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Cardiac Surgery

Cardiac Surgery

The cardiac surgery department of Valais Hospital is based in Sion. It provides state-of-the-art treatment in the field of adult cardiac and vascular surgery, and in particular uses the most recent minimally invasive surgery techniques (which allow for incisions measuring just a few centimetres, unlike traditional techniques requiring longer incisions).

The field of adult cardiac surgery includes the following treatments in particular:

  • Aorto-coronary bypass, including beating heart surgery, without using a heart-lung machine
  • Aortic and mitral valve replacement
  • Replacement of the ascending aorta, of the arch and of the descending thoracic aorta
  • Minimally invasive techniques for aortic valve replacement
  • Defibrillator and pacemaker insertion

The Valais Hospital Cardiac Surgery Department is mainly characterised by the speed of its interventions, including emergency operations as the case may be, its flexibility, its quality and its surgical results, which match those of other centres, including university hospitals.

The doctors in the department are also committed to maintaining their high level of performance by regularly taking part in specialist international conventions and by contributing to various specialist publications, in cooperation with the Cardio-Vascular Surgery Department of the Centre Hospitalier Universitaire Vaudois (CHUV).
 

Cardiac intervention involving aorto-coronary bypasses is the treatment of choice for patients suffering from a coronary disease affecting two or more coronary arteries and/or the main coronary artery.
Coronary disease is the consequence of a so-called atherosclerotic impairment (fatty degeneration) of the heart’s coronary arteries. The progression of the disease leads to a reduction in the diameter of the blood vessels, which in turn causes a reduction or interruption of the blood flow, leading to the death of the cardiac muscle.
The main symptoms of this type of coronary impairment are progressively worsening thoracic pain under stress, and the appearance of pains while at rest.

Surgical Treatment

The surgical treatment of atherosclerotic coronary disease involves creating bypasses between the ascending aorta and the coronary aortas, in order to ensure a sufficient supply of blood beyond the critical lesions.
Very often, this intervention requires extra-corporal circulation, which is provided by a so-called ‘heart-lung’ machine. However, it is sometimes possible to construct aorto-coronary bypasses with the heart beating.

Around 2% of the adult population suffers from cardiac valve dysfunction. The frequency of these valvulopathies (cardiac valve dysfunctions) increases with age to reach 10 to 15% of patients aged over 75. Aortic valvulopathy is a disease that occurs mainly in older patients, but there are also some congenital forms.

Two types of condition can develop: aortic stenosis, meaning the shrinking of the surface of the valve’s opening, and aortic insufficiency, which refers to the incomplete closing of the leaflets. These two conditions can occur simultaneously.

  • Aortic stenosis is the most common valve disease. It hinders the ejection of blood between the left ventricle and the aorta. It severe cases, it leads to the maladjustment of cardiac output under stress, with breathing difficulties, syncopes and thoracic pain. Sometimes, there may be no symptoms even though the valve is already substantially affected, which is why surgical orientation is sometimes recommended even in the absence of any symptoms.
    The treatment for aortic valve stenosis is exclusively surgical, by replacing the valve in question.
  • Aortic Insufficiency is often associated with a degeneration of the leaflets. It can be due to a congenital disease affecting the elastic tissue (Marfan syndrome).


The treatment is surgical if there is a major leak and/or if the condition has any effect on the left ventricle (dilatation).

Surgical Treatment

Replacing the aortic valve requires setting up extra-corporeal circulation and stopping the heart, then opening the aorta just above the valve. The native valve is then replaced with a mechanical prosthesis, which is either metallic or biological (made using treated animal tissue).
The advantage of the mechanical valve is that it lasts longer than the biological valve; the disadvantage is that it means that lifelong anticoagulant treatment becomes necessary. It is recommended in young patients.
The advantage of the biological valve is the short duration of treatment (3 months). However, it deteriorates more rapidly (in around 10-15 years), and a further operation is often needed.

The ascending aorta and the aortic arch sometimes need to be replaced during operations.
Operations may be scheduled to treat a progressive dilatation of the aorta (aneurysm). If this problem is not treated, the risk of a rupture of the ascending aorta or of the aortic arch is quite high in cases where the vessel’s diameter has reached 4.5 cm (the usual diameter of the ascending aorta is between 2.5 and 3.5 cm). The replacement of the ascending aorta may or may not be accompanied by the replacement of the aortic valve, depending on its condition.
The scheduled replacement of the aortic arch is more complicated and requires a period of circulatory arrest and deep hypothermia. The duration of the circulatory arrest must of course not be allowed to last too long, in order to avoid all sorts of neurological complications.

Emergency Cases

In emergency cases, the replacement of the ascending aorta or of the aortic arch, following the rupture or the dissection of the aorta (eruption of blood inside the wall of the aorta), involves very high operative and post-operative risks due to the state of shock of the patient and depending on the progression of the dissection in the peripheral arteries.
 

The development of new surgical strategies, of new technologies, and the improvement of anaesthetic and intensive care techniques have allowed for the development of so-called minimally invasive surgical techniques which allow the surgeon to treat certain cardiac pathologies through a very restricted surgical access point.

Minimally invasive techniques must guarantee the same quality standard as traditional surgical techniques, and are more respectful of the integrity of the human body, often involving smaller scars.

It has been demonstrated that minimally invasive techniques are better tolerated by patients, particularly due to the shorter post-operative recovery times, and to the reduction of pain involved. All this is reflected by the length of patients’ stays in hospital and by the quality of post-operative rehabilitation programmes.
 

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