Extra coronary bypass. Complications and their treatment

Coronary heart disease is the main reason for coronary artery bypass surgery. Stenosis - narrowing of the lumen of blood vessels as a result of atherosclerosis leads to ischemia of the heart. Violation of the blood supply leads to a deficiency of oxygen and nutrients in the myocardium. Severe vasoconstriction causes pain in the heart, in addition, prolonged ischemia of the heart can result in necrosis of cardiomyocytes - myocardial infarction.

Cardiac stenosis

Ischemic heart disease (CHD) is a common cardiovascular disease. According to statistics, seven million people die every year from causes associated with this disease. The median age of death in coronary artery disease is 40 years. In severe and complicated forms, life expectancy is relatively low - less than 2 years.

Shunting of the vessels of the heart is indicated with a significant narrowing of the lumen of the coronary vessels, leading to ischemia of the heart muscle. IHD provokes the process of sclerotization of blood vessels. Calcium-cholesterol plaques are deposited on the inside of the artery, causing partial or complete blockage of the human vascular system.

Coronary artery bypass grafting has three main indications:

1. narrowing of the trunk of the left coronary artery by more than 50%.
2. three-vessel disease with an ejection fraction of less than 50% or severe induced ischemia.
3. defeat of one or two vessels, but with a large volume of myocardium fed by them.

Other indications for heart bypass surgery:

• developing myocardial infarction;
• stable angina, resistant to drug therapy (attacks of retrosternal pain do not stop even after taking nitrates);
• ischemic pulmonary edema;
• lack of positive dynamics after angioplasty or stenting operations.

After bypass surgery of the heart vessels, the risk of relapses is reduced and the quality of life of the patient is improved. The decision to perform coronary artery bypass surgery is made in each case individually, taking into account the risks, the patient's condition and the severity of the lesion.

Attention! Ischemic heart disease is an adult disease and rarely occurs in children. Vessel sclerotization worsens with age, although the process can begin even in a child. Coronary surgery in these cases is used to treat children or newborns very rarely, mainly for structural abnormalities of the aortic or coronary valves or after renal infarction.

Coronary artery bypass grafting has a number of indications (as mentioned above), however, there are some contraindications to the procedure:

• kidney failure;
• macrofocal stroke;
• widespread lesion of all coronary vessels;
• end-stage heart failure.

What is a heart bypass?

Coronary artery bypass grafting (CABG) is a surgical procedure in which blood vessels are removed from other parts of the patient's body and an alternative blood supply is created in the affected part of the heart muscle. Its variation is mammarocoronary bypass grafting, in which vessels from other parts of the body are not used, but an anastomosis is created between the thoracic artery and the coronary artery, through which blood passes.

US

CABG surgery is performed only by an experienced cardiac surgeon. Assistants, perfusionist, nurses and anesthetist work together to minimize possible consequences and complications.

Shunting of the heart vessels is carried out in conditions of IR (artificial circulation) or on a beating heart. With various complications and pathological conditions, as a rule, preference is given to EC.

How to prepare for coronary artery bypass surgery?

The day before the coronary artery bypass surgery, the patient should refuse to eat. It is necessary to prepare the intestines for the operation so that complications do not arise. In the place where it is supposed to dissect the chest, you need to remove the hairline. In the hospital, you should take a shower before the operation.

Prescribed medications are taken the last time the day before the operation. You must notify your doctor about taking any dietary supplements or folk remedies.

Important! If coronary artery bypass surgery is performed in an emergency (for example, in case of myocardial infarction), then after appropriate preparation of the patient, only the most necessary studies are performed - coronary angiography, ECG and blood tests.

A number of mandatory examinations that a patient needs to undergo during a planned admission to a hospital:

• biochemical and clinical blood tests;
• roentgenoscopy of the chest;
• echocardiography;
• analysis of feces and urine;
• coronary angiography;
• ECG (veloergometry).

How is coronary artery bypass grafting done?

Before coronary artery bypass surgery, the patient is given muscle relaxants and benzodiazepines. After some time, he is moved to the operating unit.

Coronary artery bypass grafting is performed on an open heart, so the sternum is dissected before the procedure. The chest heals for a long time. As a result, the rehabilitation period lasts several months. In some cases, minimally invasive coronary artery bypass surgery is performed, which is performed without opening the chest. This is determined by the location of the vessel that is bypassed by the shunt.

Operating block

Bypass surgery in the operating room is performed under general anesthesia and often with a cardiopulmonary bypass device connected. The aorta is clamped, the heart is connected to the IR, and the cardiac surgeon performs coronary bypass surgery: allocates a shunt (for example, a vein) and stitches it to the other end of the aorta. If several arteries are affected by atherosclerosis, an appropriate number of shunts are used.

After coronary artery bypass grafting, special staples made of metal wire are applied to the edges of the chest. Then the tissues are sutured and a sterile dressing is applied. The stitching procedure takes about 2 hours, and the duration of the entire operation is very variable: from 4 to 6 hours.

After the operation, the patient stays in the intensive care unit for some time, connected to an artificial respiration apparatus. After recovery, he enters ITAR. and then to the clinical ward, where doctors observe him for some time. Bandages are removed from the operated patient after the sutures have healed. The percentage of successful outcomes in coronary artery bypass surgery is quite high.

Rehabilitation in the postoperative period and possible complications

After CABG, any water procedures are contraindicated. An infection can get into the seams on the legs and arms (the place where the veins are taken), so it is necessary to treat them daily with bactericides and make dressings. For rapid fusion of the chest, it is recommended to wear a special bandage on the chest. If this condition is not observed, then the seams may disperse, and complications will arise.

Often, in the period after CABG, there is a pain syndrome that lasts up to a year and usually disappears spontaneously. Complications are quite rare.

Other possible complications that worsen the quality of life of the patient:

• inflammation of the heart bag;
• problems with the immune system due to IR;
• heart rhythm disturbances;
• Iron-deficiency anemia;
• hypotension;
• postoperative myocardial infarction.

