among the public; Surgeries performed by cutting the anterior chest bone are considered open heart surgery, and surgeries performed by making an armpit incision from the side wall of the chest are considered closed heart surgery. In fact, these surgeries are minimally invasive surgery techniques.

Surgery Duration
3-6 hours
Recovery Time
2 months
Discharge Time
4-5 Days
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How is the Surgery Done?

Closed heart surgeries are performed through small incisions, called minimally invasive surgery. The location of these small incisions may vary depending on the disease. For example, for heart valves, heart surgery is performed with minimal incisions under the right armpit, while in coronary bypass surgery, if it is a single vessel, depending on the number of vessels, bypass surgery is performed with small 7-8 centimeter incisions under the breast. Sometimes, when there are two veins, two vein bypass surgery can be performed from the right side and the left side, again under the armpit. No bones or muscles are cut during the surgery. The heart is reached between the ribs and the surgery is completed by performing the necessary intervention.

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What is Closed Heart Surgery?

Minimally invasive heart surgery refers to the treatment of congenital or acquired cardiovascular diseases through small incisions without splitting the chest in the middle and therefore without cutting any bones or muscles. In this surgery, the frontal bone of the chest, known as the board of faith, is not cut. It is a method that reduces the risk of complications and provides a more comfortable recovery process compared to open heart surgery.

Can Closed Surgery Be Performed on Everyone?

Closed heart surgery can generally be performed for young and old patients. However, closed heart surgery may not be performed in people with advanced lung disease. In addition, in cases where triple coronary bypass, replacement of three or more vessels is required, and in cases where heart valve surgery must be performed together with coronary bypass surgery, heart surgery with a small incision may not be performed.

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In which diseases is Closed Heart Surgery performed?

  • Mitral valve repair and replacement
  • Aortic valve repair and replacement
  • Tricuspid valve repair and replacement
  • Pulmonary valve repair and replacement
  • Heart hole closure (ASD- Atrial Septal Defect and VSD-Ventricular Septal Defect)
  • Coronary bypass surgeries
  • Heart tumor surgeries

Is Minimally Invasive Surgery Safe?

One of the most important issues after heart surgery is that patients act as recommended by the physician. Depending on the nature of the heart problem and the surgery, the recommendations of the specialist physician should be followed. For example, after heart valve replacement, patients need to be careful about using blood thinners and protecting themselves against infections. In addition, smoking, which plays an important role in the emergence of cardiovascular diseases, should not be consumed, and attention should be paid to diet regarding cholesterol. Patients who quit smoking due to heart surgery should not start smoking again. However, regular exercises should be included in daily life in line with the recommendations of specialist physicians. In addition, regular physician check-ups to check and monitor the patient's condition and heart health should not be neglected. It should not be forgotten that a healthy heart means a healthy life.

 

Effects of Closed Heart Surgery

  • Closed heart surgeries provide many advantages to the patient. The most important of these advantages is that it provides the patient with a comfortable recovery process. The advantages of heart surgery performed with robotic surgery are as follows:
    • Since the incision is smaller, there is less bleeding during surgery and the risk of complications is lower.
    • Since there is no surgical scar on the front of the chest, it provides a good aesthetic appearance and does not negatively affect the patient psychologically.
    • The risk of complications and infection is low.
    • It does not cause any problems in cases where the patient requires a second heart surgery.
    • Since a heart-lung machine is not used, the risk of complications that may arise in other organs is prevented.
    • It allows the patient to be discharged earlier.
    • The patient can return to his daily life earlier and does not cause any problems in his social and sexual life.
    • The patient does not have to lie on his back after the surgery, he can lie in any position he wants.
    • The patient can drive a car and wear a seat belt.
    • The patient does not have to protect his chest.
    • The patient does not face any movement restrictions and can swim and lift heavy objects.

 

Things to Consider After Surgery

One of the most important issues after heart surgery is that patients act as recommended by the physician. Depending on the nature of the heart problem and the surgery, the recommendations of the specialist physician should be followed. For example, after heart valve replacement, patients need to be careful about using blood thinners and protecting themselves against infections. In addition, smoking, which plays an important role in the emergence of cardiovascular diseases, should not be consumed, and attention should be paid to diet regarding cholesterol. Patients who quit smoking due to heart surgery should not start smoking again. However, regular exercises should be included in daily life in line with the recommendations of specialist physicians. In addition, regular physician check-ups to check and monitor the patient's condition and heart health should not be neglected. It should not be forgotten that a healthy heart means a healthy life.

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Prof. Dr. Academic Statements from Yavuz Beşoğul About Closed Heart Surgery

Surgeries performed when the heart is arrested by connecting the heart to the lung pump are open heart surgeries. Surgeries performed while the heart is working and without connecting it to a heart-lung pump are closed heart or working heart surgery. However, among the public, surgeries that do not open from the front of the chest, that is, do not perform a sternotomy, are known as closed. In heart surgeries without sternotomy, various parts of the side walls of the chest may be preferred; The aim is to enter the chest and reach the heart through thoracotomy. The most useful of these techniques and the one that does not have any closure complications; It is a heart operation performed through subaxillary or infra-axillary minithoracotomy. Due to the complications of sternotomy, heart surgeries began to be performed with anterolateral thoracotomy in the world in the 1990s, and access incisions gradually became smaller.

