Current Surgical Treatments for Heart and Great Vessel Diseases

Published: 07.01.2023  ·  Last Updated: 05.08.2026  ·  Prepared by the Academic Hospital Web and Editorial Board.

Cardiovascular Surgery is the specialty in which diseases affecting the heart, the aorta and the peripheral vascular system are treated with surgical and endovascular (from inside the vessel) methods. Thanks to the advances made in surgical techniques in recent years, methods that create less trauma for the patient are successfully applied alongside conventional open operations: minimally invasive (small incision) heart surgery, endoscopic valve surgery, minimally invasive coronary bypass (MIDCAB/MICS-CABG) and stent treatment of abdominal aortic aneurysm (EVAR). Many patients therefore benefit from less pain, a shorter hospital stay and faster recovery.

The Cardiovascular Surgery Department works with the cardiology, anaesthesiology and reanimation, internal medicine, intensive care and radiology teams through the Heart Team approach, determining the most appropriate treatment method for each patient.

What Is Cardiovascular Surgery?

Cardiovascular Surgery is the specialty covering the surgical treatment of diseases involving the heart, the great vessels (the aorta and the pulmonary artery) and the peripheral vascular system. While heart operations are mostly carried out with the support of cardiopulmonary bypass (the heart-lung machine), off-pump bypass surgery on the beating heart or minimally invasive methods can also be applied in suitable patients. The treatment plan is created individually through the Heart Team approach, in which cardiology and cardiovascular surgery specialists make a joint evaluation.

Which Diseases Are Treated by Cardiovascular Surgery?

Cardiovascular Surgery treats a broad group of diseases ranging from coronary artery disease to aortic aneurysms.

When Should You Consult Cardiovascular Surgery?

Consulting a cardiovascular surgery specialist is recommended in the following symptoms and situations:

• Chest pain or a feeling of pressure in the chest: pain that appears particularly on exertion or does not pass with rest.
• Shortness of breath: breathlessness that limits daily activities, makes lying flat difficult or wakes you from sleep at night.
• Palpitations, fainting or temporary loss of consciousness.
• Swelling (oedema) in the legs or ankles.
• Pain in the calf while walking (intermittent claudication): one of the important symptoms of peripheral arterial disease.
• Sudden leg pain, coldness, pallor or discolouration: this may herald acute arterial occlusion (acute limb ischaemia).
• An expanding mass felt with a pulse in the abdomen, groin or neck: this must be evaluated for an aneurysm (ballooning of the vessel).
• Patients referred for surgical evaluation by cardiology because of heart valve disease, coronary artery disease or an aortic aneurysm.

Emergency Situations

Preoperative Evaluation and Diagnostic Methods

Before cardiovascular surgery, a detailed evaluation is carried out in order to determine the general health condition of the patient, the surgical risk and the surgical method to be applied.

The main diagnostic and evaluation methods are as follows:

Once all evaluations are complete, the most appropriate treatment method for the patient, whether open surgery, minimally invasive surgery or an endovascular procedure (EVAR, TEVAR, balloon and stent applications), is planned individually in line with scientific guidelines.

Operations and Surgical Procedures Performed

In the treatment of heart and vascular diseases, the Academic Hospital Cardiovascular Surgery Clinic applies current and scientifically accepted treatment methods, including open surgery, minimally invasive (small incision) surgery and endovascular (from inside the vessel) procedures.

What Has Changed in Cardiovascular Surgery?

Thanks to the advances made in surgical techniques in recent years, many heart operations can now be carried out through smaller incisions. In these methods, known as minimally invasive surgery, the operation is performed through small incisions between the ribs and with the help of special endoscopic cameras, instead of opening the breastbone completely. The aim is to apply less surgical trauma to the patient, to reduce the risk of bleeding and infection, to shorten the recovery period and to provide a faster return to daily life.