According to recent studies, obtained as a result of several thousand clinical observations, fifteen years after the intervention, the mortality statistics among those operated on are the same as among healthy people. Much depends on how the operation was performed, and how many of them were performed on the patient in total.

On average, the ability to work is restored within a year. For 4-5 months, the rheological properties of the blood return to normal, the heart rhythm, the functional state of the immune system are restored, and the chest heals.

Cardiorehabilitation

A few months later and in subsequent years, a series of examinations are carried out, designed to identify complications in time:

• ECG (veloergometry);
• tonometry;
• blood chemistry;
• echocardiography;
• Magnetic resonance imaging;
• coronary angiography;
• chest x-ray.

Advice! Many patients wonder if MRI can be done after coronary artery bypass surgery. As a rule, it is possible if electrodes are not left in the heart to stimulate cardiac activity. To exclude their presence, an x-ray of the chest cavity is done.

How long do people live after heart bypass surgery, and what results does this procedure give?

The lifespan of a shunt is approximately 7-9 years in the elderly and 8-10 years in the young. At the end of the service life, a second heart bypass surgery will be required, but after this, new complications may arise.

Shunts

With successful intervention, patients fully recover. However, with a poor-quality operation, they live after heart bypass surgery with a complex of complications that require additional treatment.

After myocardial infarction, the prognosis is more cautious, relapses often occur. However, coronary artery bypass surgery reduces the likelihood of having a second heart attack by 4 times. If the patient has gone through a period of rehabilitation, the chances of dying after a heart attack are further reduced.

Coronary artery bypass grafting qualitatively changes the life and well-being of the patient. Normalizes blood flow in the heart muscle and a number of other things:

• the ability to engage in physical activity is restored;
• reduces the risk of recurrent myocardial infarction;
• increased tolerance to physical activity;
• the risk of sudden coronary death decreases;
• the frequency of attacks of anginal pain behind the sternum decreases.

CABG returns patients to a full healthy life. In 60% of patients after surgery, cardiovascular symptoms disappear, in 40% they change, the course of coronary artery disease improves. After coronary artery bypass grafting, re-occlusion of the vessel rarely occurs.

The prognosis of the condition depends on a large number of factors: lifestyle, health status. Vessel sclerotization can be prevented by a low-cholesterol diet. Therapeutic diets No. 12 and No. 15 are used for cardiovascular disorders.

Before and after heart bypass

How much does heart and vascular bypass surgery cost?

Coronary artery bypass grafting is an expensive method of restoring blood circulation in the heart muscle. The difficulty of performing this procedure and the presence of diversified specialists form the cost of this treatment. The price depends on the number of shunts, the complexity of the operation in a particular patient and his condition.

Another factor that significantly affects the price is the level of the clinic. In a public hospital, the cost of such a procedure is much lower than in private clinics. Operations are also carried out according to a quota allocated by the state.

Often, the localization of a clinic becomes an important factor in determining the cost of treatment. For example, in Vitebsk the cost of the procedure varies from 100 to 300 thousand rubles, and in Moscow - 200-600 thousand rubles.

Methods for the prevention of atherosclerosis

Some preventive measures can prevent re-occlusion of blood vessels. General recommendations to help keep your arteries healthy include:

1. Add vitamins to your diet. According to studies obtained during many years of experiments, it was found that vitamin PP improves vascular elasticity, increases HDL content and has an antiplatelet effect.
2. Don't ignore physical activity. Regular exercise leads to the release of anandamide in the brain, a natural cannabinoid. Endocannabinoids are cardioprotective at low doses. Regular aerobic exercise trains the cardiovascular system.
3. Develop a dynamic stereotype. Try to go to bed, eat, exercise and study at a well-defined time. A dynamic stereotype is a succession of useful stereotypes that streamline behavior and relieve unnecessary stress.
4. Add omega-3 and omega-6 unsaturated fatty acids to your diet.
5. Limit the intake of fast carbohydrates, salt, fatty and spicy foods.
6. Visit a cardiologist regularly for timely treatment of complications that have arisen and measure blood pressure.

Advice! Some of the above recommendations can only be followed after completing a full course of rehabilitation and chest reconstruction. A healthy lifestyle will help prevent the development of coronary heart disease. If you experience pain of unclear etiology in the sternum in the postoperative period, immediately consult a doctor.

Modern medicine allows you to perform complex operations and literally bring back to life people who have lost all hope. However, such intervention is associated with certain risks and dangers. This is exactly what shunting after surgery is, we will talk about this in more detail.

Heart bypass surgery: history, first operation

What is a heart bypass? How long do they live after surgery? And most importantly, what do people who are lucky enough to get a second chance at a completely new life say about her?

Bypass is an operation performed on the vessels. It is it that allows you to normalize and restore blood circulation throughout the body and in individual organs. The first such surgical intervention was carried out in May 1960. A successful operation performed by the American doctor Robert Hans Goetz took place at the A. Einstein Medical College.

What is the meaning of surgery

Shunting is the artificial creation of a new path for blood flow. in this case, it is carried out using vascular shunts, which specialists find in the internal mammary artery of the patients themselves who need surgical intervention. In particular, for this purpose, doctors use either the radial artery in the arm or a large vein in the leg.

This is how it happens. What is it? How many people live after it - these are the main questions that are of interest to those suffering who are faced with problems of the cardiovascular system. We will try to answer them.

When should a heart bypass be performed?

According to many experts, surgical intervention is an extreme measure, which should be resorted to only in exceptional cases. One of these problems is considered to be coronary or coronary heart disease, as well as atherosclerosis similar in symptoms.

Recall that this disease is also associated with an excess amount of cholesterol. However, unlike ischemia, this ailment contributes to the creation of peculiar plugs or plaques that completely block the vessels.

Do you want to know how long they live after and is it worth doing such an operation to people in old age? To do this, we have collected answers and advice from experts, which we hope will help you figure it out.

Thus, the danger of coronary disease and atherosclerosis lies in the excessive accumulation of cholesterol in the body, the excess of which inevitably affects the vessels of the heart and blocks them. As a result, they narrow and stop supplying the body with oxygen.

