What is bypass surgery. Is this operation worth it? Reconstruction of the bones of the sternum
Bypass is an operation on the vessels, it was first performed in the late 60s by two cardiac surgeons from Cleveland - Favoloro and Efler.
What is shunting?
Shunting (eng. shunt - branch) is an operation that consists in the fact that physicians create an additional path for blood flow to bypass a section of a vessel or organ using a system of shunts (grafts). Bypass surgery is done to restore normal blood flow in the vessels (heart, brain) or restore the normal functioning of an organ (stomach).
What are the types of shunting?
Shunting of the blood vessels of the heart- the introduction of a transplant around the affected area of the vessel. Vascular grafts (shunts) are taken from the patients themselves from the internal mammary artery, the great saphenous vein in the leg, or the radial artery in the arm.
Gastric bypass is a completely different operation: the organ cavity is divided into two parts, one of which is connected to the small intestine, which is responsible for the absorption of nutrients. Thanks to this operation, part of the stomach becomes unused in the process of digestion, so the body is saturated faster, and the person quickly loses extra pounds.
During gastric bypass surgery, the surgeon does not remove anything, only the shape of the gastrointestinal tract is changed. The purpose of gastric bypass surgery is to correct excess weight.
Shunting of the arteries of the brain is a surgical operation aimed at restoring blood flow in the vessels of the brain. Brain bypass surgery is similar to heart bypass surgery for coronary artery disease. A vessel that is not involved in the blood supply to the brain is connected to an artery located on its surface.
The result of the operation is the redirection of blood flow around the clogged or narrowed artery. The main goal of bypass surgery is to restore or preserve the blood supply to the brain. Prolonged ischemia leads to the death of brain cells (neurons), which is called cerebral infarction (ischemic stroke).
For what diseases is shunting performed?
The presence of cholesterol plaques in the vessels (atherosclerosis). In a healthy person, the walls of blood vessels and arteries are a smooth surface without any barriers and constrictions. In a person with atherosclerosis, there is a blockage of blood vessels due to cholesterol plaques. If the disease is started, it can lead to the necrosis of tissues and organs.
Cardiac ischemia. The traditional case of bypass surgery is coronary (ischemic) heart disease, in which the coronary arteries that feed the heart are affected by cholesterol deposits in the bloodstream of the vessel. The main symptom of this disease is the narrowing of the lumen of the vessels, which leads to an insufficient supply of oxygen to the heart muscle. In such a situation, there are often complaints of pain behind the sternum or in the left half of the chest, the so-called angina pectoris or angina pectoris.
The presence of excess weight. A shunt inserted into the stomach divides it into large and small. The small intestine is connected to the small intestine, as a result of which the volume of food eaten and the absorption of nutrients are significantly reduced.
Violation of blood flow in the vessels of the brain. Insufficient blood supply to the brain (ischemia) can be both limited and global. Ischemia disrupts the ability of the brain to function normally and, when neglected, can lead to tumors or brain infarction. Treatment of cerebral ischemia is carried out by a neurologist in a hospital with the help of medications (vasodilators, drugs against blood clots and blood thinners, nootropic drugs to improve brain function) or through surgery (in the later stages of the disease).
Results of coronary artery bypass surgery
Creation of a new section of the vessel in the process of shunting qualitatively changes the patient's condition. Due to the normalization of blood flow to the myocardium, his life after heart bypass surgery changes for the better:
- The attacks of angina pectoris disappear;
- The risk of a heart attack is reduced;
- Improves physical condition;
- Work capacity is restored;
- The safe volume of physical activity increases;
- Reduces the risk of sudden death and increases life expectancy;
- The need for medicines is reduced only to a preventive minimum.
In a word, after CABG, the normal life of healthy people becomes available to a sick person. Reviews of cardioclinic patients confirm that bypass surgery returns them to a full life.
According to statistics, in 50–70% of patients after surgery, almost all disorders disappear, in 10–30% of cases the condition of patients improves significantly. New blockage of blood vessels does not occur in 85% of those operated on.
Of course, any patient who decides to undergo this operation is primarily concerned with the question of how long they live after heart bypass surgery. This is a rather complicated question, and no doctor will take the liberty of guaranteeing a specific period. The prognosis depends on many factors: the general health of the patient, his lifestyle, age, the presence of bad habits, etc. One thing is for sure: a shunt usually lasts about 10 years, with younger patients having a longer lifespan. Then a second operation is performed.
Life after
A person who has passed the edge of danger and stayed alive understands how long he will have to live on this earth after the operation depends on him. How do patients live after surgery, what can we hope for? How, how long will shunting take to life?
There can be no unequivocal answer, due to the different physical condition of the body, the timeliness of surgical intervention, the individual characteristics of a person, the professionalism of surgeons, and the implementation of recommendations during the recovery period.
In principle, the answer to the question: “How long do they live?” There is. You can live 10, 15 or more years. It is necessary to monitor the condition of shunts, visit a clinic, consult a cardiologist, get examined on time, follow a diet, and lead a calm lifestyle.
Important criteria will be character traits of a person - positivity, cheerfulness, efficiency, desire to live.
Sanatorium treatment
After surgery, restoring health is indicated in specialized sanatoriums under the supervision of trained medical personnel. Here the patient will receive a course of procedures aimed at restoring health.
Diet
A positive result after surgery depends on many reasons, including adherence to a special diet. Heart bypass surgery is a serious intervention in the life of the body, and therefore has certain obligations that the patient must fulfill, these are:
- doctor's recommendations;
- to withstand the regime of the recovery period in intensive care;
- complete rejection of bad habits like smoking and alcohol;
- refusal of the usual diet.
When it comes to dieting, don't worry. The patient moves away from the usual homemade food and proceeds to the complete exclusion of foods containing fats - these are fried foods, fish, butter, margarine, ghee and vegetable oils.
After surgery, it is recommended to include more fruits and fresh vegetables. Every day you should take a glass of freshly squeezed orange juice (fresh). Walnuts and almonds will brighten up the diet with their presence. Any fresh berries will not interfere, blackberries are especially useful for the heart, supplying antioxidants to the body. These elements lower the level of cholesterol coming from food.
Do not eat full-fat dairy products, except for skimmed milk and low-fat cheeses. It is recommended no more than 200 grams of kefir per day, but low-fat. After the operation, Coca-Cola, Pepsi, sweet soda are excluded. Filtered water, mineral water will be used for a long time. In small quantities, tea, coffee without sugar or sucrose are possible.
Take care of your heart, take more care of it, observe the culture of proper nutrition, do not abuse alcoholic beverages that will lead to the development of cardiovascular diseases. Complete rejection of bad habits. Smoking, alcohol destroy the walls of blood vessels. Implanted shunts "live" no more than 6-7 years and need special care and attention.