Surgery Process

In 1997, we first started performing our surgeries by converting them to subaxillary incision in our country and contributed to the national and international literature in series. In fact, although there is no difference in the surgical technique, the entry technique has proven to be advantageous from bleeding to infection and early return to daily life. It reduces complications, especially in patients with diabetes, rib cage disorders, kidney failure and obesity. In addition, the small size of the incision and its location on the side are also important from a cosmetic perspective.

On the other hand, the entrance site of the surgery provides excellent visibility and access, especially in terms of the exposure of the mitral, tricuspid and aortic valve. This is another factor that reduces complications. Since the rib spacing is different in terms of aortic and mitral valves, performing aortic and mitral valve, i.e. double valve, surgery may prolong the time and disrupt the chest structure and cause the ribs to break, which creates postoperative respiratory problems. Briefly; Aortic and mitral valve (double valve) surgery should not be performed with this technique. In such cases, a frontal incision, that is, ministernotomy, is more useful and there is no entry site complication.

Closed Heart Surgery Technique

The patient is placed on the left side of the chest under double lumen intubation and general anesthesia; That is, an anterolateral thoracotomy position is given with the chest on the right side. A vertical 6 cm incision is made on the intersection of the subaxillary line and the right breast line, pectoralis major and pectoralis minor. without cutting the muscles It is dissected and a retractor is placed, the thorax is entered through the 3rd intercostal space for the aortic valve, and the 4th intercostal space for the mitral valve, and right lung ventilation is turned off or, if not tolerated, the tidal volume is reduced. The pericardium opens and its leaves hang on the chest wall. Aorta, right and left atrium are clearly seen. After returning the aorta with the pedicle, it is suspended and the aorta, right auricle, and right atrium are easily cannulated. The patient is connected to the heart-lung pump, extra-corporeal circulation is transferred, ventilation is stopped and an x-clamp is placed on the aorta. Cardiac arrest is achieved by applying cold blood cardioplegia and topical cold saline. For the aortic valve, an incision is made at the aortic root and the aortic valve is clearly observed.

Operation

After the repair or replacement is made, the aotomy is closed. If the intervention is made from the 4th intercostal space, that is, for mitral valve surgery, the left atrium is opened and the image of the mitral valve is clear. After the repair or replacement is made, the left atrium is closed. The patient is warmed, the heart is defibrillated if necessary, and after starting, the pump flow is gradually reduced and stopped. The heart is easily decannulated. After bleeding control, a single chest drain is placed in the thorax (the location of the drain is important to avoid pain), the ribs are brought closer, and the muscles, subcutaneous and skin are closed properly. Postoperative follow-up is the same.

While this intervention technique can be applied to any patient, it is only In some cases it should not be preferred. These :

  • Those with advanced lung problems
  • Those over 75 years of age,
  • Double valve replacement (Aortic and Mitral) required,
  • It should never be applied to patients requiring aortic valve surgery for the second time.

It is also an ideal method for second and third mitral valve surgeries and/or tricuspid valve surgeries.

Definition of Closed Heart Surgery?

Prof. Dr. Yavuz Beşoğul

The method, popularly known as closed heart surgery, refers to heart surgeries performed with a minimally invasive surgical method through small incisions without splitting the chest in the middle. After the necessary tests, analyzes and evaluations are performed, if the patient's condition is suitable, the most appropriate surgical technique is decided by the specialist physician. In these surgeries, the heart is reached through small incisions and the necessary surgical interventions are performed. These incisions are made under the armpit, under the breast, and in the outer fold of the breast, and consist of small incisions of 4-5 centimeters that allow access to the heart by passing between the ribs. However, compared to open heart surgeries, closed heart surgeries provide a faster recovery process and higher comfort, especially after surgery. In addition, the risk of complications and infections is lower than open heart surgery. The patient can easily return to his daily life without any movement restrictions.

Minimally Invasive Heart Surgery

Prof. Dr. Yavuz Beşoğul

Professor Doctor Yavuz Beşoğul explains everything you want to know about Closed Heart Surgery in detail. You can watch the video for more information. All heart surgeries can be performed with minimally invasive methods. If we examine these methods one by one; Coronary bypass surgeries: can be performed with small incisions in the front of the chest, or can be performed on the working heart with a left armpit minithoracotomy, depending on the number and location of the coronary artery. Heart valve repair and replacement surgeries, ASD repair, intra-cardiac tumor and clot removal surgeries: can be performed with minithoracotomy in the right armpit or under the breast or right front of the chest.

Frequently asked Questions

How long does closed heart surgery take?

Heart surgeries performed with minimally invasive surgery take an average of 3-4 hours. After minimally invasive surgery, which is a modern method used in heart surgeries, patients return to their daily lives in a shorter time.

What is Minimally Invasive Heart Surgery?

Minimally invasive surgery is surgery performed using cameras and other surgical imaging systems inserted through incisions smaller than 4-5 centimeters. In minimally invasive surgery, muscle and bone tissue is not damaged. Patients recover quickly after surgery and return to daily life faster.

Make an Appointment

To get information about your questions about Cardiovascular Surgery and visit Prof. Dr. You can fill out the form below to request an appointment with Yavuz Beşoğul.




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