In order to return a person to normal life, doctors, as a rule, advise to carry out a heart bypass. How long patients live after surgery, how it goes, how long the rehabilitation process lasts, how the daily routine of a person who has undergone bypass surgery changes - all this should be known to those who are just thinking about a possible surgical intervention. And most importantly, you need to get a positive psychological attitude. To do this, shortly before the operation, future patients should enlist the moral support of close relatives and have a conversation with their doctor.

What is a heart bypass?

Cardiac bypass, or CABG for short, is conventionally divided into 3 types:

• single;
• double;
• triple.

In particular, such a division into species is associated with the degree of damage to the human vascular system. That is, if a patient has a problem with only one artery that needs a single bypass, then this is a single bypass, with two - a double, and with three - a triple heart bypass. What it is, how many people live after surgery, can be judged by some reviews.

What preparatory procedures are carried out before shunting?

Before the operation, the patient must undergo coronary angiography (a method for diagnosing coronary heart vessels), pass a series of tests, obtain a cardiogram and ultrasound examination data.

The preoperative preoperative process itself begins approximately 10 days before the announced bypass date. At this time, along with taking tests and conducting an examination, the patient is taught a special breathing technique, which will subsequently help him recover from the operation.

How long does the operation take?

The duration of CABG depends on the condition of the patient and the complexity of the surgical intervention. As a rule, the operation is performed under general anesthesia, and in time it takes from 3 to 6 hours.

Such work is very time-consuming and exhausting, so a team of specialists can perform only one heart bypass. How long they live after surgery (the statistics given in the article allows you to find out) depends on the experience of the surgeon, the quality of CABG and the recovery capabilities of the patient's body.

What happens to the patient after the operation?

After surgery, the patient usually ends up in intensive care, where he undergoes a short course of restorative breathing procedures. Depending on the individual characteristics and capabilities of each, a stay in intensive care may well stretch for 10 days. Then the operated person is sent for subsequent recovery to a special rehabilitation center.

Seams, as a rule, are carefully treated with antiseptics. In case of successful healing, they are removed for about 5-7 days. Often in the area of ​​\u200b\u200bthe seams there is a burning sensation and pulling pain. After about 4-5 days, all side effects disappear. And after 7-14 days, the patient can already take a shower on his own.

Bypass Statistics

Various studies, statistics and sociological surveys of both domestic and foreign specialists speak of the number of successful operations and people who have undergone this and completely changed their lives.

According to ongoing studies regarding bypass surgery, death was observed in only 2% of patients. The case histories of approximately 60,000 patients were taken as the basis for this analysis.

According to statistics, the most difficult is the postoperative process. In this case, the survival process after a year of life with an updated respiratory system is 97%. At the same time, a number of factors affect the favorable outcome of surgery in patients, including individual tolerance to anesthesia, the state of the immune system, and the presence of other diseases and pathologies.

In this study, the experts also used data from the medical history. This time 1041 people took part in the experiment. According to the test, about 200 of the studied patients not only successfully underwent the implantation of implants into their bodies, but also managed to live to the age of ninety.

Does heart bypass help with heart defects? What it is? How long do they live after surgery? Similar topics are also of interest to patients. It is worth noting that in severe cardiac anomalies, surgery can become an acceptable option and significantly prolong the life of such patients.

Heart bypass surgery: how long do they live after surgery (reviews)

Most often, CABG helps people live without problems for several years. Contrary to the erroneous opinion, the shunt created during surgery does not clog even after ten years. According to Israeli experts, implantable implants can last 10-15 years.

However, before agreeing to such an operation, it is worth not only consulting with a specialist, but also studying in detail the reviews of those people whose relatives or friends have already used the unique bypass method.

For example, some patients who underwent heart surgery claim that after CABG they experienced relief: it became easier to breathe, and the pain in the chest region disappeared. Hence, heart bypass surgery helped them a lot. How many people live after the operation, reviews of people who actually got a second chance - you will find information about this in this article.

Many argue that their relatives took a long time to recover from anesthesia and recovery procedures. There are patients who say that they underwent surgery 9-10 years ago and are now feeling well. In this case, heart attacks did not recur.

Do you want to know how long people live after heart bypass surgery? Reviews of people who have undergone a similar operation will help you with this. For example, some argue that it all depends on the specialists and their skill level. Many are satisfied with the quality of such operations carried out abroad. There are reviews of domestic mid-level health workers who personally observed patients who underwent this complex intervention, who were already able to move independently by 2-3 days. But in general, everything is purely individual, and each case should be considered separately. It happened that the operated ones led an active lifestyle after more than 16-20 years after they made hearts. What is it, how many people live after CABG, now you know.

What do experts say about life after surgery?

According to cardiac surgeons, after a heart bypass surgery, a person can live 10-20 years or more. Everything is purely individual. However, according to experts, this requires regular visits to the attending physician and a cardiologist, examinations, monitoring the condition of implants, following a special diet and maintaining moderate but daily physical activity.

According to leading doctors, not only elderly people, but also younger patients, for example, those with heart disease, may need surgical intervention. They assure that the young body recovers faster after the operation and the healing process is more dynamic. But this does not mean that you should be afraid to do bypass surgery in adulthood. According to experts, heart surgery is a necessity that will extend life by at least 10-15 years.

Summary: as you can see, how many years people live after heart bypass surgery depends on many factors, including the individual characteristics of the body. But the fact that the chance to survive is worth taking advantage of is an indisputable fact.

Shunting is called surgical intervention, during which a new path for blood circulation is created in order to bypass the damaged area of ​​the vessel, for this purpose special shunts are inserted.

If you make a literal translation of the English word "shunt", you get a "branch". This method is used mainly on the heart, however, it can be done on the brain, with excess weight - on the gastrointestinal tract.

Damage to the walls of blood vessels occurs due to cholesterol plaques that accumulate on them throughout life. Thus, the lumen of the vessel is blocked, preventing the blood flow from functioning normally.