The main minimally invasive and endovascular procedures applied in our clinic are as follows:

• Minimally invasive (small incision) coronary bypass surgery (MIDCAB / MICS-CABG)
• Endoscopic mitral valve repair and valve replacement
• EVAR (Endovascular Aneurysm Repair) for abdominal aortic aneurysm
• TEVAR (Thoracic Endovascular Aortic Repair) for thoracic aortic aneurysm
• Balloon angioplasty and stent applications in peripheral vascular disease
• Open coronary bypass, heart valve and aortic surgery

Coronary Artery Bypass Grafting (CABG)

Coronary artery bypass grafting (CABG) is the procedure of creating a new blood pathway for advanced narrowing or occlusion in the vessels feeding the heart, using vascular grafts taken from another part of the body (the internal mammary artery, the radial artery or the saphenous vein). The operation can be performed with the support of the heart-lung machine (cardiopulmonary bypass) or, in suitable patients, on the beating heart (off-pump CABG).

Minimally Invasive Coronary Bypass (MIDCAB / MICS-CABG)

Today, in selected patients, coronary bypass surgery can be performed through a small incision on the left side of the chest without cutting the breastbone (sternum). This method is called minimally invasive bypass. This technique is not suitable for every patient. The best results are obtained with appropriate patient selection.

Who is it suitable for?

• Patients with isolated left anterior descending (LAD) coronary artery stenosis
• Selected two-vessel patients
• Patients planned for hybrid treatment (bypass to one vessel, a stent to the other)
• Patients of advanced age
• Obesity
• Diabetes
• Patients with COPD
• People at high risk in terms of sternal healing

Who may it not be suitable for?

• Left main coronary artery disease
• Widespread three-vessel disease
• Very widely calcified coronary arteries
• Small calibre and unsuitable vessel structure
• Emergency patients who have developed cardiogenic shock
• Anatomical features that prevent safe access through a small incision

Advantages

• The breastbone is not cut.
• Less bleeding is seen.
• The risk of infection is lower.
• Less pain occurs.
• The hospital stay is shortened.
• A faster return to daily life is achieved.
• It leaves a cosmetically smaller surgical scar.

Heart Valve Repair and Valve Replacement

In heart valve diseases, the fundamental aim is to preserve and repair the valve wherever possible. Where repair is not possible, valve replacement is performed using biological or mechanical prosthetic valves. Valve repair is preferred first in suitable patients because it preserves the natural valve and its long-term results are better.

In our clinic, the surgical treatment of aortic, mitral and tricuspid valve diseases is carried out in line with current international guidelines.

Endoscopic Mitral Valve Surgery

A significant proportion of mitral valve operations can now be performed without cutting the breastbone, through a small incision of about 4-6 cm made under the right breast or on the right side of the chest. The operation is performed using a high-resolution camera and special endoscopic surgical instruments.

This method provides important advantages particularly in patients with isolated mitral valve disease who do not additionally require coronary bypass or another cardiac operation.

Advantages of endoscopic mitral surgery

• The breastbone is preserved.
• There is less blood loss.
• Less pain is felt.
• The risk of infection is reduced.
• The hospital stay is shortened.
• The return to daily life and to work is faster.
• Cosmetic results are better.

Not every patient may be suitable for minimally invasive mitral surgery. Suitability is determined by the Heart Team after evaluating echocardiography, computed tomography (CT angiography), the vascular structure and the general health condition of the patient.

Aortic Aneurysm and Aortic Dissection Surgery

The aorta is the largest artery in the body, and aneurysms (widening of the vessel) are seen most frequently in the ascending aorta and the abdominal aorta. Surgical treatment is recommended because the risk of rupture increases markedly when an aneurysm reaches a certain diameter or grows rapidly.

Ascending Aortic Aneurysm

An ascending aortic aneurysm is the widening of the main artery leaving the heart. According to current guidelines, surgical treatment is planned when the diameter of the aneurysm reaches the critical limit, when it shows rapid growth or when special risk factors such as genetic connective tissue diseases are present. During the operation, the widened section of the vessel is removed and a synthetic vascular graft is placed in its stead.

Acute Type A aortic dissection is a life-threatening emergency that develops as a result of a tear in the inner layer of the aortic wall. In these patients, surgical treatment in the shortest possible time is life-saving.

