Cardiovascular Surgery

Minimally Invasive Cardiovascular Surgery

In our hospital, up-to-date minimally invasive cardiac surgery (less traumatic) approaches are performed using the latest technology.

Underarm Heart Valve Surgeries

Commonly known among the public as “underarm” or “closed heart surgeries,” the scientific name of this procedure is right anterolateral mini-thoracotomy. It is performed through a 4 or 5 cm incision under the armpit without cutting muscles or bones and without making any other incision elsewhere on the body, for heart valve repair or replacement. The only difference between surgeries performed from the front and those from the underarm is the entry point. The internal procedure is the same as standard heart surgery. In addition, with this method, heart surgeries can be performed without cutting open the breastbone, which normally requires a 26–30 cm incision. No bone is cut.

In which heart problems is surgery from the underarm preferred?

Since 1997, we have used this approach for ASD (closure of a hole in the heart), mitral valve replacement and repair, tricuspid valve repair, and aortic valve replacement and repair. Similar aesthetic methods are also available for coronary bypass surgeries.

Advantages

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  Lower risk of bleeding.

   

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  Lower risk of infection.

• Much faster recovery time.

• The patient cannot even see the surgical site themselves.

• From an aesthetic and psychological perspective, the patient feels as if no surgery has been performed.

• Does not cause sexual or social problems.

• After surgery, the patient can lie in any desired position.

• The patient does not have to avoid chest impacts after surgery.

• The patient can drive and wear a seatbelt upon hospital discharge.

• The patient can use their arms as if they had never undergone surgery. They can lift heavy objects.

Who is suitable for this method?

It is ideal for young patients, and especially those with risk factors such as obesity, diabetes, and heart failure. It can also be easily performed in elderly patients for mitral and tricuspid valves; however, it is not preferred in patients over 75–80 years old, those with chronic lung disease, or those who have previously had lung surgery from the right chest. In this group of patients, especially for aortic valve replacements, a small opening from the front is preferred for aesthetic and minimally invasive purposes.

Can this method be applied to children and infants?

This method was first introduced by Japanese scientists for heart defects in children. Therefore, it can be applied to certain heart surgeries in children and infants, such as closure of heart holes.

What should patients choosing this method pay attention to?

Patients should choose physicians who have worked for years on minimally invasive cardiac surgeries at universities or training and research hospitals, who have published their cases in national or international scientific journals or congresses, and who can prove their experience through training certificates.

Is it as safe as other methods, and what is the risk?

It is 100% safe. The risks are the same for front and side entry methods. If it becomes impossible to perform surgery through the chosen entry point, the surgeon can immediately enlarge the area and switch to the standard approach. Therefore, the entry method does not increase surgical risk. The risk in cardiac surgery is related to the delay of the surgery and the heart’s strength.

Which method is safer for repeat heart surgeries?

Reopening the chest from the front for a second time carries risk. For second and third mitral and tricuspid valve surgeries, the most ideal method is from the underarm. However, for second and third aortic valve surgeries, it is not applied.

Beating Heart Bypass Surgeries (Minimally Invasive)

When we hear “heart surgery,” we often feel fear and try to find ways to avoid it. Sometimes, we go from doctor to doctor, hoping one will say, “You don’t need surgery.” But in vain… Every day we delay increases the risk, and we may lose the chance to have the surgery. Instead, the correct approach should be to research, “How can I get through this surgery more easily?”

In recent years, what we call minimally invasive cardiac surgery has been performed with a much smaller incision and without using a heart-lung machine—meaning the heart is not stopped during surgery.

What are the advantages of this?

1. Reduction in surgical trauma and blood loss.

2. Not having to open the breastbone completely—or not at all—is a great relief for the patient. It’s like the difference between a needle prick and a large nail being driven in. Because the surgical opening is much smaller, bleeding is reduced, and postoperative pain is also less.

3. Faster recovery and early discharge.

4. Small wounds heal quickly, especially if there is no bone or muscle cutting. The patient can get out of bed early, lie in any position, turn over, and use their hands and arms to meet daily needs. They can wear a seatbelt and do not need to avoid chest impacts.

5. Better cosmetic appearance.

6. Since these surgeries are performed through the underarm, under the breast, or below the chest, even the patient themselves may not see the incision site. Within a month, the entry site becomes barely noticeable. This is especially preferred for young people, women, and children.