The heart receives nutrients and oxygen from the blood that moves through the coronary arteries, if they are blocked, it is necessary to perform coronary artery bypass grafting or CABG for short.

Bypass surgery is performed after a heart attack, diagnosed angina pectoris, or as a prevention of a heart attack if the blood vessels are too narrowed. As already mentioned, a shunt is an artificially created vessel that will help blood flow to bypass the damaged area. For a shunt, a small section of a healthy artery is taken, it can be the saphenous vein of the lower leg, thigh, or radial vein. It can be taken from the patient himself. Sometimes plastic prostheses act as a shunt. For example, if you need not one shunt, but many.

If in stressful situations, physical exertion, and even at rest, pain began to appear, an examination should be carried out. After all, these are the first signs of impaired functioning of the heart.

Indications for shunting

Shunting can be performed according to the main indications or according to the patient's condition, if this method is recommended to him by a specialist.

In medical practice, there are three main indications for such an operation:

1. Left artery, fifty percent damaged.
2. The diameter of all blood vessels is less than thirty percent.
3. With a severely damaged anterior interventricular artery, at its beginning.

Bypassing the heart after a heart attack helps to eliminate ischemia, so blood flow is restored, and the risk of relapses is reduced.

Contraindications for this procedure

Just like any other operation, shunting has its contraindications, and they are as follows:

• A lot of blood vessels are affected, while the area of ​​damage is versatile.
• A sharp failure in the left ventricle, when the ejection function from it is less than thirty percent.
• Failures in the work of the heart, when it cannot pump the necessary amount of blood.

In addition to individual contraindications, there are also general ones, for example, diseases that develop in parallel with a heart attack, chronic lung diseases, and cancerous pathologies. However, each patient is considered on an individual basis.

And as for the elderly, this is most likely a risk factor during the operation itself, and not a contraindication to it.

Preparation for bypass surgery

After the patient is taken to the clinic, he signs certain documents and gives his consent (on paper) for the doctors to conduct the necessary studies and the operation itself.

As an examination, electrocardiography, various tests, a contrast x-ray of the coronary vessels are performed (this will make it possible to establish the area of ​​​​damage to the vessel). The patient is told the essence of the intervention and how to breathe.

In addition, there are other important points:

• The day before the surgery, the person should eat and drink, this will be the last time before the surgery.
• The areas where the incision will be made for surgery and vein harvesting for the bypass must be shaved.
• On the eve of the evening and in the morning, the intestines should be freed from food debris, and immediately before the operation, take a shower.
• Medicines should also be taken after the last meal.
• The day before the operation, the doctor who will operate and the staff helping him make a plan for the surgical intervention.

How is the operation itself

To date, there are several methods of shunting:

• With the help of artificial blood flow.
• Without artificial blood flow, but with the use of a "stabilizer" for shunting.
• Endoscopic operations, that is, mini instruments are used for this, for which it is necessary to make only small incisions or punctures. Thanks to this method, the patient loses less blood, experiences less pain and discomfort immediately after the intervention.

The first method is usually used, for this patient is introduced into general anesthesia. The sternum is opened, the heart is stopped and the patient is transferred to an artificial blood flow apparatus. This means that the patient's blood is now passed through the apparatus, saturated with oxygen there and returned to the patient's body again.

The surgeon first removes the graft (vein from the patient's body) and sews it into the blood vessel in such a way as to bypass the affected (blocked) area. The entire procedure takes three to six hours.

But in recent times, surgeons often practice bypass surgery on a beating heart without connecting an artificial blood flow machine. But this requires another device that will help reduce the heart rate.

Such operations have their own advantages, for example:

• After them, there are practically no complications.
• The patient loses less blood.
• Rapid patient recovery.

What happens after the operation

After the surgical intervention is completed, the patient is disconnected from all devices that are in the operating room and taken to the intensive care unit. The patient will stay there for some time, it all depends on the operation and its complexity. All this time, medical personnel, in particular a nurse, will be nearby.

Her duties include: monitor the vital functions of the patient's body, administer medications, take the necessary tests, conduct research and make dressings. After a certain time, the patient is transferred to another ward, where his condition will be monitored around the clock.

For the first time after the operation, the patient must be in special elastic stockings or bandages. This will prevent swelling of the legs. Gradually, depending on the condition of the patient, he is allowed small physical exertion. The doctor also prescribes a special diet. It is necessary to strictly follow all the recommendations of the doctor so that the rehabilitation period passes quickly and without complications, and the person returns to his usual life.

When the general condition of a person is stabilized, he is discharged and it is recommended to carry out further rehabilitation at home. The most suitable option is to go on vacation to a sanatorium or to a specially designed rehabilitation center.

Positive aspects of shunting

We have already figured out what a heart bypass performed immediately after a heart attack is. However, it should be said that along with this method, stenting is also used. In medical practice, there are no main reasons why one or another method is chosen for the operation.

But doctors can only say one thing - shunting is most effective if:

• There are contraindications to stenting, and the patient has a severe form of angina pectoris, which does not allow him to live normally.
• Several blood vessels are affected at the same time.
• Due to atherosclerotic plaques, an aneurysm of the heart develops.

The results of the operation

If the bypass performed during a heart attack was successful, then this can be recognized by the following consequences:

• The blood circulation of the heart is normalized, respectively, it will receive oxygen and nutrients in the required amount.
• The angina attacks will stop appearing.
• The risk of a heart attack will decrease.
• The working capacity of a person will be restored.
• Feeling better.
• Increased physical activity.
• The risk of death is reduced and life expectancy is increased.
• Treatment with drugs is canceled, it remains only to take medications as a preventive measure.

After bypass surgery, a person leads a normal life, in addition to the fact that he should eat right, avoid stressful situations and permanently get rid of bad habits. It is the latter that is considered the main requirement to exclude relapse.

The body of each person is individual, so the conditions after surgery are different for everyone.

Speaking of a shunt, its service life is approximately ten years, if the patient is young, then more. After the expiration of this period, a second operation should be performed.