Operation cost
Such a modern and effective method of restoring blood flow that supplies the heart muscle, like coronary artery bypass grafting, has a rather high cost. It is determined by the complexity of the operation and the number of bypasses, the patient's condition and the quality of rehabilitation that he expects after the operation. The level of the clinic in which the operation will be performed also affects how much the bypass surgery costs: in a private specialized clinic, it will cost clearly more than in a regular cardiology hospital. You will need a lot of money for coronary artery bypass grafting - the cost in Moscow fluctuates within 150,000-500,000 rubles. When asking about heart bypass surgery, how much it costs in clinics in Israel and Germany, you will hear the numbers are much higher - 800,000-1,500,000 rubles.
| Consultation with a cardiologist (highest category) | 1000,00 |
| Consultation with a cardiologist (associate professor, PhD) | 1500,00 |
| Consultation with a cardiologist (MD) | 2000,00 |
| Consultation of a surgeon (highest category) | 1000,00 |
| Consultation of a surgeon (associate professor, Ph.D.) | 1500,00 |
| Consultation of a surgeon (MD) | 2000,00 |
| Anastomosis to the coronary vessels (coronary bypass surgery without the use of a heart-lung machine - with the cost of consumables) | 236400,00 |
| Anastomosis to coronary vessels (coronary bypass surgery using a heart-lung machine - with the cost of consumables) | 196655,00 |
| Anastomosis to the coronary vessels (coronary bypass surgery using a heart-lung machine with low ejection fraction or left ventricular aneurysm - with the cost of consumables) | 242700,00 |
| Anastomosis to coronary vessels (coronary bypass surgery using a heart-lung machine with prosthetics of 1 heart valve - with the cost of consumables) | 307800,00 |
| Anastomosis to the coronary vessels (coronary bypass surgery using a heart-lung machine with prosthetics of 2 heart valves - with the cost of consumables) | 373900,00 |
| Anastomosis to the coronary vessels (coronary bypass surgery without the use of a heart-lung machine and a myocardial stabilization system - with the cost of consumables) | 80120,00 |
| Anastomosis to the coronary vessels (coronary bypass surgery without the use of a heart-lung machine and a myocardial stabilization system - without the cost of consumables) | 45000,00 |
| Anastomosis to the coronary vessels (coronary bypass surgery using a heart-lung machine - without the cost of consumables) | 60000,00 |
| Anastomosis to the coronary vessels (coronary bypass surgery without the use of a heart-lung machine - without the cost of consumables) | 75000,00 |
| Anastomosis to the coronary vessels (coronary bypass surgery using a heart-lung machine for low ejection fraction or aneurysm of the left ventricle - without the cost of consumables) | 90000,00 |
| Anastomosis to coronary vessels (coronary bypass surgery using a heart-lung machine with prosthetics of 1 heart valve - without the cost of consumables) | 105000,00 |
| Anastomosis to the coronary vessels (coronary bypass surgery using a heart-lung machine with prosthetics of 2 heart valves - without the cost of consumables) | 120000,00 |
| Coronary angiography (without the cost of consumables) | 9500,00 |
| Balloon intra-aortic counterpulsation (without the cost of consumables) | 4000,00 |
| Balloon intra-aortic counterpulsation (with the cost of consumables) | 42560,00 |
Coronary artery bypass grafting for heart attack, coronary heart disease is the only reliable way to treat the final stages of the disease and its acute manifestations. With the help of modern technologies, such an operation continues the patient's life for decades.
Indications
Cholesterol, accumulating in the tissues of the body, is deposited in the heart vessels and clogs them. This is the cause of atherosclerosis of the coronary arteries, which leads to coronary heart disease.
Cardiac tissues are supplied with food and oxygen by the coronary vessels. It is inside them that cholesterol is deposited in the form of plaques that form blood clots. With the development of the disease, the throughput decreases, the lumen inside the vessels becomes thinner.
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A neglected disease, untimely adoption of the necessary therapeutic measures threaten with serious consequences up to myocardial infarction and. Causes the most serious consequences.
If the blood flow and nutrition of the heart muscle is disturbed, an insufficient volume of blood enters it, anomalies in its functioning occur, and with a significant vasoconstriction, death of heart cells occurs.
With vascular thrombosis in a patient with a mild form of the disease and in its initial stages, pain occurs in the thoracic segment - symptoms. It is especially evident during physical stress.
The worst case is a heart attack - the death of an accumulation of myocardial cells, which threatens the patient with death. The situation will be corrected by shunting in case of a heart attack.
Therapeutic therapy for ischemia is aimed at eliminating these consequences.
The following methods are used for this:
Indications for the operation:
- critical narrowing of the left artery;
- thrombosis of all or part of the coronary arteries;
- myocardial infarction.
CABG can completely eliminate the symptoms of the disease. This is the most effective, albeit radical, method of treatment.
How do they do
Cardiac bypass surgery is effective in the vast majority of cases: when one or all vessels malfunction.
Briefly, what is heart bypass surgery after a heart attack: suturing vessels taken from the patient's body, acting as new pathways for feeding heart tissue, parallel to arteries with impaired functionality. New channels of nutrition of cardiac tissues are called "shunts".
The principle of the operation is to direct blood flow along new pathways-vessels that bypass blocked segments or areas of stenosis. This is achieved by suturing one end of the vein to the aortic and the other to the arterial opening.
Shunts are created from segments of the functional vessels of the patient's body. Usually they are taken from the limbs, as there are veins and arteries with considerable length. An artery located in the chest is also used. Its peculiarity is that it already has a connection with the aorta, the surgeon only needs to connect its end to the cardiac artery.
The tasks of CABG: the resumption of normal blood flow, the establishment of healthy nutrition of the myocardium.
Kinds
Depending on the complexity of the pathology, on how many vessels of the patient blockages have formed, several types of operations are distinguished.
Bypass surgery for a heart attack has the following types, depending on the number of treated vessels:
- single;
- double;
- triple or more.
Each affected vessel is duplicated by its own separate shunt. The state of the body is not a determinant of the number of shunts to be implanted: with severe forms of coronary artery disease, a single bypass can be done, and for an unexpressed degree of the disease, triple manipulation is sometimes required.
Varieties of CABG, depending on the work of the heart in its process:
Preparation
Before the operation, a complete examination of the patient's body is carried out:
- All standard tests, studies (complete blood, urine, etc.), as well as additional ones prescribed by a doctor.
- Complete examination of the cardiac (ultrasound, ECG), circulatory system.
- Detailed assessment of the patient's condition.
- Angiography (coronography). Its task is to determine which vessels are clogged, the size of the plaques. The procedure is carried out using an x-ray machine, a contrast agent is injected into the arteries, visible on x-rays.
Some of the studies are done on an outpatient basis, some are inpatient. The patient enters the hospital 7 days before the procedure, where the main preparatory actions are carried out for it. The patient is taught special breathing techniques, they need to be applied in the postoperative period.
Rehabilitation
The operated person, in addition to what is heart bypass surgery after a heart attack, needs to know about the importance of rehabilitation therapy. This is the first priority after the USC.
Immediately after surgery, the operated person is transferred to the intensive care unit. The functions of the lungs and myocardium are restored there. The person undergoing surgery needs to resume proper breathing. The period of stay in intensive care is up to 10 days.
After the end of the primary rehabilitation in the hospital, rehabilitation therapy continues in the special conditions of the rehabilitation center.
During the rehabilitation period of wound healing, the patient is prescribed to wear elastic bandages or stockings on the limbs. This will help eliminate venous congestion, vascular thrombosis. A bandage or corset is applied to the chest area. During the recovery period, strong physical exertion is prohibited.
Changing body positions at the correct intensity allows you to speed up the rehabilitation process. The doctor should acquaint the patient with how to lie correctly, transfer the weight of the body to the side.
Rehabilitation measures are considered completed upon successful completion of the stress test. It is carried out 2–3 months after surgery, on the basis of which the functionality of the transplanted bypasses, the quality of blood flow, and the level of oxygen supply to the heart tissues are evaluated. The test is considered passed if there is no pain, ECG changes.
Seam tightening
There are sutures on the patient's body in two places:
- where the shunt material was taken for transplantation (on the limbs);
- on the chest, at the site of the bypass.
To tighten the seams, the usual procedures in such cases are used:
- dressings;
- regular washing with antiseptics.
The task of the procedures is to avoid suppuration.
