Division of Cardiac Surgery

OCSC’s Cardiac Surgery Division is comprised of three adults’ departments and one pediatric and congenital heart diseases (CHD) department:

 

Within this operational structure there are:

All Departments and Units are distinguished for their excellent organization, staffed with qualified personnel, and competent to undertake the entire spectrum of advanced therapies and invasive procedures, such as:

1. Coronary artery bypass grafting surgeries (CABG)

1.1 Coronary artery bypass surgery (either conventional or with beating heart, with or without the use of extracorporeal circulation)

Coronary syndromes (severe – chronic) are treated surgically using arterial [stern thoracic (-s) artery (-ies), radial], as well as, venous grafts (preparation and removal of vein grafts strands with small skin incisions). There are also, a significant number of reoperations for coronary heart disease. Moreover, the option of performing coronary artery bypass with or without the use of extracorporeal circulation, depending on the individual patient clinical indications, is supported.

2. Heart valve surgeries (replacement or repair)

2.1 Aortic valve surgeries 

2.2 Mitral valve surgeries

2.3 Tricuspid valve surgeries

2.4 Interventions on multiple valves

2.5 Transcatheter, transthoracic, transaortic aortic valve implantation (TAVI) in cooperation with the Department of Cardiology

Transthoracic placement of prosthetic aortic valve  

The conventional surgical technique of aortic valve replacement continues to be the appropriate and highly effective intervention, with excellent long-term results, for the majority of patients with this indication. Although it is rare patients diagnosed with stenosis of the aortic valve pathology to be characterized as “inoperable”, nonetheless we face frequently, high-risk patients for classical surgical replacement of the aortic valve.

This category includes patients with high rates of operative mortality (Euroscore> 20% or STS score> 10%), usually elderly with serious coexisting medical conditions. The hitherto conservative treatment in these patients was simply palliative. With the achievements of modern medical technology and clinical application of the technique of implantation of aortic valve through catheters has certainly changed the scene. These shaped prostheses can be placed percutaneously from the femoral vessels as in conventional angiography, or trans-thoracically through a small left thoracotomy, or trans-aortically through a small sternotomy, or anterior thoracotomy on the right side. The valve is promoted through specially designed catheters preceded during the same time, valvuloplasty with a balloon. The cases of transthoracic or transaortic access are not supported with extracorporeal circulation machine (which nevertheless is fully ready). The objectives of this technique are to treat high-surgical-risk patients, to activate them rapidly and to reduce dramatically their stay at the hospital.

3. Aortic surgeries

We treat in our clinic all kinds of aneurysms of thoracic aorta (thoracic ascending, arch, and descending aorta) as well as acute syndromes of the thoracic aorta (divisions, lacerations, ulcers, hematomas) constituting an emergency situation and needing immediate treatment.

3.1 Aortic root replacement or Valve-sparing aortic repair 

Surgeries for aortic root and aortic valve disease

Aortic root diseases affect all age groups of the population. They require either the replacement of the aortic root with a valved graft or the replacement of the ascending aorta with a plastic correction of the aortic valve, or replacement of the root by maintaining the aortic valve.

Depending on the clinical indications and overall condition that the patient is presented with, aortic valve surgeries with semi-sternotomy are also performed. For these particular patients or even for those with conventional aortic valve replacement and concomitant pathology of severe root calcification or small aortic root, sutureless and rapid implantation aortic bio-prothesis are now also being used.

3.2 Thoracic aorta’s pathology surgeries

4. Other surgeries

4.1 Pericardium surgeries

4.2 Resection of myxoma and other cardiac tumors

4.3 Surgery for mechanical complications of acute myocardial infarction 

Surgery treatment of mechanical complications (MC) of acute myocardial infarction (AMI)

Many patients experience immediate of medium mechanical complications as a result of acute myocardial infarction, such as rupture of the interventricular septum, left ventricular aneurysm, of failure of the mitral valve rupture or papillary muscle displacement. All these situation are treated in acute or scheduled basis according to the patient’s needs

4.4 Myectomy of hypertrophic interventricular septum 

Hypertrophic cardiomyopathy (HOCM)

It is usually related with people of young age. Dew to intense hypertrophy (thickening) of the interventricular septum, the output area of the left ventricle is blocked and the proper irrigation/hydration of the body is impeded. In such cases we perform a myectomy of the interventricular septum, alone, or in combination with aortic valve replacement.

4.5 Surgical treatment of atrial fibrillation 

We proceed with ablation of chronic AF using high frequency of electric current to the wall of the left and right atrium (thermocoagulation) during surgery for valvurar disease, mainly, but also, sometimes for coronary artery bypass grafting (CABG) or for complex heart surgery.

4.6 Combined surgical procedures for patients with cardiac, carotid artery, and lung diseases

4.7 Removal of foreign bodies (pacemakers electrodes and defibrillators)

5. Mechanical Cardiac Assist Therapy

Mechanical Cardiac Assist Therapy [intra-aortic balloon pump (IABP) and ECMO placement, implantation of mechanical ventricular assist devices (LVAD & RVAD) of short and long term support, totally implantable artificial heart, heart transplant].

Each Cardiac Surgery Department has an autonomous, fully equipped surgery room, and is able to process even the most difficult and demanding operations.

NURSE LIAISON

Nurse Liaison is a member of the Cardiovascular Team and serves as the care coordinator between the patient, the Cardiac Surgery Team and the Hospital. The Liaison Nurse contributes decisively to the safer and faster handling and transport of the cardiac patient through the various services, departments and sections of OCSC, substantially improving outcomes and overall quality of services.