Medicated elimination of pain in the heart associated with ischemia alleviates the condition of patients. However, such therapy does not solve the problem of blockage of blood vessels by atherosclerotic plaques. Therefore, a more radical solution is required - surgical intervention. As a rule, preference is given to coronary artery bypass grafting. In today's article, we will take a closer look at this treatment method, indications for the procedure and its progress.
Medical certificate
Coronary artery bypass grafting is a surgical operation on the vessels of the heart, performed to restore their patency and blood circulation. Most often, its help is resorted to in case of atherosclerosis. For this purpose, new, bypass vascular pathways are created. As shunts or grafts, sections of the arteries and veins of the patient are used. As a rule, preference is given to the internal mammary arteries. They carry loads well andretain functionality for a long period of time. The radial arteries and veins of the legs are used much less frequently.
During the intervention, incompetent own arteries are replaced by shunts. One end of such a transplant from a person's own tissues is sutured into the aorta, and the other end is placed in the coronary artery just below the area of its narrowing. As a result, blood can freely flow into various parts of the heart muscle. During one intervention, the number of shunts used can vary from one to three.
The need for such an operation usually occurs in chronic ischemia. It is characterized by the deposition of atherosclerotic plaques inside the coronary arteries. This causes a narrowing of their lumen or complete blockage, which provokes a violation of blood supply in the myocardial cavity. As a result, oxygen starvation or ischemia develops. If you do not immediately restore full blood circulation, the likelihood of a decrease in human performance, a heart attack and even death increases.
Varieties of operation
Coronary artery bypass grafting is performed using local anesthesia. However, the intervention itself can be carried out in several ways:
- With the connection of a heart-lung machine (EC), when the functioning of the patient's heart is deliberately suspended.
- Operation on a beating heart. This method of exposure reduces the risk of complications, reduces the duration of the procedure itself. It requires a lot of experience from the surgeon.
- Minimally invasivetechnique. During the procedure, the specialist makes several incisions through which he introduces instruments for surgical manipulations into the body. Thanks to this approach, wounds heal quickly, and the patient's recovery period is reduced to several weeks.
Determination of the specific method of the operation is up to the doctor. When choosing, he should take into account the severity of the pathology and the individual characteristics of the patient's body.
Indications for conduction
Coronary artery bypass surgery is recommended for patients with coronary artery disease. This is not the only way to treat pathology. There is an alternative technique - endovascular surgery. It is easier tolerated by patients, but is considered less radical and does not always eliminate the disease.
Also, surgery is prescribed for the following he alth problems:
- angina pectoris difficult to respond to medication;
- narrowing of the coronary arteries by 70% or more;
- developing myocardial infarction;
- contraindications to stenting and angioplasty (these procedures are used in cardiology to restore coronary blood flow);
- ischemic pulmonary edema.
Indications for coronary artery bypass grafting are determined on the basis of a clinical examination and agreed with the doctor.
Possible contraindications
Operation is not possible when:
- diffuse coronary artery disease;
- congestion accompanying heart failure;
- scar lesions;
- kidney failure;
- oncological pathologies.
Advanced age is not an absolute contraindication to the procedure. In this case, the appropriateness of the intervention is determined by operational risk factors.
Preparatory stage
It is not uncommon for coronary artery bypass surgery to be performed urgently if the patient is admitted to the hospital with a myocardial infarction. In this case, preliminary preparation and diagnostics are not required. The doctor focuses only on the patient's condition, his blood tests for the group and coagulability. The operation itself is carried out through dynamic monitoring of the ECG.
Preparation before a planned intervention includes a comprehensive examination of the body. The patient is assigned the following measures to assess his he alth:
- ECG;
- Ultrasound of internal organs;
- Echocardiography;
- dopplerography of cerebral vessels;
- Ultrasound of the vessels of the legs;
- FGDS;
- coronary angiography;
- urine and blood tests.
10 days before the date of the proposed operation, the patient must stop taking blood thinners. We are talking about the following medicines: Plavix, Aspirin, Ibuprofen, Warfarin. If necessary, the doctor may prescribe other means to reduce blood clotting during this time.
On the day of admission to a medical institution, you can’t have breakfast so that a blood biochemistry test shows a reliable result. AfterThis patient is being examined by a doctor.
On the eve of the operation itself, a consultation with an anesthesiologist and a specialist in respiratory gymnastics is required. Dinner must be no later than 18.00. After this time, only liquids are allowed. Before going to bed, the patient is given a cleansing enema and the hair in the area where the surgical incisions are made is shaved.
Bypass Technique
Traditional coronary artery bypass grafting is performed using an IC machine. It consists of the following steps:
- The patient is placed on the operating couch. The specialist injects intravenous anesthesia. An endotracheal tube is inserted into the trachea to control breathing. She delivers gas from the ventilator. A special probe is inserted into the stomach to control its contents and prevent reflux into the respiratory tract. A catheter is also installed to divert urine.
- The cardiac surgeon performs a vertical incision along the midline of the sternum, the size of which is 30-35 cm. The chest is opened enough to provide full access to the main muscle of the body.
