Acute myocardial infarction, for the most part, requires surgery, especially with extensive or transmural necrosis. Surgical treatment allows you to almost completely restore the blood supply to the heart and its normal functioning. Such tactics are highly effective and safe, especially when using minimally invasive interventions in the shortest possible time. The sooner the patient underwent surgery, the more chances for a quick recovery and the absence of complications.
Types of operations for a heart attack and their effectiveness
Operations for a heart attack are divided into two groups - open (access to the heart occurs by incision of the chest) and percutaneous (a probe is inserted into the coronary vessels through the femoral artery using a small opening). Due to the low trauma and the minimum number of complications, the second method is now used much more often.
Types of percutaneous interventions:
- Coronary artery stenting. This technique involves installing a special expander in a narrowed area. A stent is a cylindrical mesh structure made of steel or plastic. It is brought with the help of a probe to the desired place, it expands, attaches to the wall and remains there. This method of treating a heart attack sometimes gives complications in the form of retrombosis.
- Balloon angioplasty. In this case, a probe is brought to the heart through the femoral artery by analogy with stenting. A special frame balloon is located in the probe. Inflating, it expands the walls of the affected vessels and restores normal blood circulation. This technique often gives temporary results, but it is one of the safest.
- Laser excimer angioplasty - use a fiber-optic probe, which is brought to the affected area of the coronary artery. Laser radiation passes through it. By acting on a blood clot, he destroys it, and the blood flow resumes. It is a very safe and effective method, however, incorrect use of the laser often causes bleeding.
Open surgery is done when the artery is completely blocked, when the stent cannot be placed: with extensive lesions or concomitant heart pathologies (valve defects). In such cases, shunting is used, in which bypass paths of blood flow are created using synthetic elements or autoimplants. The intervention is performed on a stopped heart using a heart-lung machine, but it is better to do it on a working organ.
There are two types of bypass surgery:
- Coronary artery - in this case, a piece of a vein is taken from a certain area of the body, and then one end of it is sutured to the aorta, and the other to the coronary artery, below the blockage site.
- Mammarocoronary - in such a case, the internal thoracic artery is used as a shunt. The advantage of this method is that this vessel is less susceptible to atherosclerosis, is more durable and, unlike a vein, does not have valves.
Do I need to have an operation and why?
Heart surgery for myocardial infarction is not a matter of preference, but an urgent need, especially in the case of extensive damage. If blood circulation in the tissues is not restored, they die off very quickly, as a result of which the area of necrosis increases. This further disrupts the normal working capacity of the organ, and the patient develops cardiogenic shock.
In addition, the decay products of necrotic tissues are very toxic and, getting into the blood, cause acute poisoning and multiple organ failure.
The operations that are performed in case of a heart attack, with their simplicity, effectively restore normal hemodynamics and eliminate ischemia of cardiomyocytes, as a result of which the work of the heart resumes.
However, it should be remembered that surgical treatment is a temporary method that does not give a complete recovery. It eliminates the consequences caused by vascular atherosclerosis. Only the prevention of fat metabolism disorders will allow you to get rid of possible relapses.
Consequences, prognosis and complications
The result of the operation after a heart attack is predetermined by the time that elapsed from the moment of the attack to the patient's delivery to the infarction department and the destruction of the thrombus. If the intervention occurred no later than six hours, then a favorable prognosis is possible.
When an urgent operation is not performed, the consequences are extremely serious:
- repeated attack;
- aortic aneurysm;
- the risk of having a stroke;
- the development of acute renal or hepatic failure;
- breathing disorders.
After the operation, the patient is transferred to the intensive care unit, where he is properly looked after and prevented from complications.
Placement of any artificial objects (stents) in the heart increases the risk of blood clots. To prevent such a situation, each patient should take antiplatelet drugs in a strictly specified dose and frequency.
The final prognosis depends on further conservative treatment, rehabilitation and the implementation of preventive measures: if the patient strictly follows the doctor's recommendations, then his condition will significantly improve, and the risk of a second attack will decrease.
Conclusions
Surgery for myocardial infarction is the most common and most effective way to treat this disease.... Cardiac surgery has a wide arsenal of different techniques, which makes it possible to apply an individual approach to each patient.
The success and likelihood of complications primarily depend on the time that has passed from the moment of diagnosis to the start of treatment. Basically, the prognosis for patients after surgery is favorable. Long-term conservative treatment and adherence to preventive measures can reduce the possibility of a second attack.
