Even if the surgery is successful, life expectancy and possible problems after the surgery are affected by the timing of the surgery.
Heart surgeries are basically classified as coronary, valve, congenital and aortic vascular surgery. The important thing in surgical timing in coronary artery surgery is to perform the surgery before problems develop. Here, unlike other diseases, very significant changes can occur in the patient's fate even within hours. Patients who are decided to undergo coronary bypass surgery and have very critical stenosis may experience vital rhythm problems and heart attacks during the delay in surgery. In patients who undergo surgery after a heart attack, the risk of surgery increases significantly and there is a serious decrease in the quality of life in the postoperative period. In these patients, the standard of living in the postoperative period is determined by the amount of tissue lost during the preoperative crisis. There are significant life risks during and after surgery for patients who undergo surgery with very low heart performance. Even after successful surgery, the exercise capacity of these patients decreases if sufficient improvement in the heart muscle is not achieved. Due to this, it is very difficult for them to carry out their daily activities and heart transplantation may be needed in the future.
In some coronary artery patients, heart performance may be very low without having a heart attack before surgery. Here, the body defense system comes into play and the heart's contraction power is reduced to a limit and military level in order to reduce the heart's oxygen need due to the malnutrition of the heart. Although the heart performance of these patients seems to be very low, a very important part of the live tissue in the heart is seen alive in the preoperative live tissue research. In the post-coronary bypass evaluation performed on these patients, it is determined that the heart performance has completely returned to normal. The state of the heart before surgery is described as a sleeping heart (hibernated myocardium).
In valve patients, years rather than days are important in the timing of surgery. What is important in these patients is to perform the operation before permanent problems develop. In these patients, permanent changes occur in the heart muscle and lung arteries. is. Due to the development of serious permanent changes in the lung arteries due to valve diseases, which are described as pulmonary hypertension, delaying the surgery greatly affects the risk of the surgery and the postoperative period. For example, in a patient with mitral valve stenosis, delaying the time of surgery in a patient whose surgery time has already come will make the changes in the pulmonary artery more chronic. Changes in the pulmonary artery continue to progress even after surgery and cause failure in the right heart muscle, which pumps blood to the lungs, in the years after surgery. As a result, the exercise capacity of these patients decreases, ascites in the abdomen and swelling in the legs develop. If these patients are treated at the appropriate time, their postoperative pulmonary artery pressure drops by half in a short time and they do not show any postoperative progression. In other words, delaying the time of surgery will subsequently cause a decrease in life expectancy and quality. Another important issue in valve patients is the chronic changes that develop in the heart muscle. For example, insufficiency (leaks) in the mitral or aortic valves causes enlargement of the left side heart muscle. If these leaks are not treated for many years, the spaces around the heart cells will be filled with non-contractile connective tissue, and the amount of this tissue will increase over the years. The surgeries performed on these patients have high risks and the desired level of improvement in cardiac performance and effort capacity is not achieved after the surgery. Sometimes these patients are evaluated regarding valve surgery or heart transplantation.
As a result, timing is of great importance for both surgery risk and postoperative risk in valve patients.
Heart failure due to various reasons. The final decision to be made in patients who develop heart disease and are followed up with drug therapy is heart transplantation. These are generally patients who are no longer likely to improve with any other treatment. Serious timing should be made for heart transplantation in patients who are being followed up due to heart failure. The chance of transplantation may be eliminated in patients who do not undergo heart transplantation at the appropriate time before heart transplantation. Or, in these patients, it may be necessary after transplantation due to a serious increase in pulmonary artery pressure. The claimed benefit is not achieved and the patient dies from right heart failure. Therefore, not delaying the transplantation of patients with heart failure who are due for transplantation is of key importance in success.
The timing of surgery is of great importance in congenital heart diseases. In congenital heart diseases, volume loading on the right side of the heart through the holes between the ventricles or atria in the heart can cause permanent deterioration in the lung artery wall (pulmonary hypertension). In patients whose surgery is delayed, if permanent changes in the pulmonary artery progress, the transition from the left side to the right side may come to a halt. In this case, even if surgery is performed and the holes in the ventricle or atrium are closed, the risk of the surgery increases and the desired benefit cannot be achieved after the surgery.
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