In descending thoracic aortic aneurysms and in selected dissection cases, TEVAR (Thoracic Endovascular Aortic Repair) is an important treatment option in patients with suitable anatomy.

Abdominal Aortic Aneurysm (AAA)

An abdominal aortic aneurysm (AAA) is the permanent widening of the aorta inside the abdomen. The most important determinant in follow-up is the diameter of the aneurysm. As the aneurysm grows, both the annual rate of expansion and the risk of rupture increase.

Small aneurysms are generally monitored with ultrasonography at certain intervals. According to current guidelines:

• 3.0-3.9 cm: a check approximately every 3 years
• 4.0-4.9 cm: a check once a year
• 5.0-5.4 cm: a check every 6 months

Surgical or EVAR evaluation is generally recommended for aneurysms that reach a diameter of:

• ≥5.5 cm in men
• ≥5.0 cm in women

and for those that grow rapidly, cause pain or are found to be at high risk of rupture.

The main factors that increase the risk of rupture are:

• Smoking
• Hypertension
• Female sex
• A large aneurysm diameter (particularly above 6 cm)
• Rapid growth
• Family history

EVAR (Endovascular Aneurysm Repair)

EVAR (Endovascular Aneurysm Repair) is a minimally invasive method that allows an abdominal aortic aneurysm to be treated without opening the abdomen. During the procedure, thin catheters are introduced through the groin arteries and a special stent graft is placed in the aneurysm region. Blood flow then passes inside the stent, the pressure in the aneurysm sac falls and the risk of rupture is considerably reduced.

Who is EVAR suitable for?

EVAR cannot be applied to every patient with an abdominal aortic aneurysm. Before the procedure, computed tomography (CT angiography) is used to evaluate in detail:

• The neck of the aneurysm
• The length of the aneurysm
• The vessel diameter
• The angulation of the aneurysm
• The structure of the iliac vessels

EVAR gives successful results in patients found to be anatomically suitable.

Advantages of EVAR

• The abdomen is not opened.
• There is less blood loss.
• Less pain occurs.
• The stay in intensive care and in hospital is shorter.
• The return to daily life is faster.
• It is an important treatment option particularly in patients of advanced age and at high risk for open surgery.

Carotid Endarterectomy

Carotid endarterectomy is the procedure of surgically removing the atherosclerotic plaque that forms in the carotid artery in the neck. The aim is to increase blood flow to the brain and to reduce the risk of stroke. Particularly in symptomatic carotid stenosis, the treatment decision is taken through a multidisciplinary approach in which neurology, interventional neurology and cardiovascular surgery evaluate the case together.

Peripheral Vascular Surgery

In patients with advanced narrowing or occlusion in the leg arteries, bypass surgery may be applied in order to restore blood circulation. In recent years, balloon angioplasty and stent applications have also been used successfully instead of open surgery in many patients with a suitable anatomical structure. The choice of treatment is determined according to the vascular structure, the length of the occlusion and the general condition of the patient.

Cardiac Tumour Surgery

Tumours inside the heart, principally myxoma, the most frequently seen benign tumour of the heart, are removed surgically once diagnosed, because they may lead to embolism (a travelling clot), valve dysfunction and sudden circulatory problems. The operation is generally performed with the support of the heart-lung machine.

Pericardial Surgery (Pericardiectomy)

Pericardiectomy is the surgical treatment applied in patients with constrictive pericarditis, in which the membrane surrounding the heart (the pericardium) becomes thickened and hardened. The thickened pericardial tissue that prevents the heart from expanding freely is removed, with the aim of restoring the pumping function of the heart. In suitable patients, a marked improvement in shortness of breath, oedema and exercise capacity can be achieved.

The Postoperative Process

After cardiovascular surgery, the recovery process is planned according to the type of operation performed and the general health condition of the patient. Our aim is to enable patients to return safely to their daily lives in the shortest possible time.

Intensive Care Follow-up

After the operation, patients are generally monitored in the coronary intensive care unit for the first 1 to 3 days. Ventilator support is ended in the shortest possible time and the circulatory and respiratory functions of the patient are closely monitored.

