2. Department
  3. Cardiovascular Surgery

Cardiovascular Surgery

(1) Overview

Cardiovascular Surgery mainly conducts surgical treatment of cardiac/vascular diseases in adults. The department conducts a wide range of heart surgeries, including heart transplants and the treatment of children. In particular, the department actively incorporates minimally invasive heart surgeries such as off-pump bypass, stent graft interpolation, and minimally invasive cardiac surgery (MICS).

(2) Policy

Conducting surgeries with little stress to eliminate fear of heart surgery

Many people probably have the image of heart surgery being dangerous and scary. There are quite a few patients who delay the timing of their heart surgery from this kind of fear, missing the timing when the surgery should have been conducted. In addition, as the symptoms of heart disease tend not to appear until the disease is severe, surgeries have a tendency to be delayed even further.
In order to enable patients to have surgery at the appropriate timing, the conventional image of heart surgery needs to be eliminated. To this end, the department is actively undertaking minimally invasive heart surgery. Not only do we seek to provide highly safe surgeries, we also seek to provide surgical treatment that can alleviate mental and physical stress.

(3) Our Strengths

Off-pump coronary artery bypass conducted without stopping the heart

In order to maintain life, the heart pumps without stopping approximately 100,000 times per day. Ordinarily, to operate on the heart, the heart is temporarily stopped, and an artificial heart-lung machine is operated.

However, recently there is a heart surgery that does not stop the heart or use an artificial heart-lung machine. The target is “coronary artery bypass”, where the patient’s own blood vessels are used to create a new passage for blood in order to recover blood flow in the coronary artery for angina pectoris and myocardial infarction. Angina pectoris and myocardial infarction are diseases where the coronary artery becomes thin or clogged due to arteriosclerosis.

Coronary artery bypass is a delicate surgery where approximately 1.5 mm blood vessels are sewn together with a thread that is thinner than a human hair, and traditionally it needed to be conducted when the heart was stopped, but with advances in surgical technology, it is possible to conduct the same quality of surgery while keeping the patient’s heart moving. We endeavor to always conduct off-pump coronary artery bypass, and compared with other surgeries that use an artificial heart-lung machine, the stress on the body is minimized.

Minimally invasive cardiac surgery (MICS) conducted with a small incision

Minimally invasive cardiac surgery (MICS) conducted with a small incision

Median sternotomy

Median sternotomy

Minimally invasive cardiac surgery (MICS)

Minimally invasive cardiac surgery (MICS)

Traditionally, heart surgery was conducted by making a “median sternotomy”, making an incision along the length of the sternum, a flat bone in the center of the chest. With this method, not only would a large scar remain from the base of the throat to the solar plexus, many patients would also struggle with pain and exercise restrictions for several months until the sternum fused.

In order to improve this, a heart surgery where the sternum is not cut very much or not cut at all is known as “minimally invasive cardiac surgery” (MICS). The department conducts surgery with MICS for cardiac valvulopathy where the heart valves function poorly. Not restricted to surgery on one value, the department conducts simultaneous surgeries on for example the mitral valve and tricuspid valve, and also conducts minimally invasive cardiac surgery for simultaneous surgeries on the aortic valve and mitral valve.

In addition, according to the location of the valve being treated and the patient’s physique, the department ensures that surgery can be conducted with a minimal incision by modifying the incision.

With MICS, surgery can be conducted with an incision of 10 cm or less. Although the artificial heart-lung machine will need to be used, and the heart will need to be stopped, minimizing the incisions made on the skin and bone has ensured fewer instances where postoperative recovery is delayed due to the pain of the incision. We seek to make the incision small and less noticeable, reducing the fear patients feel towards surgery.

Another major advantage is that by not cutting the sternum, there is no risk of sternum infections. Meanwhile, it does have the drawback of being technically difficult due to the small surgical field.

The cost of conducting the surgery for cardiac valvulopathy with MICS is not very different from conducting the surgery via a medium sternotomy. The amount paid by the patient at the hospital is approximately 150,000 yen (If the Eligibility Certificate for Ceiling Amount Application “C” is used with the one valve replacement. However, the ceiling amount for the High Cost Medical Expense Benefit System differs according to the patient’s income.)
*A median sternotomy is approximately 140,000 yen. (If the Eligibility Certificate for Ceiling Amount Application “C” is used with the one valve replacement. However, the ceiling amount for the High Cost Medical Expense Benefit System differs according to the patient’s income.)

Stent graft interpolation, conducted without cutting the chest or stomach

Stent graft interpolation is a surgery conducted to treat a disease known as an aortic aneurysm where the aorta blows up like a balloon, and if left untreated, may burst and lead to death. It is a treatment where an artificial blood vessel with metal springs called a stent graft is folded tightly and stored within the catheter, and sent into the aortic aneurysm from a blood vessel at the groin, where it is expanded and blocks the aortic aneurysm from within.
Until stent graft interpolation appeared, major surgery was required where a 20 cm to 30 cm incision would be made at the location of the aortic aneurysm, exposing the aortic aneurysm, after which it was resected and an artificial blood vessel was transplanted, furthermore, an artificial heart-lung machine was also required for aortic aneurysms in the chest area.
However, with stent graft surgery, only an approximately 3 cm incision needs to be made at the groin, and treatment can be conducted without cutting the chest or stomach. An artificial heart-lung machine is not required even in the chest area.
Unfortunately, however, not all aortic aneurysms are necessarily eligible, and there are cases where depending on the location and shape of the aortic aneurysm, an artificial blood vessel transplant with a major incision on the skin is more suitable. Going forward the stent graft indications need to be expanded.

Message to our patients

Around the end of the 20th century, when I became a cardiovascular surgeon, both the physician conducting the surgery and the patient receiving it took part with the resolve that “this is life or death”. These surgeries continue to be treatments directly involved with life or death.
However, by conducting the appropriate heart surgery at the appropriate time, the weakened functions of the heart can be recovered, and this is expected to similarly extend the healthy lifespan even for elderly patients.
In order for as many people as possible to benefit from this, we need to eliminate the unnecessary fear of heart surgery. We believe that this can be accomplished not only by simply explaining the need for surgery, but also by offering less fear of the surgery itself