7. Prevention of sexual and social problems.

8. In open-heart surgeries where the heart is stopped and the breastbone is cut from top to bottom, many organs—especially the brain and heart—are affected by the heart-lung machine. Postoperatively, hair loss, personality changes, loss of sexual desire, and sexual dysfunction can occur. Sexual intercourse is prohibited until the breastbone heals. In aesthetic surgeries performed while the heart is beating, none of these problems occur, and the patient quickly returns to normal performance.

9. Lower risk of infection.

10. The immune system is not damaged, blood is not mechanically traumatized, and blood cells remain intact. As a result, the risk of infection and inflammation at the incision site is very low.

11. Reduction in brain, kidney, and lung complications.

12. When the heart-lung machine is not used, blood cells are not affected, and complications such as brain damage, stroke, and kidney failure do not occur.

Due to these advantages, this has become one of the most preferred surgical techniques today.

Buerger’s Disease

A slight purpling of the toes or fingers, or a wound on the nail, can sometimes lead to the amputation of a finger, and in some cases, even a toe. We often do not take these complaints seriously, and when we lose a finger or toe, we cannot believe it.

Yes, think about it: first, your toe is amputated, and over time, your entire foot may be lost… One limb is gone!… Then, the other foot, followed by hands and arms… This insidious and frightening disease is called Buerger’s Disease. No one should say, “It won’t happen to me!” Although it is most common in smokers and men, its exact cause is still unknown, and hereditary transmission is also possible.

If we didn’t have our feet, or even one of them, which have carried us for years, what would we do?

This disease usually occurs in men aged 20–50 who smoke. Its symptoms are completely caused by insufficient blood circulation due to narrowing or blockage of the blood vessels. The main symptoms include pain in the calves and feet while walking, mild hair loss, and most importantly, coldness, cramping, and purpling of the toes.

If a small wound occurs while cutting the nail, or if a bruise appears on the toe from wearing tight shoes and the healing is delayed, a specialist should be consulted without delay. Unfortunately, many people try ointments to heal these wounds, which can lead to infections. Those who cannot find treatment eventually have to accept the amputation of a toe or foot.

Even after losing a limb, some patients continue to smoke. However, quitting smoking can slow the progression of the disease. Simple surgical procedures (lumbar sympathectomy) and smooth muscle relaxant medications can help heal wounds and dilate small arteries, potentially saving the toe or foot. The key is to seek treatment before ulcers and gangrene develop. In about 30% of cases, the disease also affects the fingers. Treatments for the hands (thoracic sympathectomy) are generally more successful.

Carotid Artery (Neck Artery) Surgeries

An atherosclerotic plaque can create a bulge inside the carotid artery, blocking blood flow to the brain. It can also cause clot formation, leading to stroke or paralysis. The surgical removal of the inner layer of the carotid artery along with the plaque is called carotid endarterectomy. This procedure is known as the most effective method for preventing stroke and paralysis caused by carotid artery narrowing.

On each side of the neck, there are two carotid arteries that carry oxygen-rich blood from the heart to the brain. Around jaw level, these arteries split into an internal and an external branch. The external carotid supplies the face and scalp, while the internal carotid enters the skull to supply the brain.

With age, cholesterol and fat circulating in the blood can accumulate in the vessel wall, forming atheromatous plaques. As plaques enlarge, the artery narrows and hardens—this is called atherosclerosis. Plaques in the carotid artery usually form at the point where the artery branches, extending more toward the internal carotid. The uneven surface of the plaque may become covered with clots, further narrowing or completely blocking the vessel. This significantly reduces blood flow to the brain, often resulting in a stroke. In addition, pieces of the plaque may break off, travel to the brain, and block smaller arteries, causing stroke, blindness, or speech disorders.

Endarterectomy is performed when plaque causes a narrowing severe enough to threaten a stroke.

Indications for Surgery:

• Severe narrowing (≥70%) that has caused transient or permanent stroke, blindness, or speech disorders.

• Patients with mild-to-moderate stroke in the last 6 months and 70% narrowing in the carotid artery.

• Patients with >80% narrowing in the carotid artery, even without symptoms, due to high stroke risk.

• For patients undergoing coronary artery bypass surgery, carotid endarterectomy may be performed before, during, or after the heart surgery, depending on the patient’s condition.

Non-Surgical Varicose Vein Treatment

Today, varicose veins—commonly a concern for women but also prevalent in men—are caused by damage to the small valves inside the veins that carry deoxygenated blood back to the heart against gravity. This damage increases venous pressure, causing cosmetic issues, a feeling of heaviness in the legs, numbness, burning, swelling, and even ulcerated wounds.