With normal, normal wound healing, the sutures are removed after a week. Burning, as well as moderate pain in the places of incisions, indicate a normal healing process, they disappear after a while. Usually after 7-14 days, when the wounds heal more strongly, the patient can take a shower.
Bones of the sternum
The healing period of the sternum bones is 4-6 months. This area requires rest for recovery: sudden movements, physical exertion on the chest area interfere with healing.
The necessary conditions help to provide special chest bandages, which are applied in a special way. The doctor may also consider it necessary to prescribe the wearing of a special corset.
Breath stabilization
Breathing is given special attention, as it is associated with the work of the heart. After the operation, this function needs to be restored, because the body "forgets" how to breathe properly.
Particular attention should be paid to pneumonia, inflammatory processes of the respiratory tract, lung diseases.
Almost immediately after the operation, the patient should apply the breathing exercises that he was taught during the preparatory period.
Coughing is a common occurrence after surgery, this is normal and the patient does not need to be afraid of this symptom. To facilitate coughing, it is recommended to press your palms or a ball to your chest.
Physical exercise
The rehabilitation period is accompanied by gradually increasing physical activity. Symptoms of angina pectoris, pain in the thoracic region, respiratory disorders should disappear with time.
As the patient recovers, gradually increasing motor activity is prescribed, and over time, physical exercises are increased until the body is fully restored.
The restoration of physical activity begins with walking along the corridors of the hospital or nearby territory at a distance of up to 1 km per day with a small rhythm of steps.
Loads gradually gain intensity, and after a certain period of time, the restrictions imposed on the mode of physical activity are removed in full.
Sanatoriums
The operated person will be able to engage in a full-fledged labor activity one and a half to two months after the surgical intervention.
Possible Complications
An infarction of the anterior wall of the heart or its posterior wall, together with subsequent CABG, greatly weakens the body.
Due to blood loss during surgery, short-term anemia may occur. It disappears over time - it is enough to provide the convalescent with nutrition with the necessary amount of iron and vitamins.
Complications occur infrequently, these are, for the most part, swelling or inflammation. Less often - bleeding from a wound, infectious complications.
Symptoms of inflammation: fever, joint aches, pain in the chest segment, weakness, abnormal heart rhythm. The provoking factor of inflammatory phenomena is the body's autoimmune reactions to engraftment of its own tissues.
In rare cases, the following complications are observed: stroke, thrombosis, improper fusion of the bone tissues of the sternum, heart attack, amnesia, keloid scar tissue, kidney disease, postperfusion syndrome, pain effects at the site of surgery.
Their occurrence depends on the preoperative state of the operated. It is important for the surgeon to analyze the general condition of his body in order to determine and predict the possible consequences of the intervention.
The risk of complications is increased by the following factors:
- smoking;
- excess weight;
- hypodynamia;
- high blood pressure;
- kidney disease;
- diabetes;
- the body's tendency to accumulate cholesterol.
The patient's behavior - non-compliance with prescriptions, termination of recommended procedures, diet violations, heavy loads, etc. - can itself become the cause of negative phenomena.
Separately, it should be said about relapses. In an organism prone to accumulation of cholesterol, the appearance of new plaques continues, blockages of already new bypass vessels (restenosis) are created, then stenting of these vessels is done - a new operation is not required. To exclude relapses, it is important to follow a diet, limit salt, fats, and sugar in the diet.
Results of heart bypass surgery after a heart attack
Successful shunting after a heart attack suggests the following consequences:
- normalization of cardiac blood flow and myocardial nutrition;
- disappearance of angina attacks;
- reduction ;
- ability to work is restored;
- improves well-being;
- the degree rises;
- life expectancy increases, the risk of sudden death decreases;
- drug therapy is stopped, except for the prophylactic minimum of drugs.
After CABG, the patient leads normal, full-fledged activities, with the exception that diet and a healthy lifestyle must be followed to avoid relapses. The first requirements for excluding the recurrence of coronary disease are to forget about and.
Almost all symptoms of the disease disappear in 70% of those who underwent surgery, in 85% of cases, re-occlusion of blood vessels does not occur in those who underwent surgery, the condition of a third of patients improves immediately. The average service life of a shunt is 10 years (more in young patients), after its expiration, a second operation is required.
Price
The cost of coronary artery bypass grafting, given the complexity of the operation, is quite high.
The price is determined by several factors: the complexity, the number of shunts, the use of high-quality medicines and equipment, the patient's condition, rehabilitation measures, the necessary additional preparatory actions, the conditions of the clinic, and the level of its prestige.
In Moscow clinics, the price of the operation ranges from 150 thousand to 500 thousand rubles. The higher the price, the more prestigious the clinic. In Israel, Germany, such an operation will have to pay from 800 thousand to one and a half million rubles.
Recently, more and more physicians reveal cardiac pathologies. Not always people, feeling unwell, rush to visit polyclinics. Many simply do not have enough time, others are afraid to hear about the presence of any disease, thereby exacerbating the situation.
When the symptoms of the disease are already very noticeable and chest pains become unbearable, this means that the disease is progressing. In this case, after the diagnosis, most likely the doctor will prescribe not medical treatment, but surgical. Cardiac bypass is done to direct blood flow around the affected areas.
Remember that this is a surgical intervention and any consequences are possible. Also, during the rehabilitation period, you should follow all the recommendations of the attending physician and diet. If you have been prescribed a heart bypass, you need to understand what it is, what complications can be, how to prepare for the operation and how to behave after it.
A bit of history
What is heart bypass
Until the first half of the 20th century, patients with coronary heart disease could only be treated with drugs, and those people whom they stopped helping were doomed to disability and death.
It was only in 1964 that the first surgical intervention for coronary artery bypass grafting was developed and carried out. It is pleasant to realize that a Russian, Leningrad professor and cardiac surgeon Kolesov Vasily Ivanovich, has become a pioneer.
Unfortunately, already in 1966, at the All-Union Congress of Cardiologists, it was decided to ban this dangerous operation.
Kolesov indulged in all kinds of persecution, but the situation changed radically after the world scientific community became interested in this revolutionary method of treating coronary vessels. Extensive research and development has improved this technique and reduced the number of complications.
Coronary artery bypass grafting has been constantly modernized, and the rates of successfully operated patients have constantly increased. And again, it was thanks to the efforts of our compatriot scientists that doctors managed to cut the intervention time in half.
Now saving the life of a patient with coronary heart disease can be performed in 4-6 hours (depending on the complexity of the clinical case).What is heart bypass surgery: description
Coronary artery bypass grafting (CABG) is an operation, the essence of which is to create anastomoses (bypass routes), bypassing the coronary arteries of the heart affected by atherosclerosis. The first elective CABG was performed in the USA at Duke University back in 1962 by Dr. Sabist.
Currently, hundreds of thousands of coronary artery bypass grafting operations have been performed in the world, and in many clinics they have become commonplace. Even 10-15 years ago, in order to be operated on, it was necessary to go to Europe or the Baltic states, and the cost of such an operation was simply prohibitive.
No one says that CABG is cheap, but nowadays most patients are able to find the means, especially if it is a matter of life and death.
As for the indications for CABG, they are quite obvious and are determined after the examination, including the mandatory coronary angiography, a procedure that allows you to determine the condition of the vessels supplying the heart.
There is a lot of controversy over when coronary artery bypass grafting should be preferred over stenting, but there are undeniable points when the benefits of CABG are greater than those of stenting:
- Angina pectoris of a high functional class - i.e. one that does not allow the patient to perform even everyday activities (walking, toileting, eating) if there are contraindications to stenting.
- The defeat of three or more coronary arteries of the heart (determined by coronary angiography).
- The presence of an aneurysm of the heart against the background of atherosclerosis of the coronary arteries.
