Most pathologies of the cardiovascular system pose a danger not only to he alth, but also to human life. With the ineffectiveness of conservative methods of treatment, the doctor evaluates the feasibility of the operation. In order to restore the blood supply to the affected area of the myocardium, aortocoronary or mammary coronary bypass grafting is prescribed. The difference between the methods lies in the fact that in the first case an additional vessel is created (bypassing the affected) from one's own vein. During mammary coronary bypass surgery, the mammary artery (internal thoracic) is used. Like any other treatment method, this method has its own characteristics, advantages and disadvantages.
Indications
Under the influence of various unfavorable factors, the lumen of the vessel that feeds one or another part of the myocardium narrows. As a result, the work of the heart muscle is disrupted and the process of formation of necrotic zones is started. For the purpose of restoringblood circulation in the affected areas, mammary coronary bypass grafting is prescribed.
Indications for surgery:
- Ischemic heart disease. Most often, patients have stenosis of the anterior interventricular branch (ALV). Mammary coronary artery bypass grafting is prescribed for people who are contraindicated for stenting or angioplasty.
- Atherosclerosis obliterans.
- Advanced angina pectoris, practically not amenable to drug treatment.
- Narrowing of the lumen of the coronary arteries by 70% or more.
- Myocardial infarction.
- Ischemic pulmonary edema.
- Post myocardial ischemia.
- Narrowing of the lumen of the left coronary artery by 50% or more.
- Past failure of angioplasty or stenting.
This is the main list of indications for mammary coronary bypass surgery. It can be extended following an individual consultation with a doctor. It is important to understand that the assessment of the feasibility of surgical intervention is carried out in each case. The doctor takes into account the age of the patient, his general state of he alth, the severity of the existing pathology.
Contraindications
Like any other method of surgical treatment, mammarocoronary bypass surgery has a number of limitations. Major contraindications for surgery:
- Congestive heart failure.
- Diffuse coronary artery disease.
- Availabilitymalignant neoplasms.
- Cicatricial tissue lesions that contribute to a sharp decrease in the left ventricular ejection fraction (by about a third).
- Kidney failure.
- Presence of chronic lung pathologies of non-specific etiology.
It is worth noting that old age is not a contraindication to the operation. But in this case, the doctor must consider all possible risks.
Advantages and disadvantages
The use of the mammary artery has a number of undeniable advantages. The benefits of shunting in this case:
- This vessel has a high degree of resistance to atherosclerosis.
- Mammary artery has no valves, it is not affected by varicose veins. In addition, it has a fairly large diameter, making it ideal for coronary bypass surgery.
- Artery walls have an endothelial layer. It synthesizes prostacyclin and nitric oxide, substances that help platelets fuse.
- The internal thoracic artery is able to increase in diameter, which allows you to increase the volume of incoming blood.
- Significantly improved left ventricular function.
- The mammary artery is more durable as a bypass.
- High patient survival rate.
- Significantly reduces the risk of relapses.
The disadvantage of the method is the large difference in the diameter of the internal thoracic and anterior interventricular arteries. Mammary coronary bypass grafting is complicatedand the fact that it is difficult to isolate the vessel that is planned to be used as a bypass.
Technique
In short, during the operation, myocardial revascularization is performed with the creation of an additional communication between the internal thoracic and coronary arteries. The left mammary vessel is used to create an anastomosis from this side. The right one is necessary to form a connection with the anterior descending artery.
Mammary coronary bypass surgery is performed according to the following algorithm:
- The doctor performs a median sternotomy, that is, provides access to the myocardium through the dissection of soft tissues.
- After that, the surgeon exposes the veins, subcutaneous tissue and the selected mammary artery. The next step is to tie up the side branches.
- At the point of origin, the doctor clamps the mammary artery. This prevents the development of spasm.
- The surgeon injects a weak solution of papaverine hydrochloride into the distal end. The free blood flow is then measured.
- The end of the anastomosis is released from the surrounding tissues. The surgeon then opens the coronary artery by making an incision 4 to 8 mm long. The next step is the anastomosis. The doctor does this with separate stitches or one continuous one.
The final stage is the suturing of tissues.
Post-operative period
Several days after the intervention, the patient stays in the hospital, where he is constantly monitored andregularly take biomaterial for research. At first, strict bed rest is shown. During this period, antibiotics and pain medications are prescribed.
Drainage system is removed on the first day after the operation. In addition, oxygen support also stops. A prerequisite is diet.
After a while, the patient is allowed to sit, stand up and take a few steps around the room. As you recover, exercise should increase and your diet should become more varied.
In conclusion
Mammary coronary bypass surgery is a method of surgical intervention, during which an additional vessel is created around the affected. This restores the normal blood supply to the myocardium. During the operation, mammary arteries are used, which serve as a bypass for a very long time.