Although many factors are blamed for varicose vein formation, the exact cause is not yet fully known. Factors include:

• Prolonged immobility

• Standing for long periods

• Excess weight

• Smoking

• Pregnancy

• Genetic predisposition

Very small, superficial, spider web–like veins (telangiectasias) may be an early sign of underlying disease. Larger varicose veins (varicose bulges) can cause bleeding, clot formation, infection, and serious health issues. In advanced stages, they may erode the skin and cause ulcerated wounds. Diagnosis is made with Doppler ultrasonography.

Today, treatment is no longer something to fear—non-surgical and scar-free procedures can restore the legs’ appearance. These include:

• Sclerotherapy (Foam Treatment): A common method for treating small-to-medium-sized visible veins. A fine needle injects a chemical into the vein, which foams when it contacts blood and seals the vein walls. The diseased section is then absorbed by the body. This is a quick, painless, anesthesia-free outpatient procedure with immediate results.

• Excisional Laser: A popular method for treating surface capillaries, with an 80% success rate. It is especially effective for spider veins.

• Endovenous Laser Ablation: A comfortable method involving laser application inside the vein via a small needle and guide wire. It causes minimal bleeding and bruising, with increasing popularity.

• Radiofrequency Ablation: Similar to laser ablation, but uses radio waves instead of laser. Success rates are similar.

In addition, medications can help heal the vein lining and strengthen vein walls. Diuretics and painkillers may be added to reduce swelling.

With these treatments, varicose veins are no longer a nightmare. However, early diagnosis and treatment are important for quality of life. No matter the stage, treatment is possible and straightforward. Delaying treatment can lead to bigger problems.

Laser Treatment for Telangiectasias (Spider Vein Red Spots)

When tiny veins beneath the skin expand, they can form a spider web–like appearance—especially distressing for women. These are not a serious health problem, but the appearance can be bothersome.

The latest technological treatment is laser therapy. Untreated spider veins tend to spread more quickly.

This treatment involves applying high-energy light to the vein. The darker-colored vein absorbs the laser light, heats up, and is destroyed. The vein wall and blood cells inside are damaged at 70–90°C and are then removed by the body. This is a permanent treatment for the targeted vein.

Advantages:

• Easy and painless application without anesthesia.

• No rest required; the patient can continue working during treatment.

• No permanent scarring (especially important for women who wear skirts).

• Can be applied to any area, including the face.

• If there are skin spots in the area, they may also improve.

• Leg hair may fall out or weaken due to follicle damage.

• No need for bandages or compression stockings during or after treatment.

Childhood Heart Health

Preventing serious heart problems in adulthood begins in childhood. Heart conditions correctly diagnosed and treated early can be prevented from becoming problems later in life.

Childhood heart diseases fall into three categories: congenital heart defects, rheumatic heart disease, and rhythm/electrical conduction disorders.

• Congenital Heart Defects: Occur due to developmental deficiencies in the womb. They may appear in many forms, the most common being atrial septal defect (ASD). These can be surgically closed—often through a small incision under the right arm, which is comfortable for both the child and parents. This approach is also often used for treating valve problems in children.

• Rheumatic Heart Disease: Caused by frequent throat infections, especially from streptococcal bacteria. These primarily affect the heart valves and are still seen in our country, though more common in developing nations. They can be treated with careful follow-up and timely intervention.

• Rhythm and Electrical Conduction Disorders: Problems in the electrical system controlling the heart’s beating—such as slowing, pauses, or speeding—can occur, sometimes alongside congenital heart defects. Myocarditis (heart muscle inflammation) or pericarditis (heart lining inflammation) may also be underlying causes.

Aortic Aneurysm (Bulging and Rupture)

Aortic dissection—tearing of the main artery—can be a cause of sudden death, especially in people with high blood pressure. It can sometimes be detected only by chance during screening.

Those over 50, especially with high blood pressure, smoking habits, or excess weight, should have a CT angiography or at least an echocardiogram every two years. Enlargement of the artery before rupture is a warning sign, allowing surgery to be performed with lower risk.

There are two types of aortic rupture:

• Dissection without rupture: Blood enters between the vessel wall layers without leaking outside the vessel—this requires emergency surgery.

• Complete rupture: Blood bursts out into the chest or abdomen. This causes immediate death in most cases.

Early diagnosis is critical. Surgical risk depends on the tear’s location and size. Tears extending from the aortic root toward the carotid arteries are high risk, and those extending down toward the kidney arteries are the highest risk.

People over 45 who smoke, have high blood pressure, diabetes, or heart disease should never neglect regular check-ups.