Cure heart disease without splitting the sternum

HCMCCho Ray Hospital has successfully performed two replacement of the aortic valve without the traditional sternum dissection.

Patient is a man and a woman over 66 years old. They had severe stenosis of the aortic valve due to calcification and aneurysm of the thoracic aorta. The man alone has a congenital two-piece aortic valve defect (normally this three-piece valve). For many years, they lived with the disease, were thin, could not work hard, had a prescription for valve replacement surgery.

The aortic valve is located between the left ventricle and the aorta. The valve is responsible for opening and closing rhythmically, taking blood one way from the heart to pump through the aorta to feed throughout the body. Aortic valve stenosis prevents the valve from opening completely, limiting the amount of blood pumped.

Associate Professor, Doctor Tran Quyet Tien, Deputy Director of Cho Ray Hospital, said that in the past 50 years, heart surgery has been a breakthrough, saving many patients with cardiovascular diseases. These techniques are improved and perfected each year. In particular, the goal of safety and thorough cure is always on top priority by doctors.

Currently, there are four main heart surgery techniques. The classic and most common is the full sternum split (about 20 cm long), the second is a partial split on the sternum, the third is a small opening between the ribs, combined with endoscopy, and Lastly, laparoscopic surgery (high-level technology, not many countries can implement it).

There are four current heart surgery techniques in the world. Image: Doctor provided.

The above patients are operated in a third way, which is considered the new, most complicated and difficult for cardiac surgeons in Vietnam. However, in return, patients enjoy more benefits, such as less invasive, less pain, less bleeding, the ability to heal quickly, and minimize the complications of the first two methods. .

Specifically, in the right intercostal space, between the two ribs, the surgeon makes an open incision about 5-6cm long through the muscle layer. With the support of the endoscopic camera, doctors can observe the surgery and remove the damaged valve, replacing it with a suitable biological valve for each patient. At the same time, the male patient was replaced with an up and a section of the arteries only with an artificial implant. Female patient replacing the thoracic aorta with artificial implant. All damage to the heart is thoroughly repaired.

One month after the surgery, the health of the two patients was completely stable, living almost normally and without any complications, were discharged today, December 15, Dr. Tien said.

Dr. Nguyen Thai An, Head of Cardiac Surgery Resuscitation Department compared, if the surgery is classic, the surgeon will split the sternum (whole or partial), using a full chest ball device. The surgery is clear and convenient for doctors to observe and manipulate.

However, the chest was torn off, the bone was cut after surgery, so the patient needed a lot of time to recover. For example, in the first months, patients are not allowed to lean to one side, or swing their hands up, to avoid damaging the newly healed sternum. It takes at least 6 months for the patient to be able to perform simple movements. The structure, strength of the chest and bones are also worse. Bone that has been broken, no matter how well cared for, can not heal like the original bone. The most dangerous is the patient is at risk of infection of the sternum, infection of the wound, which makes the treatment goal not reach. At Cho Ray Hospital is treating a case of sternum infection after heart surgery on the background of diabetes for 4.5 months.

The downside of right breast surgery is that when the muscle is incised, the doctor must remove one of the two arteries close to the sternum. However, another artery is still well responsible for supplying blood to the sternum. In the latter case, the patient has coronary artery disease, there are still materials for coronary artery bypass graft treatment for the patient.

Dr. Tien (left cover) and Dr. An (right cover) see off two patients discharged on December 15.  Photo: Thu Anh.

Dr. An (left cover) and Dr. Tien (right cover) see off two patients from the hospital on December 15. Image: Letter Anh.

Dr. Tien said that the similarity between the techniques is that during surgery, the patient still has to run outside the body (ECMO). The heart is inactive at least until the end of the operation. This time, the heart and brain are specially nourished and protected. Each operation lasted about 3.5 hours, with the usual number of crew members.

Doctors at Cho Ray Hospital had to practice through many heart surgeries, learn and accumulated experience over the years to dare to implement this technique. At the same time, surgical equipment and tools are also more modern and specialized to suit deep field surgery. The first two successful surgeries “opened a new door for the cardiovascular surgery industry” in Vietnam. In the future, it will be expanded to replace classic techniques. But not because of practicing new techniques, but ignoring the most important goal is the safety and effectiveness of the patient’s treatment, Dr. Dr. emphasized.

“It can be said that Cho Ray Hospital is the first unit in Vietnam to successfully perform the technique of replacing aortic valve with a small operation through the right chest”, said Dr. An.

Currently, new technology is in the process of implementing administrative procedures to be included in the list of health insurance covered. Doctors declined to say the cost of specific treatment.

Letter Anh


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