Complications

Many patients often ask the same question: “Are complications possible after surgery?” The answer is that in some cases complications may occur, and they manifest themselves as follows:

• High temperature.
• Rapid pulse and rapid heartbeat.
• Pain in the chest or joints.
• Lethargy and weakness in the body.
• The occurrence of an infectious disease.
• Open bleeding.
• Inflammation and accumulated fluid.
• Inflammation of the lungs.

Some experts suggest that this is how the body reacts to the inserted shunt.

So that pathologies do not begin to develop in the lungs, it is recommended that he inflate a balloon up to twenty times a day, so that the lungs will expand and be ventilated.

Bypass surgery is a very important procedure for a sick person, because it can prolong his life. However, it cannot cope with the reason that led the body to such a decision.

The condition of the patient after the operation largely depends on him. Therefore, it is necessary to strictly follow all the advice that the doctor gives him.

As already mentioned, it is necessary to quit smoking and drinking alcohol, balance the daily diet, lead a healthy lifestyle, do physical exercises, take medicines prescribed by a doctor.

In addition, you need to monitor your weight and check your blood for cholesterol levels.

After the patient is discharged from the hospital, he will still feel weak and “broken” for some time. To eliminate this, you need to do physical exercises. But it is worth remembering that the sternum will grow together after the operation for a long time, so you should not give a big load on it. Do not avoid walking in the fresh air, but it is necessary to monitor your pulse.

Take only those medications prescribed by the doctor, do not add or remove anything yourself. If any adverse symptoms appear, you should consult a specialist.

Coronary artery bypass grafting and coronary artery bypass grafting are surgical treatments for the consequences of coronary artery disease. Surgical intervention is indicated in cases where conservative (drug) therapy does not have the desired effect.

IHD (myocardial ischemia) is a pathology that occupies a consistently leading position among all heart diseases. From the consequences of coronary artery disease, mainly from myocardial infarction, thousands and thousands of people die every year in any, even the most prosperous country.

Pathological changes in the coronary arteries are a direct consequence and one of the clinical manifestations. As a result of insufficient supply of blood to the heart muscle, irreversible pathological processes in it increase, and the whole organism as a whole suffers.

Medicines that have been used by cardiologists in the treatment of coronary artery disease for decades were developed to improve the impaired blood supply to the heart muscle. The therapeutic effect of such drugs is the expansion of the coronary arteries. But drugs can only help in certain cases.

Therefore, the development of radical treatment methods and the improvement of the operation itself is a task for cardiac surgeons around the world. After all, the number of people who suffer from the consequences of myocardial ischemia is steadily increasing every year.

Cardiac surgery is the most effective method for coronary artery disease

Until the second half of the 20th century, cardiologists had only drugs in their arsenal, which in many cases could not change the situation dramatically. The question in this case was only about a delay for a while.

Before the operation. Action algorithm

• Hospitalization in a medical institution, after obtaining the consent of the patient (in writing) to conduct both examinations and the surgical intervention itself.
• Filling out forms (special form).
• Carrying out various types of tests and diagnostic studies (electrocardiography and x-rays).
• Conversation with an anesthesiologist.
• Consultation with a specialist in breathing exercises.
• Physician's recommendations for physical therapy.
• Conversation with the priest (at the request of the patient).

• enema;
• treatment of the operation zone (shaving);
• taking prescribed medications.

On the eve of the operation, you can not eat, only pure water is used, no later than midnight, if the operation is scheduled for the morning of the next day.

Operation day. Preparatory activities

• Delivery to the operating room.
• Placement on the operating table.
• Next, the anesthesiologist performs the necessary manipulations (administering the necessary drugs, connecting to monitors and lines for intravenous drug administration).
• The action of drugs and sleep.
• The doctor, making sure that the patient is deeply asleep, gives a signal for intubation.
• Intubation (introduction of an endotracheal tube into the respiratory tract) is performed only after the introduction of anesthetics.
• Next, a probe is applied into the stomach to control gastric secretion.
• A Foley catheter is placed to drain urine.
• Various medications prescribed by the doctor are also used.
• The surgical field is subject to treatment with special antibacterial solutions.
• The patient's body is covered with sterile sheets, the area of ​​surgical exposure is limited.

Operation result

After successful shunting, the following results are provided:

Preservation in many cases of life.

Elimination of negative symptoms of coronary artery disease, which reduces the quality of life of the patient.

Return after a certain period of time to normal life.

Recovery period

The time required for recovery for each may be different, it depends on the individual factors of the patient's body and the characteristics of the course of his illness, its type and degree, as well as the presence of concomitant diseases.

Improvement in well-being comes gradually, although immediately after the operation the patient may feel relief. Almost complete recovery occurs in a few weeks or months.

The essence of the operation and indications

The decision on the need for the procedure is made by the doctor (council of specialists), taking into account:

• Data from laboratory studies.
• Functional studies.
• Radiography and other instrumental studies.

The essence of the operation

Creating an optimal bypass during the surgical intervention, as a result of which the blood supply to the heart muscle will be restored.

Anastomosis

Shunts are used to bypass coronary arteries affected by atherosclerosis. This path in cardiac surgery received a special name - anastomosis.

How is the operation carried out?

1. Natural biological material is used, usually one's own vein. A fragment of a vein is taken from the patient himself (usually from under the skin, in the thigh area).
2. One of its ends is sutured into the aorta.
3. The other end is sutured in the area slightly below the stenosis (narrowing or blockage) into the coronary artery.

Features of the veins in the legs

The veins of the lower extremities are usually less affected by atherosclerosis, they are quite long, large in size and easy to reach for a cardiac surgeon. Circulatory disorders after surgery in the legs are usually not severely disturbed, the recovery process is relatively fast.

Common complaints after surgery concerning the lower extremities

In the first postoperative period, patients complain of leg pain. Especially the pain increases with active load (walking long distances, standing for a long time).