Currently, CABG is equally performed both on a beating heart and under cardiopulmonary bypass. When performing coronary artery bypass surgery on a beating heart, the risk of surgical complications is much lower compared to surgery on an inactive heart, but it is also more complicated.
There is also an opinion that if CABG is performed on a beating heart, then the quality of the workarounds performed suffers. That is, in terms of long-term results, surgery on a beating heart may give worse results compared to surgery on a non-working heart.
To create bypass shunts, the veins of the patient's legs, as well as the internal thoracic artery, are used; a person can do without these vessels.
Artery shunts are much more durable and reliable than vein shunts. So, about 10% of venous bypasses close in the first month after CABG, another 10% - during the first year, and about 10% - in the next 6 years after bypass surgery.
Compared to arterial shunts, more than 95% of anastomoses continue to function after 15 years, but it is not always technically possible to use arterial shunts only. If the CABG operation ends favorably, and this is the vast majority of cases, then the patient will face a difficult stage of rehabilitation.
However, all the inconveniences during this period disappear after a few months, and the benefits of coronary artery bypass surgery in the form of the disappearance of angina pectoris become obvious.2-3 months after CABG, a VEM stress test or Treadmill test is recommended. These tests help determine the status of shunts and blood circulation in the heart. CABG surgery is not a panacea and does not guarantee stopping atherosclerosis and the growth of new plaques in other arteries.
Even after coronary artery bypass grafting, all principles of coronary heart disease treatment remain unchanged. CABG is carried out with only one goal - to save the patient from angina pectoris and reduce the frequency of his hospitalization due to the exacerbation of the process.
For all other criteria, such as, for example, the risk of re-infarction and death within 5 years, the indicators are comparable both with coronary artery bypass grafting, and with stenting or conservative treatment.
There are no age restrictions for CABG, only the presence of concomitant pathology that limits the abdominal operation matters. In addition, if coronary artery bypass surgery has already been performed previously, the risk of complications in case of repeated CABG is much higher, and such patients are rarely taken for a second operation.
What is the operation for?
Stenting of the heart vessels and coronary artery bypass grafting are the most modern methods for restoring vascular patency. They are carried out in different ways, but have the same high result.
Lack of oxygen in atherosclerosis can lead to tissue necrosis and cause myocardial infarction in the future. Therefore, in the absence of the effect of drug treatment, it is recommended to install shunts on the heart. The indication for this operation may be coronary disease, atherosclerosis and myocardial aneurysm.
Such treatment as CABG does not pose a danger to human life and helps to reduce the mortality rate from cardiovascular pathologies by several times.
Before the operation, the patient must undergo thorough preparation and pass the necessary tests. The elimination of negative factors such as smoking, diabetes, high blood pressure, etc. will help reduce the risk of complications during surgery and in the postoperative period.
CABG is performed on several vessels at once or only on one, depending on the individual pathology. The rehabilitation period after coronary artery bypass grafting will be greatly facilitated by a special breathing technique, which the patient must master even before the start of the operation.
Shunting of the vessels of the lower extremities helps to restore blood circulation in the absence of the effectiveness of the standard treatment method. Since this surgical intervention is considered the most dangerous and very difficult, the operation should be carried out by a professional surgeon with modern equipment.
Rehabilitation after heart bypass surgery takes place in the first days in the intensive care unit, so that it is possible to carry out emergency resuscitation measures if necessary.The presence or absence of negative consequences depends on how long the patient will stay in the hospital, and how the body will recover. Also, the recovery process depends on how old the patient is and on the presence of other diseases.
Tip: Smoking increases the risk of coronary heart disease by several times. Therefore, you can get rid of complications after installing a coronary artery bypass graft if you quit smoking once and for all.
After determining the treatment regimen by a cardiologist and a rheumatologist, the patient is hospitalized in a hospital, where all the necessary preoperative studies are carried out in 2-3 days:
- ECHO-KG (to assess the work of the heart muscle);
- urine and blood tests (to study general indicators and exclude or confirm other diseases and latent inflammatory processes);
- angiography (to visualize the circulatory system of the heart and locate the exact location of the obstruction);
- CT and MRI (in order to see the layered image of the arteries and assess how much the nearest tissues have already suffered);
- studies of the circulatory system of shunt sampling sites (lower and upper limbs, sternum);
- a decision is made - how many shunts, and from which places will be taken.
Additionally, other types of examinations may be prescribed. In addition, the hospital staff will explain in detail how to behave immediately after the operation (breathing exercises, coughing technique, etc.). Also, the anesthesiologist and the attending physician will give detailed information about the course of the upcoming coronary artery bypass grafting - how long the operation takes, possible complications, how many bypasses will be taken, etc.
On the eve of the operation, the patient can only eat liquid food, and 6-8 hours immediately before the intervention, in general, it is forbidden to eat or drink anything.
Conventionally, there are three options for aortocoronary bypass grafting (CABG):
- 1 - single;
- 2 - double;
- 3 - triple and so on.
With this or that type of operation, the choice made is determined only by the extent of the vascular lesion: if only one artery does not function and only one shunt is required, then this is a single type bypass, two arteries are blocked - double, and three - respectively triple heart bypass.
With coronary heart disease, the main culprit of which is atherosclerosis of the coronary vessels, blocking of one or more arteries of the heart can occur. This process is accompanied by severe myocardial ischemia, the patient often has angina attacks and myocardial infarction may develop.
To restore blood circulation in the heart muscle, surgeons create detours by performing an anastomosis from a vein excised from under the skin of the thigh, or a patient's artery taken from the forearm or inner surface of the chest.
One end of such a bypass vessel is attached to the aorta, and the other is sutured into the coronary artery below the site of atherosclerotic blockage or narrowing.
If the internal thoracic artery, which is already connected to the aorta, is used for the bypass, then one of its ends is sutured to the coronary vessel. Such a cardiac surgery is called coronary artery bypass grafting.
Previously, femoral veins were used to create an anastomosis, but now surgeons more often use arterial vessels, since they are more durable. According to statistics, a shunt from a venous femoral vessel does not undergo re-occlusion within 10 years in 65% of patients, and from an arterial vessel of the internal thoracic artery it functions properly in 98% of those operated on.
When using the radial artery, the anastomosis has been working flawlessly for 5 years in 83% of patients. The main goal of coronary artery bypass grafting is aimed at improving blood flow in the area of myocardial ischemia.After the operation, the area of the heart muscle experiencing insufficient blood supply begins to receive an adequate amount of blood, angina attacks become less frequent or eliminated, and the risk of developing a heart muscle infarction is significantly reduced.
As a result, coronary artery bypass grafting allows to increase the life expectancy of the patient and reduces the risk of sudden coronary death. The main indications for coronary artery bypass grafting may be the following conditions:
- narrowing of the coronary arteries by more than 70%;
- narrowing of the left coronary artery by more than 50%;
- ineffective percutaneous angioplasty.
What diseases are shunts indicated for?
The list of health problems that are indications for bypass surgery includes 4 main diseases. As a rule, they are relevant for older people, but recently they are increasingly common even in young people.
In particular, these include:
- Atherosclerosis.
- Ischemia.
- Excess weight. Recently, this operation has become a particularly common method of combating obesity. The mechanism that helps to lose weight has already been described above.
- Ischemic disease of the brain.
With this disease, specific plaques form on the walls of blood vessels. Normally, no formations should be there, because plaques are the main obstacle to full blood flow.
If the disease is not paid attention in a timely manner, it will end in tissue necrosis with all the ensuing consequences.
