Ischemic heart disease is a real scourge of the 21st century. Almost every second person suffers from this disease. Some can treat this disease with medication, but for some, surgical intervention is vital. One of the main operations that restores blood flow in the vessels of the heart is coronary bypass surgery.
What is this?
This term began to appear in many medical sources for quite a long time. Currently, this operation is practically the only one of its kind. According to statistics, around a million such interventions are performed annually worldwide.
As stated, most coronary patients require coronary bypass surgery. What it is, unfortunately, few know.
Coronary artery bypass grafting involves the imposition of detours on the vessels of the heart.
The operation is extensive and rather difficult.
According to statistics, this operation is carried out only by 12 percent of all those who need it. Some havecontraindications to its implementation, while others do not always seek medical help.
As soon as the operation appeared, many eminent scientists showed considerable interest in it, however, two years after its creation, the operation was banned. It was re-implemented only a few years later, when this operation began to appear in world publications. Since then, its use has become almost everyday, and many doctors do not see any other way to cure coronary artery disease, except for this operation.
Pathogenesis of IHD
Ischemic heart disease develops when the coronary vessels begin to experience oxygen deficiency. This is due to the narrowing of their lumen. There are many reasons leading to narrowing - ranging from congenital malformations and pathological narrowing from birth to a decrease in the lumen due to the growth of atherosclerotic plaques.
Normally, CHD symptoms do not manifest themselves until the lumen is narrowed by more than 70 percent. The clinic can only appear in case of significant physical activity.
The main signs of coronary artery disease are chest pain, accompanied by shortness of breath and a feeling of fear. With a significant narrowing of the coronary vessel, the risk of developing a heart attack increases.
If conservative therapy (taking vasodilator drugs) fails, coronary artery bypass surgery is performed.
Progress of operation
The operation is performed on an open heart, i.e. it is necessaryopen the chest. The incision is usually made along the left costal cartilage.
The patient is connected to a heart-lung machine during the intervention.
The operation is performed under general anesthesia.
To create a shunt, usually superficial vessels are used (saphenous vein of the leg or internal thoracic artery). The resulting shunt, after its removal, is placed above and below the level of the narrowing of the coronary artery and sutured inside the vessel. This facilitates blood flow through the affected artery and allows you to remove myocardial ischemia.
In some cases, a radial artery transplant is used, as the blood flow through the arteries is much better.
Currently, more tend to perform operations without the use of cardiopulmonary bypass, since the passage of blood through this machine contributes to damage to red blood cells and hemolysis.
Indications for surgery
Coronary artery bypass grafting is indicated in the following cases:
- Reduction of blood flow through the left coronary artery by at least 50 percent. This vessel is the main one in the nutrition of the myocardium. Most of the blood goes through it, which is why a block at the level of this vessel is fraught with severe ischemia and myocardial infarction.
- Reduction of the lumen of all coronary vessels up to 70 percent.
- Presence of stenosis of the anterior interventricular artery (especially at the site of its bifurcation).
These indications are essential for coronary bypass surgery.
In addition to them, side, symptomatic indications can be distinguished. They are caused by frequent attacks of angina pectoris (pain, a feeling of pressure in the chest) and are usually stopped by medication. However, the problem becomes more serious when drug therapy loses its effectiveness and seizures become more frequent. It is in this case that the question of shunting should already be raised.
Contraindications
Thanks to the widespread use of information technology, learning about coronary bypass surgery - what it is, what its indications - is not difficult. Everything is somewhat more complicated with contraindications.
Unlike indications for surgery, all contraindications are relative, since each patient should consider surgery based on his specific data.
It was believed that the age of the patient, especially over 70 years old, is a prohibitive factor for intervention. Currently, many older patients tolerate cardiac intervention well (this is due to the absence of concomitant chronic diseases that affect hemodynamics). For those who have such diseases, doctors are more inclined to transplant the heart and blood vessels (if there are no decompensated conditions).
Previously, coronary artery bypass grafting was not performed in case of renal failure or active oncological process. Now you can find information aboutquite successful interventions in such patients with a favorable outcome and prolongation of life by more than 10 years.
Patient rehabilitation
Because the operation is quite extensive and difficult, the proper management of patients undergoing coronary artery bypass grafting is of no small importance. After surgery, complications such as impaired ventilation of the lungs (due to the patient being on a ventilator for a long time) and infectious complications often develop.
Prevention of respiratory disorders is carried out by inflating a balloon or a special toy. It is more difficult to prevent the development of infectious complications - not always a thorough and timely change of dressings helps to prevent the infectious process.
Be sure to monitor the patient's blood counts, as due to the massiveness of the operation, significant blood loss can often be observed. In this case, the patient simply needs a blood transfusion to make up for its lack.
All patients who underwent this operation - coronary bypass surgery - must undergo a long rehabilitation period and avoid stress. This is done in order to prevent the divergence of metal staples placed on the sternum.
Patient opinions about surgery
More and more patients undergo intervention on the vessels of the heart. If you look at various sites and forums dedicated to this problem, you can see that many people who have undergone coronary bypass surgery have quite positive reviews. The quality of life is greatly improved, and many patients can return to full activity (only after a period of rehabilitation). The number of angina attacks is reduced, which significantly affects daily activities.
Many people wonder how much this operation costs?
It all depends on the state of he alth of the patient at the time of determining the indications for surgery. If you are indicated for coronary artery bypass surgery, the price will be made up of factors such as the amount of intervention, the qualifications of the operating surgeon, but almost all such operations are performed free of charge. Money for their implementation is allocated by the state budget (in private clinics, the cost of the operation ranges from 7 to 10 thousand dollars, which is quite expensive).
Should this operation be done?
Many patients with long-term angina are indicated for coronary bypass surgery. Few know what it is, which is why they definitely need a detailed explanation from the doctor. Some are frightened and refuse the operation, since the procedure is quite complicated and difficult, and the risk of complications is extremely high. Others deliberately take risks, realizing that without intervention, things can turn out much worse.
Whether it is worth doing the operation is a purely individual choice. However, if the operation is indicated, then it is better to carry it out, since with a favorable outcome (lethality during the operation is less than 2 percent), the condition and quality of life significantly improve.