Attention! In the past few years, cardiac surgeons have increasingly used arteries rather than veins as bypasses. A fragment of the artery is taken either from the zone of the inner surface of the chest, from the zone of the forearm. The use of both venous and arterial vessels has its pros and cons. Therefore, the choice of material for the shunt is the prerogative of the doctor, who will make the best decision.

Coronary artery bypass grafting and coronary artery bypass grafting. Is there a difference?

The purpose of the operation is to create a new channel through which the heart will be supplied with blood. Blood from the aorta will begin to flow freely through the shunt created by the cardiac surgeon into the coronary artery. Hence the term "coronary artery bypass grafting".

When the internal mammary artery is used as a shunt, it is not required to suture it to the aorta, since the surgeon separates it from the patient's ribs and his sternum, then cuts off its lower part, which is sewn to the coronary artery.

After a successful operation, the distribution of blood flow to the heart muscle occurs already from the sternum and ribs. The term "coronary bypass" refers to such a case, since here the artery (internal thoracic) does not depart from the aorta.

In the medical literature, in general, both terms are freely used, the authors do not set themselves the task of strictly adhering to a strict formulation. Both methods can be called so and so, although this is not exactly the same.

Advantages of the artery during coronary artery bypass surgery

Such a shunt is currently considered to be more durable and more adapted to long-term and trouble-free operation in extreme conditions, namely in the case of high blood pressure. In the aorta, the pressure is at its highest. However, each specific case requires making its own decision, therefore it is impossible to say unequivocally that the artery is always better.

Reference. The medical literature provides the following information:

Shunt from a vein. Able to work for at least ten years from the date of the operation (at least 65% of cases). In 80-90%, the service life (guaranteed risk of blockage) is about a year.

Shunt from an artery. 12 months after surgery almost 100% of cases - there are no malfunctions (a fragment taken from the chest). 10 years - about 90% of cases.

Shunt from the forearm. Perfect work 12 months in 92-93.5% of cases, 5 years - about 82-84% of cases.

Operation coronary artery bypass grafting (ACS). Is cardiac arrest necessary?

During the operation, cardiac surgeons open the chest, this is an inevitable action. Whether a cardiac arrest is necessary is decided on a case-by-case basis.

How is the choice made?

Taken into account:

• The results of coronary angiography.
• Expert assessment of the degree of damage to the coronary arteries.
• Individual features of the patient.

Attention! If a diagnosis of “multifocal damage to the coronary arteries of the heart muscle” is made, including combined pathologies of the myocardium, for example, post-infarction aneurysm of the left ventricle, as well as a congenital or acquired defect that requires radical treatment, then coronary bypass grafting is necessarily performed on a stopped heart with the provision of cardiopulmonary bypass.

Use of a heart-lung machine

The first options, which were made at the beginning of the introduction of this method, were carried out purely on a stopped heart. In this case, almost complete disclosure of the chest is necessary. The duration of the entire operation depends on the number of anastomoses created (from 3-4 to 6 or even more hours).

essence:

The operation is performed using a special heart-lung machine.

Blood from the heart muscle is drained into a special apparatus.

In the apparatus, the blood is filled with oxygen.

Then enriched blood enters the organs and systems of the body, bypassing the heart muscle.

The blood in the apparatus is filtered, cooled or, conversely, warmed, depending on the need, thereby maintaining the required temperature of the patient's body.

Result:

A cardiac surgeon is engaged in the creation of an anastomosis during cardiopulmonary bypass, which is located between the vein and the coronary artery. Anastamosis is located below the narrowing of the coronary artery. After the restoration of cardiac activity, the other end of the vein is sewn to the aorta.

Flaws

During the operation, functional disorders of some organs and systems are possible (from 5 to 15% of all those operated on):

• Brain.
• Lungs.
• Kidney.
• Cookies, etc.

Fortunately, in the overwhelming majority of cases, such processes are reversible. These complications do not adversely affect the patient's health after surgery.

The risk group includes older people who suffer from serious diseases (liver, lungs, kidneys, cerebral vessels).

Postoperative Recovery

The rehabilitation process in this case takes a longer time, since the opening zone is significant and a certain period is required for its restoration. Therefore, rehabilitation can take several months.

Operation on a beating heart

Less traumatic option, which is widely used at the present time. This technique has become possible thanks to the achievements of modern medicine and the use of endoscopic techniques.

essence:

An incision is made in the intercostal space.

A special expander is introduced.

The dilator provides access to the cardiac surgeon and, in addition, helps to reduce myocardial contractility.

Benefits of beating heart surgery

• Preservation of bone integrity.
• Low chance of infection.
• Minor bleeding.
• Less pain.
• Possibility of deep spontaneous breathing during the operation.
• Short operation period (about an hour or two).
• Not a long and not difficult rehabilitation period (staying in a hospital for several days).

The main two pluses:

1. There are no age restrictions (successful operations of the older age group - after 80 years).
2. The presence of serious concomitant diseases does not play a role.

Reference. Such an operation is well tolerated by patients, but requires the highest skill of a cardiac surgeon. For example, only a few of the world's leading clinics have the highest rates (mortality of 0.5% on coronary bypass surgery).

Although the operation on a stopped heart is longer, it is much easier for the doctor. The following fact confirmed from the point of view of medicine is also interesting.

Operation on a beating heart is less traumatic for the patient in terms of the impact on intellectual abilities in the future.

Figures are given - at the time of discharge from the hospital, patients note a decrease in intelligence (at least 53% of those operated on using cardiopulmonary bypass).

After about six months, about 25% of patients demonstrate reduced intelligence to one degree or another. Such problems generally do not occur in those who have undergone surgery on a functioning heart.

Is a repeat coronary bypass surgery necessary?

In some cases (this is about 1-2%), a second operation is required after a certain time.

The rehabilitation period after coronary artery bypass grafting. What to pay attention to?

Do not think that after the operation the problems disappeared forever.

Despite the apparent good health and even in the absence of complaints at all, it is necessary:

• Strictly observe a certain diet aimed at anti-atherosclerotic measures.
• Be sure to stop smoking tobacco and other bad habits.
• Stabilize the mode of work, work and rest.
• Take prescribed supportive medication.
• Regularly visit a cardiologist at the place of residence, who will monitor the patient in dynamics.
• Pass the examinations prescribed by the doctor, follow all the instructions of the specialists.

