How to avoid complications after cardiac surgery

”It's fascinating how the heart starts to beat again”

Prof. Dr. med. Fischlein knows the risks of surgery: that is why he places his trust in Medela's system Thopaz+.

What made you want to become a doctor? Moreover, why a heart surgeon?

I always wanted to be a doctor. As a medical student, I read an interesting report on Bruno Reichart. At the time, as a young professor, he had begun work on transplants in Germany. He would later go on to succeed Christiaan Barnard in Cape Town. I was so fascinated by his career that I applied to become an assistant at the Anatomical Institute in Vienna. That was my way into surgery. I came to heart surgery through a research group. Following an invitation from Bruno Reichart, I went to Munich. I qualified as a professor and worked my way up to senior physician there. Following several years as a managing senior physician in Frankfurt and a professorship in Erlangen, I have now been chief physician in Nuremberg for 12 years.

Which challenges do you see in heart surgery in comparison to other disciplines?

What fascinates me about the heart is how it always starts to beat again once we have stopped it in surgery.

As our patients are getting older and older, they have high levels of co-morbidities such as kidney diseases or strokes. This requires more engagement with physiology and problems related to internal medicine. We also need to work very precisely with a magnifying glass and very thin threads to perform anastomosis on the small vessels. That's an extremely difficult task. What fascinates me about the heart is how it always starts to beat again once we have stopped it in surgery.

How many operations do you do? In addition, what does your clinic focus on?

Here in Nuremberg, we perform up to 1,000 procedures each year - primarily bypass
and catheter-assisted aortic valve surgery.

What does a typical patient pathway look like and what is the most critical situation in a heart operation?

Patients will bleed slightly afterwards, and secretion builds up that needs to be drained off. That's why drainage is so important

Before a patient comes to us, a specialist in internal medicine or a cardiologist has usually already diagnosed them. There are preliminary examinations we need to take place such as heart catheter, echo, carotid Doppler, and lung function. These tell us, for instance, whether the carotid artery is free. The most critical situation is not the operation itself. It is the first twelve hours after the operation.

During the operation, we need to fully anti-coagulate the patient with heparin. Otherwise, the blood would clot in the tubings that lead to the heart-lung machine. This effect is neutralised again after the operation using protamin. Nevertheless, patients will bleed slightly afterwards, and secretion builds up that needs to be drained off. That's why drainage is so important. Otherwise, this may result in a tamponade, where the heart is surrounded by a build-up of fluid. Additionally, the patient could also lose too much blood.

What is particularly important for you when it comes to drainage and why do you use the Medela system Thopaz+?

The drainage should be operational as soon as we have sealed the thorax. In many systems, this is not guaranteed, as we need the wall vacuum for it. It can take up to an hour after surgery for the patient to be transferred, arrive at the intensive care unit and for monitoring to be performed. That is a critical stage. Thopaz+, however, guarantees a constant drainage.

What's your vision for heart surgery?

Heart surgery is an innovative field. Our focusis ensuring minimally invasive surgery with as little access as possible. This is technically challenging and requires the use of new technologies such as 4K monitors and 3D videos. On the one hand, we are under more and more pressure from interventional cardiologists, who do a lot using catheters.On the other hand, however, they are also the gatekeepers who bring us the patients. We are already performing TAVI procedures together in hybrid surgery. In ten to twenty years, both disciplines, interventional cardiology and conventional heart surgery, will grow closer together.

When can you say, 'today was a good day'?

When I do something new that works well and can be financed. I am always particularly pleased by positive feedback from patients. That's when it's been a good day.

Prof. Dr. med. Theodor Fischlein

Chief Physician at the Heart Surgery Clinic

University Hospital of Paracelsus Medical Private University

Professor of Heart Surgery

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