Is heart surgery a big deal?…  

The minute the doctor deems heart surgery necessary, it is the most anxiety-inducing circumstance for patients. The thought of undergoing a major surgery on such a vital organ can be overwhelming, even for those who understand its necessity. Patients may feel terrified of the risks and uncertainties associated with heart surgery, fearful of the treatment more than the disease it intends to cure. Some patients may become so anxious that they try to avoid surgery altogether, even if it means risking their health.

Despite its fearsome reputation, heart surgery is not as dreadful as it may seem. Dr Boonlawat Homvises, a cardiothoracic surgeon, argues that present-day heart surgery is more effective and returns a good quality of life. The risk many frets about may be blown out of proportion of the actual one.  

“The two main types of heart surgery are coronary artery bypass surgery and heart valve surgery. Coronary artery bypass surgery treats coronary artery diseases caused by high blood cholesterol levels and fatty deposits in the blood vessels. Typically, balloon angiography is the primary method to treat coronary artery disease. If the blood vessels narrow too severely, bypass surgery may be necessary.”  

“Heart valve diseases, such as stenosis or regurgitation, can require surgery to repair or replace a diseased valve, if severe or symptomatic.”

Why is everyone on edge about heart surgery?

“Questions like: Will I die from the surgery? Will I wake up after it? Will I be okay again? -- come up repeatedly.”

From a patient's perspective, heart surgery is a profound undertaking, considering the intricacy of the heart function and its crucial role in sustaining life. Despite remarkable technological advancements, people continue to harbor apprehensions about this procedure. The primary duty rests upon healthcare professionals and their medical teams to effectively communicate essential information to patients, ensuring a clear and comprehensive understanding of the steps of heart surgery.

“Every patient aspires to achieve a cure, and their loved ones share the same hope for recovery. The common wish is to reclaim a sense of normalcy and ensure a longer life. This objective closely resonates with my surgical goals, comprising two key aims. Firstly, to extend longevity, as without surgery, the illness could hasten demise. Secondly, to enhance the quality of life, surgery can empower patients to live in a state of contentment and well-being.”

Regarding the risk of surgery, medical professionals commonly categorize patients based on their likelihood of experiencing adverse outcomes into three groups: low-risk, medium-risk, and high-risk. These risks include:

1. Mortality (Death)
2. Complications 

“The high-risk category comprises individuals facing severe medical conditions, including those requiring emergency surgery or those experiencing cardiac arrest, cardiogenic shock, or reaching the end stage of their condition, marked by uncontrollable complications or advanced age. In contrast, most, about eighty percent, fall within the low-risk bracket. In this group, the surgical mortality risk is as low as one to two percent, a significantly lower figure than what many patients might conjure up.”

Another aspect to consider is post-surgical complications. These complications encompass delayed awakening from anesthesia, brain-related issues, substantial post-operative bleeding, kidney failure, and severe sepsis. In some cases, a reoperation may be necessary. Serious complications can potentially lead to fatal outcomes, while less severe complications can result in extended hospitalization. It is important to note that the likelihood of adverse effects affecting the low-risk group is generally less than 5 percent.  

“Patients who enjoy good health without underlying medical conditions, or whose symptoms and conditions are well controlled, are frequently categorized within the low-risk group. In this group, the risk of mortality and the likelihood of experiencing complications are notably low.” 

Heart surgery is a life transformative procedure.

“Remarkably, the majority—around 80%—of patients I have encountered throughout my career fall into the low-risk category, and for them, heart surgery represents a profoundly beneficial intervention.” 

Medical advancements bring multifaceted benefits, particularly for medical technology and equipment. One illustrative example is open heart surgery, which often requires temporarily halting the heartbeat and employing cardiopulmonary bypass (CPB) to take over the essential functions of the heart and lungs. Notably, the performance and capabilities of medical technology have seen substantial improvements over time.

Advancements in medicine have not only elevated medical technology but have also greatly benefited the knowledge and expertise of physicians. The acquisition and exchange of in-depth medical knowledge and information have become more seamless for healthcare professionals. This advancement led to treatment and surgical technique improvement, resulting in highly effective treatment modalities. Open heart surgery has emerged as a modality with satisfactory treatment outcomes.

Subsequently, medical professionals endeavored to develop methodology yielding even better results. This quest led to the invention of minimally invasive cardiac surgery (MICS), a technique involving making small incisions without compromising treatment effectiveness. However, MICS requires specialized equipment and highly skilled and experienced surgeons. The advantages of MICS are manifold, including reduced pain, faster recovery times, and a quicker return to normal activities for patients.

Due to the technical challenges inherent to minimally invasive cardiac surgery (MICS), it is most suitable for early-stage diseases or uncomplicated lesions. Conventional open-heart surgery may be deemed necessary and more appropriate for patients with severe and complex disease.