Bypass surgery is a panacea that gets rid of coronary heart disease once and for all. The operation allows in the vast majority of cases to save a life, but it does not eliminate the main cause that caused the pathology.

Life after surgery

Stay in the intensive care unit for several days, under constant supervision. The decision to transfer to a regular ward is made by the doctor. The initial postoperative period is characterized by a ban on physical activity, which should be minimal. At first, it is recommended to roll over from side to side, in order to avoid the formation of bedsores.

The recovery schedule depends on many factors and is determined by the doctor individually. First, they are allowed to sit down. Then walk within the ward and department, then in the fresh air. The final stage is climbs and lists on the stairs.

To eliminate edema on the leg where the shunt was taken, it is recommended to use special compression stockings (slimming stockings).

When are stitches removed?

After seven to ten days on the leg, on the chest - just before discharge.

Rules of conduct after discharge

• The ban on lifting weights weighing more than five kilograms (the term is negotiated with the doctor).
• Permit to drive a car - usually 60-70 days after issuance.
• Return to work - after six weeks (mental work), after two to three weeks in the case of sedentary simple activities.
• Sexual life - the terms are negotiated with the doctor.

Particular attention is paid to nutrition. Improper nutrition will quickly lead to the formation of new atherosclerotic plaques and aggravation of the disease. Such actions of the patient can lead to death. The diet is required to be followed throughout life, regularly passing laboratory tests (lipids and cholesterol).

Forecasts

First two weeks. There is a possibility of blockage due to blood clots. Such a process is possible both during the first two weeks and in the next 12 months. Aspirin reduces the risk by 50%.

next five years. Scar tissue may form. risk of developing atherosclerosis.

next ten years. The likelihood of blockage, therefore, it is necessary to tune in to the constant intake of special drugs recommended by the doctor.

Medical History of the President

Of course, it is impossible not to guess that we are talking about Clinton.

No matter how many articles you open about coronary artery bypass surgery, Clinton's name will be mentioned in 99% of cases.

Have you ever wondered why?

Everything is very simple, because the history of the illness of the president of America is very typical for any unknown layman, whether he is a resident of a prosperous country, or a remote place in Russia, some regional center that America has never heard of.

In America, unlike Russia, and other countries of the former USSR, they attach great importance to the appearance of sports and promote healthy eating and an active lifestyle in every possible way.

This is not surprising, because America is a country of very fat citizens who eat fast wood and wash it all down with dozens of liters of Coca-Cola. The passion for such food and drinks led to the fact that doctors began to sound the alarm - something must be done about it!

Now many other countries, including Russia, are following a similar path. Food in bags that have no nutritional value, all kinds of crackers, chips and all kinds of rubbish in bright attractive wrappers with an abundance of fats, carbohydrates, chemical ingredients in the form of sweeteners, flavor enhancers, dyes, flavors, etc. etc. All this cannot but “shoot”!

As for Clinton, it was also a matter of burdened heredity and a passion for restaurant, not always healthy food. The president, who was only 58 years old at the time, was shocked. How? He is not overweight, and sometimes he does sports. Everyone associates a taut figure with health, but here everything was the other way around.

Clinton's examination showed that a violation of blood flow was already recorded in four coronary arteries, and the narrowing was 90%. Four anastomoses were needed.

Given the running process, surgery was performed on a stopped heart muscle. Cardiac surgeon Craig Smith performed the operation almost all day - from eight in the morning until half past five in the evening.

The rehabilitation period went well and the prognosis was optimistic. But the state of health did not return to normal and left much to be desired, although enough time had already passed.

Presidents are not celestials, they are people too. The examination showed the development of a rare complication - a cicatricial adhesive process, which was found in the chest.

As the president's attending physician later reported, such a process was observed in his entire medical practice in only ten people (out of 6,000 cases).

The situation was aggravated by the fact that often measures to remove scar tissue give only a temporary effect, since the process tends to be repeated. In such cases, repeated operations are required, how many there will be - no one knows.

What can be the conclusion?

Any pathology is much easier and easier to prevent than to go to doctors' offices later. Moreover, if there is a genetic predisposition, you should pay attention to every little thing in your life - what you ate, what you drank, how you rested, how you worked, how much you were outdoors and how many packs of cigarettes you smoked the day before.

Conclusion. Coronary artery bypass surgery is performed in cases where medication does not work. For the success of the operation, it is necessary to behave correctly in the postoperative period. A special diet, prescribed medications and general preventive measures make the prognosis favorable.

Shunting is an extremely complex operation that is performed on the vessels. Its purpose is to normalize and restore blood circulation throughout the body, as well as each individual organ.

The bypass procedure is always associated with certain risks, although in most cases it is this operation that allows you to return a person to life. Until recently, it was available only to patients with great financial resources. Everyone else had to be content with only vague hopes. At the moment, the picture is already completely different, but many still do not even know what heart bypass surgery is.

• Show all

  The essence of the operation

  Shunting artificially creates a new pathway for blood flow. If you understand how to do shunting, then first of all it should be noted that it is carried out using a vascular shunt. His surgeons are looking for the patient himself in the internal mammary artery, whose health requires surgical intervention. For similar purposes, doctors can use the radial arteries of the hands, or the large veins of the legs.

  

  Indications for carrying out

  The main indication for shunting is usually the presence of coronary heart disease - a chronic disease, the final stage of which can be myocardial infarction. Ischemia is associated with damage to the coronary arteries responsible for the nutrition of the heart muscle. It is in these arteries that cholesterol is deposited. At a certain stage, these deposits lead to a narrowing of the lumen inside the vessel, and, as a result, a deterioration in the access of blood to the heart muscle, as well as a subsequent oxygen deficiency.

