Bayındır Hospitals Cardiovascular Surgery Department is serving since foundation of our hospital in 1992, and it is a department accepted as a reference center and working according to international standards. The department, serving with leading specialists in the country, continuously renewed modern equipments, modern surgery room, experienced perfusionist and nurse group, the low rates of mortality and infections, gained the trust of our patients. Our only aim is to provide a fast, continuous, safe and good service to our patients.
The weekly number of operations in our department varies between 20-25. The system works on an appointment basis, but we immediately accept emergency cases.
Cardiovascular Surgery Department also has an Intensive Care Unit equipped with latest technology, in which postoperative care is provided.
Performed Surgeries
In the Cardiovascular Surgery Department of Bayındır Hospital we perform the following surgeries to our patients aged between 1-90;
* Cardiac valve repair
* Surgeries for changing cardiac valves with artificial ones
* Cardiac surgeries with a small cut
* All kinds of Coronary by-pass surgeries
* Aorta aneurysm and dissection surgeries
* Operations of congenital cardiac diseases
* Emergency interventions to arterial obstructions
* Cervical arterial obstruction surgeries
* Operations for arm and leg arterial obstructions
* Reoperations
* Medical treatment of vein disorders succesfully.
SURGICAL RESULTS:
A. GENERAL EVALUATION:
We performed surgery on 6878 patients between 1992 – 2003.
OPEN HEART SURGERY 5919
CORONARY BYPASS SURGERY 5579
CORONARY BYPASS SURGERY ON BEATING HEART 566
VALVE SURGERY 758
OTHER SURGERIES 541
B. COMPLEX OPERATIONS:
Complex cardiac operations were performed on a total of 606 patients between 1992 – 2003. Complex cardiac surgeries include combined cardiac operations and their reoperations. In these complex surgeries our department got incredibly successful results.
C. MORTALITY RATES:
Mortality rates (patient death) was below world standards in our operations performed on 6878 patients between 1992 – 2003 :
General Mortality 1.6%
Coronary Bypass Mortality 1.0%
SCIENTIFIC STUDIES :
A. ATTENDANCE TO SCIENTIFIC MEETINGS:
Between 1992 – 2003, we attended a total of 12 national and international congress and meetings with 40 presentations:
Number of national congress 8
Number of presentations in national congress 33
Number of international congress 4
Number of presentations in international congress 7
B. SCIENTIFIC PUBLICATIONS :
Between 1992 – 2003 we published a total of 41 scientific studies in national and international medical journals:
Publication in national journals 25
Publication in international journals 16
Frequently Asked Questions About Coronary Bypass
What is a Coronary Bypass Surgery?
As all organs in the body our heart also needs blood to function. Blood arrives to heart muscle via arteries called coronary artery. As well known, atherosclerosis (vascular obstruction) is a disease that can affect all blood vessels in the body and causing obstruction in those locations involved. Coronary arteries are also affected by atherosclerosis. As a result of this narrowing and obstruction can be seen in coronary arteries, which are the only source of blood for heart muscle. This condition, called ischemic heart disease, presents itself with pain called “angina”. Although angina may not be seen in all patients, it is the most important sign of heart attack. Sometimes patients may have heart attack without experiencing any pain.
Constrictions in coronary arteries, which cause chest pain and heart attack, prevent blood circulation when reached to a certain level. This means that blood is not provided to heart sufficiently and heart cannot perform its functions completely. Surgical operation in order to correct this negative situation is called coronary bypass surgery. The aim of coronary bypass surgery is to eliminate chest pain and to prevent heart attack. Thus to improve the quality of life and increase the life span.
Who are the Candidates for Coronary Bypass Surgery?
There are 3 options for the treatment of coronary artery obstructions. These are, medical treatment, coronary balloon angioplasty (stent application is included in this group) and coronary bypass surgery. The appropriate treatment method is chosen by cardiovascular surgeon and cardiologist together according to the status of the disease. There are a lot of factors affecting the treatment modality, such as general health condition of the patient, structure of coronary arteries and heart’s contraction force.
What is the Duration of Surgery?
The duration of operation changes according to the number of arteries that bypass is going to performed, and if present additional applications, but it lasts approximately 4 hours.
What is the Classical Method in Coronary Bypass Surgeries?
Currently, coronary bypass surgeries are the most common method. Before the surgery patient is completely anesthetized by general anesthesia, and does not feel pain and anything else. In order to reach the heart, the chest bone is cut with a special device. Then, the circulation of lungs and heart is connected to heart-lung machine with special lines. In this method, which is also called open heart surgery, heart can be stopped for a while, and meanwhile the functions of heart and lungs are provided by this machine. After surgeon performs all the necessary procedures in the motionless and bloodless heart, the heart is started to beat again. Then, the lines with heart-lung machine are disconnected; the chest bone is sutured with special steel wires.
What is “Minimally Invasive” Coronary Bypass Surgery?
Minimally invasive methods, which means less trauma and short duration of recovery for the patients can only be applied in certain conditions. The characteristics of patient, presence of concomitant diseases, most importantly, the location and number of obstructed arteries are the factors affecting the selection of this method. It is generally applied to coronary arteries located on the front descending part (known as LAD). In one of these methods, which is known as “small cut”, the surgery is performed with a 5-6 cm long cut that is done under left breast. Operation is performed on beating heart and all the procedures are done through this small opening. Although it is a very attractive method as the duration of recovery and hospitalization is short, there are disadvantages such as; preparation of breast artery that is used for bypass has a limited quality due to restricted view.
What is Coronary Bypass Surgery done without Heart-Lung Machine (Off-Pump)?