- The patient's heart is deliberately stopped, and he himself is connected to the IR machine. Another surgeon at this time performs the sampling of a part of the vein, for example, from the patient's leg. One end of the shunt is sutured to the aorta, the other - directly to the coronary artery. Immediately after this procedure, the work of the heart is restored. The patient is disconnected from the IC machine.
- After the restoration of the heart and the successful functioning of the shunt, the surgeoninstalls drains. The chest is closed. Doctors gradually sew up the tissue in the incision area.
The whole operation takes about 3-4 hours. After the intervention, the patient is left in intensive care. If no complications occur over the next day, the patient's condition gradually returns to normal, he is transferred to the ward for further observation.
The minimally invasive coronary artery bypass grafting technique is somewhat different. Access to the heart is through several punctures in the chest. To perform the operation itself, a thoracoscope is used. This is a miniature camera, the image from which is continuously transmitted to the computer monitor. After removing the defects and installing the shunt, the incisions are sutured and a sterile dressing is applied. The whole procedure takes no more than two hours.
Recovery period
After coronary artery bypass grafting, the patient is in intensive care, where primary rehabilitation begins. It involves the restoration of the work of the heart and lungs. This period lasts about 10 days. It is essential that the patient breathes properly during this time. Further recovery continues in a specialized rehabilitation center.
The stitches in the area of the breast incision are washed with antiseptic solutions to avoid suppuration. They are removed with successful wound healing on the seventh day. In these places, a burning sensation and even pain may appear, but you should not be afraid of it. After another 1-2 weeks you can take a shower.
Sternal bone usuallylasts a little longer. This period is up to 6 months. To speed up the process itself, this area should be given complete rest. For this purpose, chest bandages work well. To avoid venous stasis and thrombosis in the legs after coronary artery bypass surgery, it is recommended to wear compression stockings. You should also completely eliminate physical activity.
Due to blood loss during the intervention, the patient may experience anemia. It does not imply specific therapy. It is enough to eat a diet rich in foods with high levels of iron. In about a month, hemoglobin should return to normal.
After the operation, the patient will have to make efforts to restore proper breathing and prevent pneumonia. At first, you need to do special breathing exercises. During the procedure, a cough may appear, but you should not be afraid of it. To minimize discomfort, you can press the ball to your chest. Accelerates recovery by frequent changes in body position.
The logical continuation of rehabilitation after coronary artery bypass surgery is an increase in physical activity. When the patient ceases to be bothered by angina attacks, the doctor gives instructions on the necessary motor regimen. First, walking along the hospital corridors is recommended, then the load is increased. After some time, the restrictions are completely removed.
For the final recovery after discharge from the clinic, it is better to go to a sanatorium. After about 1-2 months, you can return to work. At the same time, the patient is givenload test. It allows you to evaluate the work of the heart. In the absence of pain and significant changes on the ECG during the test, the recovery is considered successfully completed.
Complications after surgery
Complications after coronary artery bypass grafting are extremely rare. They are usually associated with inflammation or swelling. Even less often, bleeding occurs at the site of the wound. Inflammation is accompanied by fever, weakness, discomfort in the chest and joints. It may be due to the body's autoimmune reaction, when its defense system reacts "incorrectly" to its own tissues.
Among other rare complications after coronary artery bypass surgery, doctors highlight:
- incomplete fusion of the sternum;
- stroke/heart attack;
- thrombosis;
- kidney failure;
- memory deterioration;
- keloid scars.
The risk of these problems depends on the state of he alth of the patient before surgery. To lower it, before the intervention, the doctor must evaluate all the factors that may adversely affect the course of the procedure. These include: smoking, obesity, physical inactivity, high blood pressure, diabetes and high cholesterol.
If a patient does not follow the doctor's recommendations during rehabilitation, does not take prescribed medications, ignores diet and exercise restrictions, a relapse is possible. It manifests itself in the form of the appearance of plaques and re-occlusion of a new vessel. As a rule, in such cases, the patient is denied bypass surgery.
Operation cost
Coronary artery bypass surgery is a high-tech procedure. Therefore, its cost is quite high. The final price depends on a combination of several factors: the number of shunts used, the complexity, the patient's state of he alth, and hospital stay. It should also be noted that the level of the clinic affects the cost of the operation. It can be carried out both in a regular cardiological hospital and in a private medical center. For example, in Moscow the price for this service varies from 150 to 500 thousand rubles. In foreign medical centers, the cost is much higher and can reach up to 1.5 million rubles.
Reviews from patients and doctors
Opinions of patients about the operation are extremely positive. After coronary artery bypass surgery, rehabilitation is almost painless. The likelihood of complications during this period is up to 6%. It is quite difficult to prevent the appearance of unpleasant consequences in the later stages. The average lifetime of shunts is 10 years. Approximately 70% of patients after surgery note the complete disappearance of signs of the disease, in the remaining patients, the intensity of disorders decreases significantly. Subject to the recommendations of doctors, it is possible to avoid the recurrence of atherosclerosis and the need for surgery in 85% of cases.
Medics also have positive feedback about coronary artery bypass graftingcoloring. After the procedure, the life of patients changes for the better. Their angina attacks disappear forever. Physical condition and working capacity gradually improve. The need for drugs is reduced to a preventive minimum. Thus, after coronary artery bypass surgery, the life of an ordinary he althy individual becomes available to a person.
