INTERVENTIONAL CARDIOLOGY TURKEY (ANGIOPLASTY AND STENT)
Coronary Angiography: This is the most reliable method used to test the anatomical structure of arterial constriction, and to provide functional assessment with supplementary techniques.
The method is used in patients whose results from other tests suggest coronary constriction, patients who are scheduled for stent or balloon angioplasty, or in the diagnosis and treatment of emergency heart attacks.
The procedure is performed in the catheter laboratory, making hospitalization necessary The patient does not feel any pain during the procedure, but only a warmth spreading across the entire body during the few seconds of the injection of a radio-opaque substance. Under normal circumstances, the procedure is short, lasting only 5 to 10 minutes.
It has an extremely low mortality rate when conducted by experienced personnel in experienced centers (< 0.1%).
After the procedure, the patient needs to be monitored for 2 to 6 hours in the hospital.
Wrist Angiography: Angiography plays a key role in the diagnosis of cardiovascular diseases. With the help of recent technologies developed, it can be done from the wrist instead of the inguinal region. If constriction exists in the veins in the inguinal region or if the inguinal region is not suitable due to excessive weight, wrist angiography is preferred.
It can be used in 99 percent of patients. Vein complications in the patient are observed only very rarely. Following the procedure, the patient is able to sit, walk around and eat. The patient can return to his/her daily life within the same day.
Treatment
Coronary Angioplasty And Stent Applications: Coronary angioplasty (balloon endarterectomy) is the widening of local constrictions in coronary arteries using non-surgical methods. A “wire of guidance” is inserted and pushed from the inguinal aorta to the coronary veins. A deflated balloon slides through this wire until it reaches the constricted area. When the balloon is inflated from outside (approximately 3 cm in length and 3-4 cm in width), the constriction in the coronary veins is removed.
Yet, not every coronary constriction is suitable for this method. For some patients, bypass surgery might be necessary. while for others heart medication can be an effective and safe form of treatment. Such decisions should only be made by relevant specialists.
Bypass Surgery: Depending on the degree of arterial constrictions, the doctor may recommend coronary artery bypass intervention. This intervention corrects the blood flow that supplies the heart, thus restoring health. Coronary bypass surgery may provide a second chance for your heart and for life.
Coronary artery bypass surgery re-supplies blood to the heart through the formation of a different path, other than the constricted or narrowed artery. In the event of more than one constricted artery, more than one bypass is required.
The artery to be used for the bypass, also known as a graft, is taken from the chest, arm or leg and attached to the constricted coronary artery. The most commonly used grafts are internal thoracic arteries, aorta from the arms, and vena from the legs. Since the areas of origin of these veins have additional veins, their removal does not affect the blood circulation of the body.
Small Incision Surgery: Endoscopic surgery is a minimally invasive method in which open heart surgery is done using special endoscopic devices through a small incision made in the chest region. During the operation, all surgical instruments are under the control of the surgeon. In the meantime, the endoscopic camera can be used to view the surgery area.
Coronary bypass using the endoscopic method can be used for valve repair, valve implant, and the repair of ventricular septal defects and ablation for rhythm treatment.
Compared with open surgery, mobility is higher and scar healing is much faster. Following surgery, patients return to work and resume active life much earlier. However, the structure of the sternum wall and the anatomy of the heart must be suitable for this method.
TAVI: Transcatheter Aortic Valve Implantation (TAVI) involves the implantation of an aortic valve to the heart using the catheter method without open surgery. Biological cardiac valves are used in valve implant surgeries around the world and in Turkey. In the TAVI method, this biological valve is placed in a stent jacket, when opened, is firmly placed on the valve implant area.
Two different techniques can be used in this method. In the first technique, similar to a valve angiography, the valve is pushed from the inguinal area to the heart with the help of a catheter. When in place, the stent mechanism is opened. The second technique is used when there is a constriction in the inguinal region or the abdominal region that will be used to access the heart.. Then, a small incision of 4 to 5 cm is made in the front wall of the sternum to access the end point of heart. The valve is placed with the help of a catheter pushed to the heart. In both methods, there is no need to stop the heart and perform open surgery. The procedure can be completed under local anesthesia.
Patients are taken to their rooms after the TAVI procedure. During this time, the patient is given anticoagulants and monitored under normal conditions for 4-5 days and discharged. Following several days of rest, the patient returns for a follow-up exam and resumes daily life. The TAVI method is primarily recommended for high risk patients who would otherwise not be able to endure valve implant open surgery. Additionally, it can be used on patients who have other obstacles against open surgery. The TAVI method is proven to be effective on such patients and to prolong their lives and improve their clinical condition.
Although TAVI is a recently developed method, technological developments, application experiences, and scientific results indicate that it will become much more common.
TAVI AT ACIBADEM: TAVI valve procedures have been performed in experimental environments since 2002 and on humans since 2004 around the world. The operation has been successfully implemented in a number of prominent centers both in the USA and Europe as of 2010. It was first used in Turkey in 2009. The Acıbadem Cardiology and Cardiovascular Surgery team have at their disposal the necessary equipment to perform this new and successful treatment method and are able to successfully implement the TAVI procedure.
The procedure is organized and completed by a team composed of many specialists from different disciplines, including cardiovascular surgery, cardiology, anesthesiology, and reanimation and radiology.