Actor Heinz Hoenig had to undergo emergency heart surgery at the beginning of the week. A stent was inserted into him. The 72-year-old actor is said to be in very critical condition. According to his management, another “urgent, life-saving heart operation” was scheduled to take place on Friday, May 3rd. But the procedure had to be postponed.
Hoenig is one of around 410,840 people who have heart surgery in this country every year. This is evident from figures from the Federal Statistical Office (as of 2018). Accordingly, the most common interventions were:
Implantation of a pacemaker and defibrillator (127,113 procedures) Implementation of a bypass (64,430 procedures) Removal, replacement and correction of a pacemaker and defibrillator (60,586 procedures)
At the time of the operation, the heart patients were predominantly male (65.7 percent) and were on average 71 years old – a profile that also applies to the actor.
The reasons for heart surgery vary. The “Heart Medicine” portal lists the following causes:
Coronary heart disease Heart valve defects Cardiac arrhythmias Heart weakness Enlargements of the main artery (aortic aneurysm) Heart tumors Congenital heart defects
These diseases may require surgical intervention if medical treatment is unsuccessful. This is apparently also the case with Hoenig. However, it is not known exactly which operation is due.
1. Most common heart surgery: pacemaker
Caused
If the heart beats too slowly, a pacemaker can bring it back into the correct rhythm. A heart that beats too slowly often manifests itself in symptoms such as dizziness or fatigue. If so-called bradycardia remains untreated, heart failure can result.
Sequence
During the operation, local anesthesia is usually sufficient and the patient is awake during the approximately one-hour procedure. As “Heart Failure Guide” explains, an incision is made five to ten centimeters below the left or right collarbone. Through this, the surgeon guides the pacemaker probe to the heart via the subclavian vein. The battery-operated pacemaker is placed under the subcutaneous fatty tissue. It measures the heartbeat and delivers an electrical impulse to speed it up.
Risk
The procedure has few complications. As with other surgeries, possible risks include bleeding, the formation of a blood clot and nerve injuries.
2. Defibrillator
Caused
A heart that beats too slowly can also be treated with a defibrillator. In contrast to the pacemaker, the device also normalizes a too fast heartbeat and palpitations (ventricular fibrillation). A heart that beats too fast triggers symptoms such as restlessness, nervousness and shortness of breath. Heart palpitations, which occur in the heart chambers, are life-threatening and can lead to death.
Sequence
As with a pacemaker, the procedure takes about an hour and is carried out under local anesthesia. The surgeon makes an incision approximately seven centimeters long in the area of the left pectoral muscle. He uses this to push probes through a vein into the right ventricle and sometimes also into the atrium. Then he connects the defibrillator and puts it under the pectoral muscle or just under the skin.
One day after the procedure, he sets up the device. The defibrillator detects cardiac arrhythmias and, if necessary, delivers an electric shock that the patient notices. It also records all cardiac arrhythmias.
Risks
This procedure also poses few risks (complication rate 1-2 percent). Bleeding and incorrect positioning of the device or long-term consequences such as a technical malfunction of the device or an infection with pathogens are possible. Very rarely a patient dies as a result of the operation.
3. Bypass
Caused
In coronary artery disease, the coronary arteries are narrowed or even blocked by calcification, which then restricts the blood flow to the heart muscle. This heart disease manifests itself as chest tightness, a dull ache behind the breastbone and pain radiating to the neck or jaw. In order to avoid the bottlenecks, a bypass made of the body’s own tissue can be created. If left untreated, coronary artery disease can cause heart attacks and cardiac arrhythmias.
Sequence
Bypass surgery is carried out either open-heart or minimally invasive. In the former, the patient receives general anesthesia. The chest is then opened through a longitudinal incision in the sternum. At the same time, a surgeon removes a leg vein or arm artery, which will later form the heart bypass. Another surgeon opens the pericardium to get to the narrow area. Then he puts the bypass. This is possible both with a beating heart and with a stopped heart – in this case a heart-lung machine takes over the function of the heart. The procedure lasts between one and five hours.
During the minimally invasive procedure, the surgeon makes an approximately seven centimeter long incision below the left breast. The chest wall artery can then be removed and sewn onto the diseased vessel at the beating heart.
Risks
According to Heart Medicine, there is a small risk of having a heart attack or stroke during or after surgery. This could happen if the bypass closes due to coagulation disorders or poor wall condition of the coronary artery. Other possible risks include cardiac arrhythmias, poor circulation and bleeding into the pericardium.
“ Netdoktor ” points out that the risks increase if it is an emergency procedure, the heart has already been operated on or the cardiac output is reduced.
4. Stent
Caused
A stent can be inserted in people who suffer from coronary heart disease or chest tightness. In addition, stent surgery is common immediately after a heart attack, which is manifested by symptoms such as a feeling of pressure in the chest, shortness of breath and sweating. If left untreated, a heart attack can lead to life-threatening ventricular fibrillation or heart failure. A stent is a small metal tube that permanently opens vessels and thus maintains blood flow. This prevents vascular constriction.
Sequence
Stent surgery is a minimally invasive procedure. The stent is often inserted under local anesthesia during a cardiac catheterization. The doctor inserts a small plastic tube (catheter) into the narrowed area either through an artery in the groin or in the arm. He pushes the stent over the catheter to the narrow area. There the stent is expanded by a kind of balloon. He uses X-rays to check the correct position of the stent and removes the balloon catheter again.
Risks
The complication rate is very low. In rare cases, cardiac arrhythmias, a heart attack or vascular occlusion may occur during the procedure.