Cardiac surgery is an integral part of the Heart Clinic and all indications for surgery are discussed (cardiologists and cardiac surgeons) in the heart team. There entire spectrum of conventional heart surgery is offered (elective, emergency). We perform all cardiac surgery procedures apart from transplants and assist devices. For most indications a median sternotmoy is the method of choice to access the heart; however our main focus is on minimally invasive surgery. All procedures are performed in most advanced hybrid operating room of Europe. This allows us to combine the latest surgical procedures with catheter interventions, in order to offer patients the best therapy.

 

Anatomy of the Heart

 

The normal heart is composed of four chambers, two atria and two ventricles (Left and Right for both). Valves separate these chambers (Aortic, Mitral, Tricuspid and Pulmonary Valves) and coronary arteries (in red) provide blood to the heart muscle – the left ventricle provides blood flow to the entire body and is much thicker than the right ventricle which is responsible for blood flow to the lungs.

 

Treatment by Bypass Surgery (CABG)

Therapeutic Access

The Median sternotomy remains the approach of choice for full coronary artery revascularization. In all cases the left internal mammary artery (LIMA) is used, whenever possible also the right internal mammary artery (RIMA), and alternatively we can also use a piece of vein from the leg.

Coronary Artery Bypass Grafting, also called CABG describes the oldest form of treatment for coronary artery disease. In all cases the left mammary artery (LIMA) is used to provide additional blood to the main coronary artery, namely the LAD (left anterior descending). Other arteries (from the forearm) are also often used, and in some instances veins from the leg can be taken to bypass a stenosis.

 

Hybrid Revascularisation (MIDCAB & PCI)

Therapeutic Accesses

For this approach the LIMA is harvested either directly or thoracoscopically. A mini thoracotomy is then performed to access the anterior part of the heart to perform an anastomosis between the LIMA and the left anterior descending (LAD) artery on the heart. This is called a MIDCAB.

This picture demonstrates a hybrid treatment of coronary artery disease. A stent is in place in the right coronary artery and the left mammary artery is used to revascularize (= provide fresh blood) to the left anterior descending artery. This procedure is called a MIDCAB – minimally invasive direct vision coronary bypass grafting. Through a 4cm incision in the left chest the LIMA is harvested and a bypass can be made to the left anterior descending artery. These procedures can either be done in a step wise approach or in the same setting (hybrid).

 

Aortic Valve Replacement

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Therapeutic Access

(1) When only an aortic valve replacement needs to be done, we can perform this over a 5 cm incision (mini-thoracotomy) also known as a minimally invasive AVR. (2) however the Median sternotomy remains the approach of choice for complicated procedures, especially when several cardiac problems must be addressed.

The treatment for this condition is to replace the aortic valve with an artificial valve. This can be a biological or mechanical valve. The procedure is called aortic valve replacement. In our institution this is done in most cases in a minimally invasive fashion through a 5 cm incision in the chest without opening the sternum (chest bone).

 

Mitral Valve Repair

Therapeutic Access

Minimally invasive mitral valve repair can be done either by port access approach, or with da vinci robot.

Surgical mitral valve repair is the gold standard (= the best therapy) for mitral valve insufficiency. At our institution all surgical mitral valve procedures are performed in a minimally invasive fashion. These are either video- assisted through a mini- thoracotomy or robotically-assisted with the Da Vinci Robot. Our rate of repair is in excess of 96% for patients with degenerative mitral valve disease.

 

Aorticaneurysms

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An aortic aneurysm (say "a-OR-tik AN-yuh-rih-zum") is a bulge in a section of the aorta, the body's main artery. The aorta carries oxygen-rich blood from the heart to the rest of the body. Because the section with the aneurysm is overstretched and weak, it can burst. If the aorta bursts, it can cause serious bleeding that can quickly lead to death.

 

Tirone David Operation

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The Tirone David Operation is a complex surgical procedure. During Valve Sparing Root Replacement (David Procedure), the enlarged ascending aorta is replaced by a graft (artificial tube) but the patient's aortic valve is preserved and sutured inside the graft. By preserving the native aortic valve, patients avoid the need for lifelong anticoagulation therapy (Coumadin) or the risk of bioprosthesis failure. We will discuss with you the most appropriate treatment or surgery for your individual condition and discuss the benefits and risks of surgery. We will evaluate your risk of aortic dissection and measure the diameter of your aorta when deciding if you are a candidate for surgery.

 

Heart Clinic Zurich offers the following treatments

  • An experienced team of surgeons who have had thorough training at the university hospital of Zurich in addition to specialised international training.

  • Conventional Heart Surgery including Coronary artery bypass graft surgery (ACBP), Aortic Valve Replacement and Repair, as well as Mitral and Tricuspid Valve Repairs.

  • For CABG we prefer to the off-pump approach not using the heart-lung machine. In addition we have developed a hybrid program for minimally invasive Lima-to LAD Bypass (MIDCAB) in combination with.

  • Our Aortic valve replacement program offers the entire spectrum from minimally invasive valve replacement through an anterior mini thoracotomy (4cm incision) to TAVI (transaortic, apical and femoral access).

  • As for Mitral and Tricuspid valve repair, these procedures are all performed endoscopically when possible.

  • Aortic aneurysm surgery, classic and hybrid procedures (bypass and stent graft).

  • We also offer the entire spectrum of atrial fibrillation surgery. This goes from concomitant surgical ablations (Maze Procedure, PVI), left atrial appendage therapies to stand alone treatment of atrial fibrillation (closed chest Maze), and stand-alone left atrial appendage closure (minimally invasive) without opening the chest.

 

Meet our Experts in Cardiac Surgery