Ward Follow-up

After intensive care, patients are generally monitored in a ward room for 4 to 7 days. During this period:

• Pain control is provided.
• Wound care is carried out.
• Breathing exercises are started.
• Early mobilisation (standing up and walking) is encouraged.
• The necessary education is given before discharge.

After Discharge

Avoiding heavy lifting and intense physical activity is recommended for the first 6 to 8 weeks. In operations performed by opening the breastbone (sternum), movements that strain the arms are limited until bone healing is complete. After minimally invasive (small incision) operations, the return to daily life is generally faster.

Cardiac Rehabilitation

The controlled exercise programmes recommended after heart surgery increase the physical capacity of patients, raise their quality of life and reduce the risk of complications related to cardiovascular disease.

Drug Treatment

The medicines to be used after the operation are arranged individually.

• Blood thinning medicines (where required)
• Antiplatelet treatment (after bypass and vascular procedures)
• Blood pressure medicines
• Cholesterol lowering medicines (statins)
• Medicines for heart failure or rhythm disorders

Drug treatment is planned jointly by cardiology and cardiovascular surgery specialists.

Follow-up Examinations

After discharge, checks are generally carried out at:

• Weeks 1 and 4
• Months 3, 6 and 12

Where required, long-term follow-up is continued using echocardiography, CT angiography, Doppler ultrasonography or other imaging methods.

Cardiovascular Surgery at Academic Hospital

The Academic Hospital Cardiovascular Surgery Department carries out open surgery, minimally invasive surgery and endovascular procedures under one roof. The decision to operate is taken through the Heart Team approach, after joint evaluation with the departments below:

• Cardiology: coronary angiography, echocardiography and joint assessment in the Heart Team decision
• Anaesthesia and Reanimation: determination of surgical risk and anaesthesia planning
• Coronary Intensive Care: circulatory and respiratory monitoring in the first days after surgery
• Radiology: preoperative imaging with CT angiography and Doppler ultrasonography
• Interventional Radiology: imaging support in EVAR, TEVAR and peripheral vascular procedures
• Internal Medicine: management of accompanying diseases before and after surgery
• Neurology: evaluation of stroke risk and treatment decisions in carotid stenosis

Frequently Asked Questions

The answers to the questions most frequently asked in the Cardiovascular Surgery Department are given below.

References

The general information given on this page about heart and vascular diseases, surgical methods and postoperative processes is supported by the reliable health sources listed below.

1. European Society of Cardiology Clinical Practice Guidelines on Cardiovascular Disease Prevention (2021).
2. European Association for Cardio-Thoracic Surgery Guidelines on Myocardial Revascularization (2022).
3. Society for Vascular Surgery Clinical Practice Guidelines for Abdominal Aortic Aneurysm (2022 update).
4. American College of Cardiology / American Heart Association Guideline for the Diagnosis and Management of Aortic Disease (2022).
5. European Society for Vascular Surgery Clinical Practice Guidelines on Abdominal Aorto-Iliac Artery Aneurysms (2024).
6. American Association for Thoracic Surgery Expert Consensus Documents on Mitral Valve Surgery.
7. Society of Thoracic Surgeons Adult Cardiac Surgery Database Reports.
8. European Association for Cardio-Thoracic Surgery Guidelines on Valvular Heart Disease (2021).
9. National Institutes of Health, "Coronary Artery Bypass Grafting", StatPearls, PubMed Central (2024 update), ncbi.nlm.nih.gov
10. NHS, "Coronary Artery Bypass Graft", National Health Service (2024 update), nhs.uk
11. Mayo Clinic, "Heart Valve Disease: Symptoms and Causes", Mayo Foundation (2024 update), mayoclinic.org
12. National Institutes of Health, "Aortic Aneurysm", StatPearls, PubMed Central (2024 update), ncbi.nlm.nih.gov

The information on this page is for informational purposes only; it does not replace medical examination, diagnosis or treatment. Please consult a healthcare institution regarding your complaints.