The most common disease in which specialists prescribe shunting. Again, the main problem here is the blockage of blood vessels by cholesterol. Actually, the disease is diagnosed with the help of a thorough examination of the blood channels for possible narrowing.
The narrowing leads to limited access of oxygen to the heart, which can lead to a variety of negative consequences. Ischemia manifests itself as pain in the chest (more often in its left part), as well as angina pectoris.
The stomach is divided into a larger and a smaller part, the latter being connected to the small intestine. Accordingly, the amount of food needed for saturation decreases, and the body loses weight.
The principle in this case is very similar to the heart. Cerebral ischemia can be limited or global. The disease leads to disruption of the organ, and in the worst cases - to a stroke or to the formation of tumors of an oncological nature.
Diseases of this kind must be dealt with in a hospital setting. Before shunting, conservative therapy is carried out, which includes the use of drugs for vasodilation, anti-clotting, blood thinning, etc. Bypass is prescribed only in cases where the disease is advanced.
It is believed that such implants can last up to 7 years, but this period can be significantly reduced due to the use of nicotine. Therefore, after shunting, the patient will have to quit smoking. In addition, further nutrition will also be significantly limited.
First of all, the restriction will affect fats of animal origin. Depending on the disease, the doctor may prescribe a particular diet to the patient, for example:
- diet number 12 - with blockage of blood vessels and ischemia;
- diet number 15 - with chronic circulatory failure.
Operation
During the operation, you will be in deep sleep and will not remember the progress of the operation. During the operation, the heart-lung device will take over the functions of your heart and lungs, allowing the surgeon to bypass all the arteries. Gradually stop artificial circulation, if it was used.
To complete the operation, drainage tubes will be placed in the chest to facilitate the evacuation of fluid from the surgical area. Careful hemostasis of the postoperative wound is carried out, after which it is sutured.
The patient is disconnected from the monitors located in the operating room and connected to portable monitors, then transported to the intensive care unit (ICU).
The duration of the patient's stay in the intensive care unit depends on the volume of surgery and on his individual characteristics. In general, he is in this department until his condition is completely stabilized.
Day after surgery: postoperative period
While the patient is in intensive care, blood tests are taken, electrocardiographic and x-ray studies are performed, which can be repeated if necessary. All vital signs of the patient are recorded.
After completion of respiratory support, the patient is extubated (the breathing tube is removed) and transferred to spontaneous breathing.The chest drains and gastric tube remain. The patient uses special stockings that support blood circulation in the legs, wrap him in a warm blanket to maintain body temperature.
The patient remains in the supine position and continues to receive fluid therapy, pain relief, antibiotics, and sedatives. The nurse provides constant care for the patient, helps him turn over in bed and perform routine manipulations, and also communicates with the patient's family.
Day after surgery: postoperative period - 1 day
The patient can remain in the intensive care unit, or they can be transferred to a special room with telemetry, where their condition will be monitored using special equipment. After restoration of fluid balance, the Foley catheter is removed from the bladder.
Remote monitoring of cardiac activity is used, drug anesthesia and antibiotic therapy continue. The doctor prescribes dietary nutrition and instructs the patient about physical activity; the patient should begin to sit down on the bed of the bed and reach for a chair, gradually increasing the number of attempts).
It is recommended to continue wearing support stockings. Nursing staff performing a rubdown on a patient.Postoperative period - 2 days
On the second day after the operation, oxygen support stops, and breathing exercises continue. The drainage tube is removed from the chest. The patient's condition improves, but monitoring of parameters using telemetry equipment continues.
The patient's weight is recorded and the administration of solutions and medications continues. If necessary, the patient continues anesthesia, and also fulfill all the doctor's prescriptions. The patient continues to receive dietary nutrition and his activity level gradually increases.
He is allowed to gently get up and, with the help of an assistant, move to the bathroom. It is recommended that you continue to wear support stockings, and even start doing light exercise for your arms and legs.
The patient is advised to take short walks along the corridor. The staff constantly conducts explanatory conversations with the patient about risk factors, instructs how to process the suture and talks with the patient about the necessary measures that prepare the patient for discharge.
Postoperative period – 3 days
The monitoring of the patient's condition is stopped. Weight registration continues. If necessary, continue anesthesia. Perform all doctor's prescriptions, breathing exercises. The patient is already allowed to take a shower and increase the number of movements from bed to chair up to 4 times, already without assistance.
It is also recommended to increase the duration of walks along the corridor and do this several times, remembering to wear special support stockings.The patient continues to receive all the necessary information about dietary nutrition, medication, home exercise, full recovery of vitality and preparation for discharge.
Postoperative period - 4 days
The patient continues to perform breathing exercises several times a day. The patient's weight is again checked. Diet food continues to be carried out (restriction of fatty, salty), however, the food becomes more varied and the portions become larger.
It is allowed to use the bathroom and move around without assistance. The patient's physical condition is assessed and final instructions are given before discharge. If the patient has any problems or questions, then he must resolve them before discharge.
Shortly after the operation, the bandage will be removed from the incision on your chest. Air will contribute to the drying and healing of the postoperative wound.
The number and length of incisions in the legs may vary from patient to patient, depending on how many venous bypasses you were planning to perform. Someone will have incisions only on one leg, someone on both, someone may have an incision on their arm.
First, your stitches will be washed with antiseptic solutions and bandages will be done. Somewhere on the 8th - 9th day, with successful healing, the sutures will be removed, and the safety electrode will also be removed.
Later, you can gently wash the incision area with soap and water. You may have a tendency to have swelling in your ankles, or you may feel a burning sensation at the site where the veins were taken.
This burning sensation will be felt when you stand or at night. Gradually, with the restoration of blood circulation in the places of vein sampling, these symptoms will disappear.You will be asked to wear elastic support stockings or bandages to improve circulation in your legs and reduce swelling. However, one should not forget that full fusion of the sternum will be achieved in a few months, so you will need to discuss with your doctor the timing of an adequate load on the shoulder girdle.
Usually, after bypass surgery, patients spend 14-16 days in the clinic. But the length of your stay may vary. As a rule, this is associated with the prevention of concomitant diseases, since this operation will require the patient to spend a lot of effort on the whole organism - this can provoke an exacerbation of chronic diseases.
Gradually, you will notice an improvement in your general condition and a surge of strength. Quite often, patients feel fear and confusion at discharge. Sometimes this is because they are afraid to leave the hospital, where they felt safe under the supervision of experienced doctors. They think that returning home is risky for them.
You must remember that the doctor will not discharge you from the clinic until he is sure that your condition has stabilized and that further recovery should take place at home.
A nurse or social worker will help you with any discharge related issues. Usually, you are discharged from the hospital around noon.
From the foregoing, it follows that CABG surgery is the main step towards returning the patient to a normal life. CABG surgery is aimed at treating coronary artery disease and relieving the patient of pain.
However, it cannot completely rid the patient of atherosclerosis. The most important task of the operation is to change the patient's life and improve his condition by minimizing the effect of atherosclerosis on the coronary vessels.
As you know, many factors directly affect the formation of atherosclerotic plaques. And the cause of atherosclerotic changes in the coronary arteries is a combination of several risk factors at once.
Sex, age, heredity are predisposing factors that cannot be changed, however, other factors can be changed, controlled and even prevented:
- High blood pressure;
- Smoking;
- high cholesterol;
- Overweight;
- Diabetes;
- low physical activity;
- stress;
The creation of a new section of the vessel during shunting changes the patient's quality of life. Life after heart vessel bypass involves the normalization of blood flow that feeds the myocardium, which is a consequence of bypass surgery, has a number of positive effects:
- Attacks of stenocardia disappear.
- Reduces the risk of MI.
- Work capacity is restored.