“While minimally invasive cardiac surgery (MICS) has gained recognition for its effectiveness in treating various conditions, it is crucial to acknowledge its limitations. Complex and severe diseases may not be amenable to this approach due to the constraints of working through small incisions. Consequently, undergoing regular health checkups is strongly advised.”

Early detection of abnormalities significantly increases the likelihood that a patient can benefit from MICS when needed. Timely intervention not only improves treatment outcomes, but also enhances the patient's overall quality of life during and after treatment. This proactive approach is preferable to seeking medical attention after symptoms worsen.

Heart surgery is a worthy endeavor, with notable improvement in quality of life following the operation.

Following the heart surgery, patients typically spend approximately two nights in an Intensive Care Unit (ICU) because this is a critical period demanding heightened medical attention. During this time, a specialized medical team provides vigilant care, closely monitoring the heart activity and blood pressure to ensure a safe and stable recovery.

“Post-heart surgery care demands appropriate equipment and a dedicated CCU, which are essential because patients require specialized devices for continuous blood pressure monitoring and the expertise of a medical team well-versed in cardiac care. At MedPark, we are fully equipped to provide comprehensive care, boasting a team of highly skilled and experienced medical professionals specializing in both heart surgery and the critical aftercare of patients with heart diseases.”

“Normally, nearly all severe complications arise during the initial two days following surgery. Once a patient successfully navigates this critical period, their chances of survival significantly improve. However, the ICU stay can be uncomfortable due to the ventilator, medical monitoring instruments, and drainage catheters. To ease this discomfort and help patients transition through this critical phase as smoothly as possible, we prescribe pain relievers as needed.” 

During the rehabilitation phase, the involvement of both physical therapists and physiatrists is crucial. Only physiatrists with expertise in heart care can oversee and administer therapy, creating tailored treatment plans that incorporate appropriate physical therapy techniques unique to each patient-specific heart condition.

These personalized treatment plans include consideration of individual limitations of patients after cardiothoracic surgery. The goal is to formulate a safe and effective individualized exercise program that could yield the best treatment outcomes while minimizing potential negative impacts on their health.

During the rehabilitation phase, patients typically undergo five days of physical therapy. Without complication, patients can successfully return to their customary lives. This improved quality of life is attributable to the improved functionality of their hearts post-heart surgery. The rehabilitation phases are:

1. One Month after Heart Surgery: Patients may require assistance with daily tasks and walking due to temporary mobility limitations. However, their condition typically improves gradually during this period. Patients are also encouraged to continue their rehabilitation at home by diligently following prescribed physical therapy exercise regimens.
2. Three Months after Heart Surgery: Patients usually achieve full recovery at this point. Their sternal bones have completely healed, and they can resume their usual daily activities, returning to their regular lives.

“Starting at the three-month mark after surgery, I refer to it as a 'profitable phase,' when the combined efforts of the medical team and the patient cooperation begin to yield noticeable benefits. Patients can enjoy an improved quality of life compared to their pre-surgery condition. They transition from experiencing fatigue and reduced activity levels to becoming more active, unhindered by any deficiencies that previously interfered with their daily lives.”  

Of utmost importance, patients can perform exercises surpassing the level before surgery, and their overall health stands to see remarkable improvement. This step toward regaining health is crucial. However, they must continue to have follow-up checkups and diligently adhere to taking the prescribed medications as instructed by their physician to maintain and sustain the health of both the heart and the body.

Regular heart screening leads to early detection, easier and more effective treatment.  

Dr Boonlawat stressed that fatigue is a common and noticeable symptom of heart disease. However, patients often disregard it, attributing it to factors like aging or physical deconditioning if it occurs during physical activities. Unfortunately, if left untreated, the symptoms can escalate to a degree needing medical intervention.  

“This is particularly relevant for older individuals who lead relatively sedentary lives. They may not readily perceive fatigue because of their limited physical activity. However, when they eventually deteriorate to having fatigue at rest, it often indicates the disease has progressed to a more severe stage.”  

“Hence, I strongly advise people to undergo routine health checkups, especially those with preexisting conditions that are risk factors for heart disease, which may include diabetes, high blood pressure, a family history of heart disease, or smoking. Regular heart assessments as part of these checkups can help in the early detection and management of potential heart issues.”

Dr Boonlawat's conclusion underscores the significance of proactive health management. Taking early steps to prioritize health, including maintaining a balanced diet, engaging in regular physical activity, and managing mental well-being while minimizing stress, is crucial. Moreover, regular health checkups are pivotal since early detection often leads to more facile and effective treatment options.

By adhering to these principles, the need for surgery is often avoidable, as less invasive modalities suffice, which not only streamlines the physician's approach but also safeguards the patient's health. In cases where surgery is deemed necessary, patients benefit from more options, with reduced mortality or complication risks.

“Heart surgery is not as frightening as it might seem, and it is important not to shy away from it. This low-risk procedure can bring significant benefits, including longevity, improved quality of life, and a life free from undue worries.”