  

  According to patients, chronic coronary heart disease is often associated with pain behind the sternum, next to the heart muscle. In advanced cases, there is a possibility of tissue necrosis and the muscle itself. In this case, angina ("angina pectoris") is usually put as a diagnosis. The work of the heart in conditions of affected blood vessels leads to the fact that it wears out very quickly and may need to be renewed.

  Coronary artery bypass grafting of the heart vessels, carried out on the recommendation of doctors, usually helps to bring the body back to normal. To ensure moral readiness for the upcoming operation, the patient should talk with their loved ones, feel their support, and also talk in detail with their doctor.

  

  intervention in atherosclerosis

  According to most experts, the use of surgery is an extreme measure that can be used only when all other methods of treatment can no longer have the desired effect. These cases include ischemic or coronary heart disease (CHD), as well as atherosclerosis, which has similar symptoms.

  

  In the formation of atherosclerosis, cholesterol is also of particular importance, but in this case, the deposits of this compound do not just narrow the vessels, but completely block them. Therefore, the likelihood of coronary heart disease, or atherosclerosis, directly depends on the amount of cholesterol accumulated inside the body. Excessive amount of it with a probability of 100% will cause narrowing and blocking of the vessels of the heart. As a result, oxygen does not enter the heart (or does, but very poorly) and myocardial hypoxia is formed.

  

  Types of heart bypass surgery

  Conventionally, there are three options for aortocoronary bypass grafting (CABG):

  1. 1. single;
  2. 2. double;
  3. 3. triple.

  

  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.

  Preparatory stage

  On the eve of surgery, the patient is sent for coronary angiography (a method for checking the condition of the coronary vessels of the heart). In addition, you will need to pass some tests, undergo an ECG and ultrasound.

  

  The preparation period for the operation begins 1.5 weeks before the day when the bypass surgery is scheduled. In parallel with the delivery of tests and the passage of various studies, the patient masters the special breathing technique necessary for recovery in the postoperative period.

  Operation duration

  The duration of a heart bypass operation may vary depending on the condition of the patient and how difficult the surgery will be. In most cases, the patient is given general anesthesia, and he is on the operating table for 3-6 hours.

  

  The shunting process is very time consuming and extremely exhausting. For this reason, one team of specialists is allowed to perform only one such operation per day. Life expectancy after bypass surgery depends on the experience of the surgeon, how well the CABG was performed, and the body's own ability to recover.

  Postoperative period

  When the operation is over, the patient is usually taken to the intensive care unit, where he will need to undergo a short course of procedures related to restorative breathing exercises, which he mastered even before the bypass.

  

  Taking into account certain individual moments, the patient may not leave the intensive care unit for up to 10 days after heart surgery. After the operation, the patient is given a referral to stay in a special rehabilitation center for the purpose of subsequent final recovery.

  All this time, the seams are regularly treated with antiseptics. This is usually accompanied by burning and pulling pain. If the healing process is successful, then the stitches are removed after a maximum of a week. All adverse symptoms disappear within five days, and after one or two weeks, the operated person is already able to take a shower on his own.

  Forecast of a successful outcome

  Accurate information about how many bypass surgeries ended successfully, as well as how many people returned to normal life after that, or even managed to radically change it, can be obtained from statistical data. In addition, there are numerous results of studies and sociological surveys on this topic, the authors of which are both domestic and foreign experts.

  

  According to studies on CABG, the probability of death is only 2% of the total numbersick. These results were obtained through the analysis of case histories of more than, than 60 thousand examined.

  According to statistics, the most difficult stage on the road to recovery is the postoperative phase. After updating the respiratory system, 97% of those operated on live for at least a year. Those who survived these 12 months are no longer in danger of dying from the consequences of surgery.

  The favorable outcome is determined by how the patient tolerates a particular type of anesthesia, how strong the defenses of his body are and whether he has pathologies or diseases of other organs and systems.

  

  Another study conducted by experts on the basis of data reflected in the medical records of more than a thousand people. The results of this testing showed that approximately 20% of the subjects not only did not experience any complications and problems, but were able to live to their ninetieth birthday.

  Lifespan

  In most cases, heart bypass surgery after a heart attack "gives" a patient suffering from coronary heart disease at least a few more years of life. Despite widespread beliefs, the shunt installed by the surgeon will not clog even after 10-15 years of life, these are the data of Israeli doctors.

  

  However, despite the high likelihood of success, you should not rush right off the bat and insist on the operation without consulting with a specialist and without reading the reviews of those who have already had experience of going through this procedure.

  It happens that operated patients note a general relief of the condition: the breathing process is simplified, pain in the chest area disappears. In this case, one can judge the extraordinary effectiveness of the operation. Sometimes, relatives of the patient note that recovery from anesthesia and other procedures can take a long time. There are also reviews previously about operated people who have been living for ten years and do not have any complications, especially since they have not had cases of recurrence of heart attacks.

  Expert opinions

  Cardiac surgeons believe that a person who has undergone heart bypass surgery can live up to 20 years after the operation, of course, if at the same time he does not treat his health too dismissively. In addition, it is recommended to visit the attending physician and cardiologist with a certain regularity, undergo examinations, monitor the condition of the implants, adhere to the prescribed diet and devote time to physical activity.

  In most cases, doctors refer not only elderly people to surgery, but also younger patients if they have a heart defect. According to them, surgery is tolerated by young people much easier, and the rehabilitation process takes much less time. However, this is not a reason to be afraid of the bypass procedure if you have already reached a more mature age, especially since it will increase life expectancy by a decade and a half.

  

  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: 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.
  • Is it possible to perform cardiac catheterization after bypass surgery? A: Yes, this is perfectly acceptable. In this case, the blood supply is restored, even if the patient's coronary disorders are quite complex. 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.
  • Does pain in the heart after surgery mean that it was unsuccessful: If the patient feels heart pain 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.
  • Should Medications Be Taken Long After Bypass Surgery?: surgery for heart bypass is such an event in which there is no cure for concomitant diseases. Medications are required. They will stabilize blood pressure, maintain a certain level of glucose in the bloodstream, regulate cholesterol, triglyceride.