- The patient's well-being improves markedly.
- The safe level of physical activity increases.
- Of the medicines, only a preventive minimum is required.
- Life expectancy increases and the risk of sudden death decreases.
In other words, after CABG, the life of a healthy person becomes practically available for a sick patient. Patients who have undergone coronary artery bypass grafting leave the most positive feedback - for the most part they talk about returning to a full life after bypass surgery.
Statistics show that up to 70% of patients get rid of almost all disorders after surgery, and the condition of a third of patients improves markedly. In 85% of those operated on, there is no new blockage of blood vessels.
Any patient considering this operation is no doubt interested in the question of how long they live after heart bypass surgery. There is no standard answer to this question, and no honest doctor can guarantee a specific time.
The prognosis is influenced by many factors: from the general condition of the patient, age, to his lifestyle and the presence of bad habits. To add to this, the average lifespan of a shunt is approximately 10 years, but in younger patients it can last longer, after which a second operation is required.
After CABG, you should stop smoking. If the patient continues this addiction, then the risk of the return of coronary artery disease will increase many times over. Therefore, after this operation, the patient should not have any compromises regarding smoking.Consequences and complications
Cardiac bypass, or more specifically coronary artery bypass, is a very common procedure for patients suffering from coronary artery disease. It is the only way to improve the quality of a person's life when drugs do not help, and the disease progresses.
Ischemic heart disease is caused by atherosclerosis of blood vessels. Plaques do not allow the vessels to function normally, and the heart to be saturated with nutrients. Shunting aims to eliminate this situation. During this operation, a second path is created for the passage of blood, bypassing the "sick" vessel.
To do this, use the vein of the patient himself, which, most often, is taken from the thigh (saphenous vein of the thigh). Such an operation will protect a person from the risk of future heart attacks.
The operation requires careful preparation of the patient for several days. You should stop taking blood thinners (aspirin, ibuprofen, etc.) and tell your doctor in detail about past illnesses and allergic reactions to medications.
Usually, within a month after the operation, a person returns to his usual life (with some restrictions). But, like any operation, heart bypass surgery can lead to very unpleasant consequences (complications).
Complications:
- Specific - these are complications associated with the heart and blood vessels.
- Non-specific - these are complications that are characteristic of any operation, including heart bypass surgery.
Among the specific complications of the operation are the following:
- The development of heart attacks in a number of patients and, as a result, an increase in the likelihood of deaths associated with them.
- Pericarditis is an inflammation of the serous membrane of the heart.
- Acute heart failure.
- Various heart rhythm disturbances (atrial fibrillation, blockade, and so on).
- Phlebitis is the development of inflammation in the venous wall.
- Pleurisy of an infectious or traumatic nature.
- Narrowing of the lumen of the shunt.
- Strokes.
- The development of the so-called postpericardiotomy syndrome.
Non-specific complications
- Pneumonia.
- Large blood loss during surgery can lead to anemia.
- Thickening of the blood with the formation of clots and their entry into the pulmonary arteries (PE).
- infectious complications. It could be a urinary tract or lung infection. For example, pleurisy, pyelonephritis.
- Infection of the postoperative wound. People with obesity and diabetes are especially susceptible to this complication.
- Ligature fistulas, the appearance of which is associated with inflammation of the wound after surgery, the cause of which can be either infection or rejection of the suture material.
- Diastasis of the sternum.
- Renal failure.
- Pulmonary insufficiency.
- Deterioration of memory and thinking.
- Seam failure.
- Formation of a keloid scar.
Since heart bypass surgery is very complex and involves the patient being on a ventilator for some time, complications from the lungs are not uncommon. They begin to develop congestion.
After surgery, working with your breathing is very important. Breathing exercises or a simple exercise - inflating balloons, are great for helping the lungs straighten out and improve their blood supply.
And then, congestive postoperative pneumonia will not be terrible.To prevent its occurrence, in the postoperative period, food should be meat (beef, liver, and so on). The meat is saturated with iron and vitamin B12, which is necessary to restore hemoglobin levels.
In order to reduce the risk of complications to a minimum, it is necessary to identify patients with a burdened history and use all possible preventive measures in relation to them.
After the operation, it is very important to properly monitor the patient and follow the patient's rational diet after heart bypass surgery, and in the future to carry out rehabilitation measures. The latter is quite well analyzed in the material life after shunting.
The operation solves the problems created by coronary heart disease. However, the causes of the disease remain, the condition of the walls of the patient's vessels and the rate of atherogenic fats in the blood do not change. As a result of this state of affairs, there is a risk of a decrease in the lumen in other parts of the coronary arteries, which will lead to the return of old symptoms.
Rehabilitation is aimed at preventing negative scenarios and returning the operated patient to a full life.
More specific rehabilitation tasks:
- Creating conditions to reduce the likelihood of complications.
- Adaptation of the myocardium to changes in the nature of blood circulation.
- Stimulation of recovery processes in damaged tissue areas.
- Consolidation of the results of the operation.
- Reducing the intensity of the development of atherosclerosis, coronary heart disease, hypertension.
- Adaptation of the patient to the external environment. Psychological help. Development of new social and household skills.
- Recovery of physical strength.
Rehabilitation program after CABG from the 2nd day
The patient performs exercise therapy in a gentle mode, focusing mainly on breathing exercises. Of the methods of general exposure, bioresonance therapy, aerotherapy are used. The methods of local exposure include inhalation through a nebulizer (mucolytics, bronchodilators, furacillin, etc.) 2 times a day.
To control the safety and effectiveness of rehabilitation of patients, mandatory research methods are used - electrocardiogram (ECG), blood pressure (BP), heart rate (HR) daily.Troponin, creatine phosphokinase (CPK), transaminases, prothrombin, activated thromboplastin time (APTT), bleeding time and blood coagulation are also monitored, a clinical blood test, a general urine test are performed.
Of the additional methods, Holter monitoring, echocardiography (EchoCG), determination of indicators of a biochemical blood test are used. The duration of the course is 7-10 days with a further transition to the next stage of rehabilitation treatment.
Rehabilitation program after CABG from 7–10 days
The patient continues to perform exercise therapy in a sparing mode. Intravenous laser therapy or intravenous ozone therapy, bioresonance therapy, aerophytotherapy can be added to the methods of general exposure.
From the methods of local influence, there are:
- peripheral classic therapeutic massage,
- massage in the electric field of the cervical-collar region,
- low-intensity laser radiation on the heart area and postoperative scars,
- magnetic therapy of peripheral influence (on the calf muscles),
- ultratonophoresis (lidase, pantovegin).
Mandatory and additional methods for monitoring the safety and effectiveness of rehabilitation of patients are the same as after the second day of rehabilitation after CABG. The duration of the course is 10-15 days before the transition to the next stage of rehabilitation treatment.
Rehabilitation program after CABG from day 21
Exercise therapy or cardio training on power and cyclic simulators in the mode of dosed stepwise increasing physical activity. The issue of choosing simulators and loading should be decided individually, depending on the condition of postoperative sutures and scars.
For detrained patients, patients with low exercise tolerance, it is recommended to start a course with exercise therapy in a gentle mode.
The methods of general influence have been expanded: interval hypoxic training, complex halotherapy, dry carbon dioxide baths (for hands, or alternating every other day for hands and feet), bioresonance therapy, aeroionotherapy, aerophytotherapy are added to the above.
From the methods of local exposure, you can choose a classic therapeutic back massage using a sparing technique, massage in the electrostatic field of the anterior surface of the chest, low-intensity laser radiation on the heart area, low-frequency electromagnetic field on the cervical-collar area, drug electrophoresis (magnesium sulfate, panangin, anaprilin, but -shpa, papaverine) on the cervical region, electrotherapy (SMT).