This method, known as off-pump, is performed on beating heart. Thus, the operation is not open heart surgery. It allows removing most of the negative effects of heart-lung machine that is used in classical method.
As there are no machines taking over the functions of heart, the blood must be pumped to body, especially to brain by heart during the procedure. Thus, it is important to avoid actions that will significantly affect the pumping force of the heart. As it can be understood from this explanation, it may not always be possible to reach the arteries located on the back of the heart with this method.
In off-pump surgeries access to heart can be done by cutting chest bone as in classical method, or with a small cut under left breast. In order to perform the surgery, the area of coronary artery that will be bypassed stabilized by some special devices, and thus providing to surgeon partially motionless area.
What are the Grafts Used in Coronary Bypass Surgery?
Coronary bypass means that to provide blood circulation of the area behind the obstructed artery with a new artery, which is called “graft”.
Grafts can be prepared from the patient’s own artery or vein. Grafts prepared from arteries are more advantageous compared to vein grafts, as they can stay open for a longer duration.
The Most Commonly Used Grafts:
Internal mammarian artery (breast artery): they are the most common used grafts as the duration of staying open is long. Mammarian artery lies inside the chest wall, facing the lungs, run along the two sides of chest bone.
Radial artery (arm artery): it is the second most common preferred artery graft. There are 2 arteries on forearm parallel to each other, one is radial and the other one is ulnar artery. In most of the people, ulnar artery is sufficient to provide blood to forearm and hand, even if radial artery is not present. Thus, for suitable patients radial artery can be used as a graft. Your physician will be able to decide if it is possible to use radial artery with a simple test before surgery. Patients need to use a medication at least for 6 weeks after the surgery if radial artery is used as a graft.
Saphenous vein (leg vein): It is being used since the first applications of coronary bypass surgery. The rate of staying open is less than arterial grafts. However in cases that arterial graft cannot be used or if bypass required for 4 or more arteries, vein grafts can be used.
Postoperative Care:
You will be hospitalized in intensive care unit in order to be closely monitored after your operation that will last approximately 4 hours. Here, respiratory support, which is required at the early phase of postoperative period, will also be provided. You will be connected to respiration device with a tube that will be placed in your mouth. Moreover, you will be receiving necessary treatment and follow up via serum lines and cables that are placed on your arm and neck. These may be astonishing or frightening to you when you wake up after the surgery. However, these procedures, which are applied to all patients who had heart surgery and do not indicate a problem in your condition, are only for your monitorization and safety. The duration of hospitalization in intensive care unit is approximately 2 days. This period may extend due to the type of your operation or treatment methods; this should not frighten you. The extension of this period is not a sign of negativity. The aim is to provide you treatment and follow-up in more safe conditions.
Recovery Period:
Complete recovery takes 2-3 months after coronary bypass surgery. According to the patient’s degree of recovery, after 3-8 weeks, he or she can start to drive. For sexual activity, a period of 3-6 weeks must pass. People doing office work can go back to work after 4-6 weeks. They have to wait 12 weeks to go back to work if their job is requiring physical force.
Duration of going back to work and starting other activities may vary between patients. Thus, your doctor will give you more exact information during your first control visit (1 month after the surgery).
Precautions that must be taken for protection from coronary artery disease
These precautions are more important especially for patients who had surgery. Patients must make important changes in their life style in order to decrease the risk of recurrence after the coronary bypass surgery. These precautions are, quitting smoking, regular exercise, weight loss, decreasing blood cholesterol level, getting diabetes and high blood pressure under control, appropriate diet, using necessary medications and regular doctor controls.
Pre-post Operational Care
The weekly number of surgeries varies between 17-20 in our cardiovascular surgery department. Our department generally works on an appointment based system, but we accept emergency cases. Patients who come for surgery are placed in their rooms, and then informed about what kind of preparations are needed during the preoperative period. The aim of giving information is controlling the anxiety level of the patient during the preoperative period. The importance of communication in elimination of concerns and fears is accepted and applied by all department personnel.
Our patients are generally hospitalized 1 day before the surgery and discharged 5-7 days after it. Preoperative tests (laboratory, cardiology and radiology tests) are done and surgery is planned according to results during the 1st day of hospitalization.
Patients, who are planned to have the surgery, informed about the preoperative procedures such as all body must be cleaned, must not eat anything all night long before the surgery and sedation and anesthesia procedures are explained. As intensive care unit environment is frightening both for the patient and family, the duration that will be spend in intensive care unit also described.
Information is given to the patient and family, by explaining in detail and proper words, that the patient will wake up connected to a respiratory machine, there will be an incision area and wound dressing, there will be infusion sets and serums.
The blood supply that may be used during the operation is organized in cooperation with blood bank, patient relatives are directed about this procedure. After completion of all preoperational procedures patient is send to operation room.
The success rates of our heart surgeries are parallel to international hospitals and postoperative care and follow-up is performed at the most perfect level. In intensive care unit, postoperative care is given at least 1-2 days or more if necessary. A cardiovascular surgeon is present in intensive care unit 24/7 including weekends, holidays and nights. Moreover, 1 nurse serves to 1 patient in intensive care unit. Our intensive care unit nurses are specially trained about cardiovascular surgery patients in order to obtain a care parallel to international standards. Also, 1 physiotherapist, 1 dietician, 1 patient counselor are continuously serving in this unit.
On the 2nd day of postoperative period, the patient is brought to clinic. The patient is given physical and psychological support and help is provided for care of the patient beginning with the first day in service.
A detailed discharge education is given to patients and their relatives by nurses about how they are going to act in their postoperative life, factors affecting lifestyle, and daily activities.
