Adult Cardiovascular Surgery
Coronary By-pass Surgery
Coronary artery implies an arterial structure which supplies blood to heart. Heart attack is secondary to sudden-onset occlusion of these vessels. Coronary arteries are bypasses using vascular grafts obtained from chest cavity, arm or leg and thus, impaired blood flow to heart is corrected and patients are protected against heart attack or heart failure. Duration of operation varies depending on number of vessels to be bypassed and the technique.
Conventional Coronary By-pass Surgery
In this technique, heart is exposed by completely opening rib cage. While blood circulation is maintained with heart - lung machine, heart beat is stopped. Bypass procedure is carried out in non-beating heart. This technique is commonly preferred for bypass surgery in patients who have multi-vessel disease.
Off-Pump Coronary By-pass Surgery (OPCAB)
In this technique, vessels are bypassed while heart is still beating. It is usually preferred for patients, whom heart-lung machine poses risks.
Minimally Invasive Direct Coronary Artery Bypass (MIDCAB)
A small incision is made between two ribs (intercostal space) and bypass surgery is carried out. Although hospital stay is short and recovery is rapid, it is recommended for patients, who require one or two vessels bypassed, since it provides a limited field of view.
Heart Valve Operations
There are 4 heart valves (Mitral, Aortic, Tricuspid and Pulmonary Valves). These valves allows blood flow only at one direction due to its structure. In this case, impaired heart valves are repaired and treated. However, native valve is replaced with prosthetic valve, if valve is heavily damaged such that a repair procedure is not possible.
Open (Surgical) and Closed (Endovascular) Treatment of Aortic Aneurysms:
Aorta is the largest artery that carries oxygenated blood to body. Aneurysm is defined as a bulging or a balloon formation on wall of artery, resulting with more than 50% enlargement in diameter of the vessel. In general population, principal cause of aortic aneurysm includes genetic factors. Hypercholesterolemia, hypertension and atherosclerosis can also lead to aneurysm.
Open (Surgical) or closed (Endovascular) methods are used for treatment. Endovascular methods are preferred especially in selected vases, since duration of operation and hospital stay is short and complications are scarce.
Prevalence of stenotic carotid artery is 8-12% in persons with coronary artery disease. Therefore, it is of vital importance to evaluate carotid artery with Color Doppler Ultrasound in patients who should undergo coronary artery bypass.
Peripheral Vascular Diseases and Up-to-date Therapy Methods:
This group of diseases is secondary to partial or complete occlusion of vessels, which supply blood to extremities, and this condition is very common in general population. The disease is manifested by claudication, which implies a pain that is provoked by walking and impairs gait. Conventional angiography and CT Angiography are used in diagnosis of peripheral artery disease. Balloon dilatation, stent implantation and surgical methods are used in treatment of the disease, along with medication therapy.All current treatment methods are available for peripheral artery disease.
Varicose Vein Surgery
Varicose vein is a venous disorder and very common among vascular diseases. Patients with varicose vein are evaluated with Doppler ultrasound. After etiology of varicose vein is identified, treatment options are identified.
External Radiation: It is preferred for red capillary varices, which measure ≤1 mm in diameter and are referred as telengiectasis. Laser or radiofrequency is used as energy source.
Sclerotherapy (foam, needle therapy): It is usually used for varices that are referred as “reticular varix” and measures 1 to 3 mm in diameter. Enlarged vessel is occluded by destructing wall of vessel with a sclerosing agent that is injected into a vessel.
Mini phlebectomy: Large varicose dilatations, measuring >3 mm in diameter, in major branches can be excised with very small incisions that do not require stitching.
Intravascular Laser – Radiofrequency Ablation Therapy: Varicose lesions, >Grade I, are treated with surgical method or with Laser -Radiofrequency Ablation Therapy, a new technique developed as an alternative to surgical management. A special catheter is inserted into vessel with ultrasound guidance and the vessel is burned, ablated and occluded. Local anesthesia is required for this procedure.
Contemporary Open Surgery: In this method, varicose vessel is excised using a special catheter that is inserted through a very small inguinal or subpatellar incision.
Venous Valve Repairs: This method requires substantial experience and preferred when advanced stage leakages in deep veins lead to swelling, pain and wound on legs. Valve repair is performed in pioneering healthcare facilities worldwide and it can be performed at Cardiovascular Surgery Clinic.