Mandatory and additional methods of monitoring the condition of patients remain the same. The duration of the course is 20-40 days.Rehabilitation program after CABG in 1–2 months
They continue to perform exercise therapy or cardio training on strength and cyclic simulators in the mode of dosed stepwise increasing physical activity. For detrained patients, patients with low exercise tolerance, it is recommended to start a course with exercise therapy in a gentle mode. You can use hydrokinesitherapy.
Aerophytotherapy, carbonic baths according to A.S. Zalmanov, alternating every other day with dry carbon dioxide baths, four-chamber vortex contrast baths every other day with potassium-sodium-magnesium or iodine-bromine baths.
The choice of methods of local influence has been expanded: classical therapeutic back massage in a sparing mode, massage in the electrostatic field of the cervical-collar zone, low-intensity laser radiation on the heart area, magnetotherapy, transcerebral electroanalgesia, ultratonophoresis (lidase, pantovegin, heparin).Mandatory methods for monitoring safety and efficacy are the same studies as in the previous rehabilitation stage. The duration of the course is 15-30 days.
Psychological rehabilitation of patients after CABG is extremely necessary, since due to extensive chest trauma, which serves as a source of pain, postoperative cerebral hypoxia, functional disorders of the nervous system are detected in almost all patients after CABG.
These patients are irritated, often fixated on pain, anxious, sleep poorly, complain of headaches, dizziness.Physical rehabilitation
The rehabilitation program is considered successful if the patient managed to return to the lifestyle of healthy people. Physical rehabilitation in patients undergoing CABG is essential from the first days of the postoperative period, when, along with drug therapy, patients are prescribed gymnastics and massage.
On the first day after the operation, the patient sits down, on the second day he is allowed to gently stand near the bed, perform simple exercises for the arms and legs. On the third day, the number of independent movements from bed to chair increases up to 4 times.
In the following days, patients gradually increase physical activity, mainly due to dosed walking along the corridor, and by 10–14 days they can walk up to 100 meters. The best time for walking is from 11 am to 1 pm and from 5 pm to 7 pm.
With dosed walking, it is necessary to keep a self-control diary, where the pulse is recorded at rest, after exercise and after rest after 3-5 minutes in compliance with the established methodology. The pace of walking is determined by the patient's well-being and indicators of the work of the heart.
First, a slow pace is mastered - 60–70 m / min. with a gradual increase in distance, then the average pace is 80–90 m / min., also gradually increasing the distance; and then fast - 100-110 m / min.Equally important at all stages is given to dosed climbs to the steps of the stairs. The pace of walking up the stairs is slow, not faster than 60 steps per minute. Going down stairs is equivalent to 30% going up. As with any training load, patients keep a diary of self-control.
Therapeutic diet - basic rules
When compiling a food intake chart for those who underwent heart bypass surgery, it is necessary to focus on the fact that it is categorically not allowed to consume foods containing harmful cholesterol and fats in large volumes. This is due to the fact that their excess in the body, as well as carbohydrates, adversely affects the health of blood vessels, clogging them.
As a result, the question of the return of the disease is acute. But even despite such caution, throughout the life of a person who has undergone such operations, he will need to carefully monitor his weight so that he stays at approximately the same mark.
Therefore, in this case, the credo for life should be this: “moderation is above all!”.
Important! Those who have undergone such operations need to monitor the amount of sugar and table salt consumed. It is better to replace the first with stevia, and the last with a marine analogue, which, due to its high iodine content, is even good for the heart.
Foods to Avoid After Cardiac Bypass Surgery:
- fatty meat (pork, lamb, beef, duck, goose, lard);
- sausages - sausages, ham, sausages, shank;
- hard cheese;
- homemade dairy products (cream, sour cream, butter);
- fatty fish with a high cholesterol content (halibut, catfish, stellate sturgeon, herring, sturgeon and saury);
- pasta made from premium wheat flour;
- any semi-finished products;
- alcoholic drinks;
- carbonated water;
- fried potatoes.
How to replace fats:
- fat-free cottage cheese (0%);
- milk 1.5%;
- diet cheeses;
- tofu;
- Soy meat;
- white chicken;
- rabbit carcass;
- turkey;
- veal;
- cereals, with the exception of rice and semolina.
Special attention should be paid to the benefits of fish oil for the heart. If it is regularly used as a dietary supplement to main dishes, then it will be good to protect blood vessels from cholesterol. This is possible due to the content of omega acids in the product.
In light of this, in addition to fish oil, nutritionists recommend eating 100-200 g of sardines, herring or salmon 2-3 times in 7 days to maintain heart function. This fish belongs to moderately fatty varieties.
What else can you eat after heart bypass surgery: margarine, mayonnaise and butter are not included in the group of allowed products for operated patients. The same applies to sunflower oil.
Nutritionists advise replacing it with cold-pressed olive oil. It does not contain polyunsaturated fatty acids harmful to the heart. It is allowed, but only in limited quantities, the use of beef and / or chicken liver, as well as kidneys.
As an alternative, boiled rabbit meat, turkey and veal can be considered. In order for rehabilitation after surgery to go like clockwork, it is important to adhere to the following rules:
- calorie consumption during exercise should not be more than their excess;
- it is strictly not recommended to consume alcoholic beverages in any form;
- monitor the intake of sodium (one of the components of table salt). It is supposed per day that this figure does not exceed 2 grams;
- it is highly undesirable to drink sweet drinks - coffee, soda, compotes, juices, etc.;
- if the diet includes fatty transgenic foods, then their percentage of total consumption should not exceed one unit;
- the emphasis in the menu should be on fresh vegetables and fruits that have not been subjected to heat treatment;
- cooking dishes based on fish or fish oil is welcome, but not more than 5 times in 30 days;
- for dairy products of all types, the fat content threshold should be no more than 1%;
- the norm of cholesterol consumption per day - no more than 200 mg;
- fats should account for 6% of the total calories eaten.
Diet foods that are good for the heart:
- Pancakes made from rye flour with stewed salmon or salmon wrapped inside;
- Vegetable soup with barley groats and black croutons;
- Canned corn with oven baked tuna or cod in the form of a salad;
- Yushka with fresh carrots and lentils;
- Pea mash;
- Oatmeal on the water;
- Oranges and grapefruits;
- Oven baked apples with avocado;
- Pine nuts with herbs and lettuce;
- Rye tortillas with avocado cream sauce;
- Low-fat sardines;
- Oat pancakes with low-fat sour cream;
- Fish stewed in tomato;
- Egg omelette with dill;
- Beets with walnuts and sesame oil;
- Zucchini caviar without preliminary frying.
Sample menu for the day:
- boiled chicken egg;
- green tea (1 glass);
- a slice of rye loaf;
- slice of tofu.
Lunch
- baked green apple;
- a glass of kefir.
- vegetable soup with lentils;
- 25 g of rye bread;
- barley groats with vegetables;
- 50 g stewed low-fat fish.
- salad with spinach and peas;
- steamed chicken chop;
- a glass of tomato juice without salt;
- a piece of bread.
Popular questions
The duration of the shunt: Each medical institution has its own data on this. As a result, data from Israeli cardiac surgeons suggests that a shunt can remain in working order for more than a decade. However, venous substitutes serve much less.
- What is a shunt
- Is it possible to perform cardiac catheterization after bypass surgery? Yes, this is perfectly acceptable. In this case, the blood supply is restored, even if the patient's coronary disorders are quite complex.
- Does pain in the heart after surgery mean that it was unsuccessful
- Should Medications Be Taken Long After Bypass Surgery?
