Coronary artery bypass grafting (CABG) is an operation prescribed in case of coronary heart disease. The narrowing of the lumen of the arteries supplying the heart with blood (stenosis), resulting from the formation of atherosclerotic plaques in them, is fraught with serious consequences for the patient. When the blood supply to the heart muscle is disrupted, the myocardium does not receive the amount of blood necessary for normal functioning, which ultimately leads to its damage and weakening. In this case, during physical activity, a person experiences angina (pain behind the sternum).
The most common pathology among all heart diseases is coronary heart disease (CHD). She spares neither women nor men. Lack of blood supply can lead to necrosis of part of the heart muscle - myocardial infarction, which threatens with the most severe complications, even death. Heart bypass surgery after a heart attackin order to eliminate its consequences, for the prevention of a heart attack, as well as in other clinical forms of coronary artery disease, it is prescribed if a positive effect has not been achieved with the help of conservative treatment. This is the most radical, but at the same time the most adequate method of restoring blood flow. In our article, we will tell you what coronary artery bypass surgery is and how to prepare for it.
What is the essence of the operation
CABG can be performed with multiple or with a single lesion of the arteries. During the operation, in those vessels where the blood flow is disturbed, shunts are created - workarounds. This is done by attaching he althy arteries to the coronary arteries. As a result, blood flow follows the site of blockage or stenosis. Bypassing the heart, therefore, allows for a full supply of blood to the heart muscle.
Preparation for surgery
No less important for the success of CABG than the professionalism of the surgical team is the positive attitude of a person towards a favorable outcome of treatment. This operation is not more dangerous than other types of surgical interventions, but it requires preliminary thorough preparation. First, as before any cardiac surgery, the patient is sent for an examination, which consists of an ECG, ultrasound, laboratory tests and tests, as well as an assessment of the general condition. You will also need to do angiography (ticoronarography). This diagnostic procedure makes it possible to determine the condition of the arteries supplying the heart muscle, to identify the exact locationplaque formation and the degree of narrowing. They conduct a study using X-ray equipment (an X-ray contrast agent is injected into the vessels, and then a picture is taken).
Part of diagnostic measures is carried out in a hospital, part - on an outpatient basis. A person is admitted to the hospital, as a rule, a week before the operation, at the same time, thorough preparation begins. One of its important stages is the development of a special breathing technique, which will be very useful later.
Operation
As already mentioned, coronary artery bypass surgery is performed with the aim of creating an additional bypass from the aorta to the artery with the help of a shunt, which will make it possible to bypass the blocked area and restore blood flow. Most often, the thoracic artery becomes a bypass because, due to its unique features, it has good resistance to atherosclerosis and has a long service life as a bypass. In some cases, the radial artery or saphenous vein of the thigh is used.
Heart bypass can be single, double, triple and so on. It depends on how many coronary vessels there is narrowing. By the way, it does not depend on the degree of manifestation of the disease. Thus, a patient with severe coronary artery disease may require only one shunt, and a person whose pathology manifests itself less - two or even three. The operation is performed on an open heart under general anesthesia, depending on the level of complexity, it can last three to six hours.
Three types of CABG
- Susing a heart-lung machine. If this option is used, then the patient's heart is stopped.
- On a beating heart. This method allows you to complete the operation more quickly and reduces the likelihood of complications, but requires a lot of experience from surgeons.
- Minimally invasive access (with or without a heart-lung machine). This is a relatively new technique that makes it possible to reduce blood loss during the intervention and reduce the risk of infectious complications. After such CABG, the patient recovers faster, the hospital stay is reduced to five to ten days.
It must be said that any heart surgery carries certain risks. However, thanks to modern equipment, sophisticated technology and wide application practice, they can be minimized. Cardiac bypass surgery has a very good performance in terms of positive results. The reviews of most people who have undergone such an operation are saturated with words of gratitude to the doctors. Nevertheless, the prognosis depends on the individual characteristics of the patient and the clinical picture of the disease.
Post-operative period
Immediately after surgery, a person is in intensive care, it is there that the primary restoration of the work of the lungs and heart muscle begins. It is very important that during this time the operated person breathes correctly. The period of stay in intensive care can be up to ten days, it depends on how the heart bypass was performed. Rehabilitation also begins in a hospital, and then continues in a rehabilitation center. The sutures on the chest and where the material for the shunt was taken from are washed with antiseptics to avoid decay and contamination. They are removed somewhere on the seventh day, if the wounds have successfully healed.
Rehab
In places where there were stitches, pain and burning will be felt for some time. When the wounds have healed somewhat (after one to two weeks), the patient is allowed to take a shower. The healing of the sternum bone will take more time - four to six months. You can wear a chest brace to speed up this process. In the first four to seven weeks, special elastic stockings must be worn on the legs to prevent swelling. At this time, you should save yourself from intense physical activity.
Due to blood loss that occurred during the operation, a person may develop anemia. However, no special treatment is required in this case. It is enough just to follow a diet, which is based on the use of foods containing a large amount of iron, and after a month the hemoglobin level will return to normal. The patient will have to make an effort to restore normal breathing. For this, special breathing exercises should be carried out, which he was taught even before surgery. They can also help prevent pneumonia.
Cough after heart bypass. You shouldn't be afraid of it. Coughing is an essential part of rehabilitation. It can be alleviated bypressing the palm or ball to the chest. Frequent changes in body position will speed up the healing process. Doctors usually explain how to turn and when it is necessary.
Rehabilitation is accompanied by a gradual increase in physical activity. When the patient stops angina attacks, he is prescribed the required motor regimen. First, a person is allowed to walk short distances (up to one kilometer per day) along the hospital corridor, then gradually the load increases, and after some time, almost all restrictions are removed.
After discharge
People who have undergone heart bypass surgery are advised to visit a sanatorium after the end of inpatient treatment. After one and a half to two months, you can return to work. At the same time, a stress test should be performed to assess the patency of the imposed bypass shunts and see how well the heart is being supplied with oxygen. If there are no changes on the ECG, the patient does not experience pain during the testing process, then the recovery can be considered successful.
Heart bypass: price
The operation is high-tech, therefore it has a rather high cost, which depends on the required number of bypasses, the method of intervention, the current state of the patient's he alth, the degree of comfort that will be provided after CABG. Another important price criterion is the level of the clinic where heart bypass surgery will be performed. Of course doan operation in a regular cardiological hospital will be cheaper than in a specialized private clinic. On average, in Moscow the cost of CABG fluctuates between 150-500 thousand rubles, in Israel - 23-30 thousand dollars, in German clinics the price for such an operation starts from 25 thousand euros.
Heart bypass surgery: patient feedback
Many people report that recovery from CABG is difficult. Patients experience difficulty breathing, especially at night. Some say that for some time they were forced to sleep half-sitting. But after some time, people stop feeling pain behind the sternum, after about a month there is a significant improvement in the condition, and this trend continues. Patients who underwent surgery a few years ago say they feel good, on a par with he althy people. Some complain that they had to reconsider their lifestyle, quit smoking, diet. But in general, all people should give up bad habits, and not just those who have undergone heart surgery.
In conclusion
In certain cases, only surgery can save a life. Heart bypass surgery done in time can prevent a heart attack and its serious consequences, return a person to full-fledged activity. Stay he althy!