The term "shunt" refers to a part of a vein used as an alternative branch for blood flow, allowing blood to flow around the affected and blocked artery.
At a certain moment, the vessel walls are deformed, some areas expand, and in these areas an accumulation of thrombi of atherosclerotic plaques is formed. An arterial shunt allows you to bypass these accumulations.
In this case, the bypass procedure is performed in such a way that the coronary artery is not affected. Special centers provide services for balloon angioplasty of other arteries or bypasses.
If the patient experiences pain in the heart after recovering from surgery or in the later stages of recovery, then he should seek the advice of a cardiac surgeon so that he can assess the likelihood of blockage of the shunt.
If the suspicion of this problem is confirmed, then urgent measures will need to be taken, or the patient will soon feel the first symptoms of angina pectoris.Cardiac bypass surgery is an event in which there is no cure for comorbidities.
Medications are required. They will stabilize blood pressure, maintain a certain level of glucose in the bloodstream, regulate cholesterol, triglyceride.
The deposition of plaques on the inner side of the coronary arteries leads to their narrowing and a decrease in throughput. The current situation provokes the development of a dangerous disease - coronary heart disease (CHD). If the diagnosis is confirmed, the patient is scheduled for coronary artery bypass grafting (CABG). Its essence boils down to the installation of bypass routes on the vessels, or, as doctors call them, shunts. In the case of successful completion of the surgical intervention, the blood flow literally "circles" the clogged area. Shunts are placed using the radial or internal mammary artery.
In cardiology, there are a number of clinical signs, in the presence of which CABG is prescribed without fail.
Namely:
- the presence of severe pain in the retrosternal region;
- the number of myocardial infarctions suffered by the patient;
- the likelihood of a relapse;
- deterioration in the contraction function of the left ventricle - determined on the basis of the echocardioscopy;
- decrease by ½ of the patency of the left venous artery;
- the patency of all coronary arteries does not exceed 30%;
- the presence of III or IV class of angina, not amenable to conservative treatment;
- the presence of ACS;
- acute myocardial infarction not later than 6 hours from the onset of the pain syndrome;
- the presence of ischemia of a painless type;
- heart disease complicated by myocardial ischemia.
Important! Before making a decision to perform CABG, the cardiologist considers the clinical manifestations and the results of the examination.
An important role in making a decision is played by possible contraindications:
- severe condition of the patient;
- the presence of diffuse lesions of most of the coronary arteries.
The list ends with an acute form of heart failure.
Operation cost
It is determined on the basis of the survey. As soon as the cardiologist determines the severity of the patient's health condition and the amount of necessary manipulations, an estimate is formed. You need to understand right away that she will not be small. The lower price threshold is at around 150 thousand rubles, and the upper one ranges from 450 to 600 thousand. If the operation is performed in leading foreign medical institutions, then the patient will need at least 800,000 - 17,000,000.
Important points before surgery
The intervention is carried out in a planned or emergency manner. When the patient was admitted with signs of acute myocardial infarction, then surgical actions are carried out without delay. All preparation is reduced to coronary angiography. Its purpose is to determine the actual state of the coronary arteries. Supplements the preparatory stage in emergency cases of ECG in dynamics, the delivery of a blood group analysis and an indicator of its coagulability.
The need for a survey
In the case of a planned surgical intervention, the preparatory course takes longer.
Without fail, the patient undergoes the following types of examinations:
- ultrasonography;
- radiography;
- general analysis of urine and blood;
- blood biochemistry;
- test for sexually transmitted diseases and hepatitis;
- coronary angiography.
After collecting and detailed analysis of the results, the cardiologist decides on the appropriateness of the surgical intervention.
How is a heart bypass performed?
The patient is administered specially selected sedatives and tranquilizers. Their goal is to improve the effect of the general anesthesia used. After some time, the patient is taken to the operating table. The duration of the operation ranges from 4.5 to 7 hours. The surgeon uses one of 2 methods. The first is a sternotomy, or incision of the sternum. The second method, which is considered less traumatic, provides for a minimal violation of the integrity of soft tissues. The surgeon makes an incision on the left side in the gap between the ribs.
On a note! During CABG, the patient is connected to life support devices.
The further procedure for the doctors is as follows:
- 60-minute aortic clamp;
- 1.5 hour connection of the heart to the device;
- the doctor allocates a vessel;
- performs its supply to the affected area of the coronary artery;
- produces filing of one of its ends to the aorta;
- makes sure that the blood flow successfully bypasses the pathologically narrowed area;
- the number of installed shunts directly depends on the number of affected arteries;
- after all shunts are sewn, special staples are placed on the breastbone;
- their purpose is to suture damaged soft tissues;
- a bandage is applied.
The doctor carefully removes the used drains. After 7-11 days, the sutures and bandage are removed. The specified time interval changes up or down.
What to expect after the operation
After completing CABG, the doctor sends the patient to intensive care. The duration of the effect of the administered drugs varies from 1 to 5 hours after the end of the procedure. Unconditionally, a 4-month temporary disability is issued. As soon as the specified time period has expired, patients undergo a mandatory medical and social examination. Its purpose is to determine the appropriateness of assigning a certain degree of disability.
First days after shunting
When the patient wakes up after the effects of anesthesia, the effect of "bad consciousness" from certain drugs lasts for some time. In this regard, he is connected to a ventilator. Without fail, the patient is fixed to exclude involuntary movements. Electrodes are installed on the body, fixing all vital signs.
Important! On the first day after the completion of the operation, a number of mandatory tests are carried out:
- blood analysis;
- x-ray;
Possible Complications
Develop in different systems. Much depends on the individual predisposition of the patient:
- acute form of perioperative myocardial necrosis;
- heart attack or development of a pre-infarction state;
- violation of the pancreas;
- asthma pathologies.
The task of the doctor is to take preventive measures.
Life outside the hospital
The doctor gives the patient specific recommendations based on the results of the examination. A person until the end of his days refuses bad habits. A strict diet and moderate exercise are the basis of a full recovery. The ration is formed as follows:
- refusal of salt and spices;
- bet on proteins;
- increase in consumption of vegetable oils;
- avoidance of saturated fats;
- moderate consumption of fruits and vegetables;
- rejection of fatty and fried menus.
Important! The above list should not be taken as the ultimate truth. In each case, the doctor gives individual recommendations.
Expected results after bypass surgery
The prognosis regarding life expectancy after surgery is made by the doctor based on a detailed analysis of a number of factors. Opens a list of the duration of use of the installed shunt and the risk of myocardial infarction. It has been clinically proven that the likelihood of developing sudden cardiac death for the first time 10 years after vascular bypass surgery is reduced to 2-3%. Operated people often note a higher tolerance for physical activity. By strictly following the recommendations of doctors, a person will be able to minimize all the risks of complications.
Recovery period
Provides exercises aimed at improving the respiratory system. The patient receives something similar to a balloon, which must be inflated at a moderate pace. The purpose of the procedure is to improve lung function, preventing the development of venous congestion. The second type of exercise involves the performance of physical gymnastics. It begins at the stage when the patient is in a supine position. Exercises are performed under the supervision of a doctor. After some time, the person moves a little along the corridor. The intensity of the load depends on the severity of the health condition.
After discharge from the hospital, the patient undergoes a comprehensive rehabilitation course. It is divided into outpatient and inpatient parts. In addition to the obligatory implementation of the doctor's advice, one must strive to constantly be in the recommended temperature regime. Drafts and heat are not allowed. The task of the patient is to learn the basic skills of self-monitoring of the state of health. This is the only way to notice an impending problem at an early stage.
