Extra coronary bypass surgery. Complications and their treatment

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

Cardiac stenosis

Coronary heart disease (CHD) is a common cardiovascular pathology. Statistics show that seven million people die every year from causes related to this disease. The average age of death for ischemic heart disease is 40 years. In severe and complicated forms, life expectancy is relatively low - less than 2 years.

Bypass surgery of the heart vessels is indicated for significant narrowing of the lumen of the coronary vessels, leading to ischemia of the heart muscle. IHD provokes the process of vascular sclerotization. Calcium-cholesterol plaques are deposited on the inside of the artery, causing partial or complete blockage of a person's 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 lesions with an ejection fraction of less than 50% or with severe inducible ischemia.
3. damage to one or two vessels, but with a large volume of myocardium fed by them.

Other indications for cardiac bypass surgery:

• developing myocardial infarction;
• stable angina pectoris, resistant to drug therapy (attacks of chest 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 patient’s quality of life improves. 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! Coronary heart disease is a disease of adults and rarely occurs in children. Sclerotization of blood vessels worsens with age, although the process can begin even in a child. Coronary surgery in these cases is used to treat children or newborns extremely 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:

• renal failure;
• large focal stroke;
• widespread damage to all coronary vessels;
• end-stage heart failure.

What is heart bypass surgery?

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 variety is mammary coronary bypass surgery, 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.

CABG

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

Bypass surgery of the heart vessels is performed under IR conditions (artificial blood circulation) or on a beating heart. For various complications and pathological conditions, as a rule, preference is given to IR.

How to prepare for coronary artery bypass surgery?

The day before coronary artery bypass surgery, the patient should refuse to eat. It is necessary to prepare the intestines for surgery to avoid complications. In the place where the chest is supposed to be cut, you need to remove the hair. You should shower before surgery in the hospital.

Prescribed medications are taken for the last time the day before surgery. 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 tests are performed - coronary angiography, ECG and blood tests.

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

• biochemical and clinical blood test;
• X-ray of the chest organs;
• echocardiography;
• stool and urine analysis;
• coronary angiography;
• ECG (bicycle ergometry).

How is coronary artery bypass grafting performed?

Before coronary artery bypass surgery, the patient is administered 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 cut before the procedure. The chest takes a long time to heal. 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 the connection of a device for artificial circulation. The aorta is clamped, the heart is connected to the IC, and the cardiac surgeon performs coronary artery bypass grafting: a shunt (for example, a vein) is isolated and sutured 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 surgery, special metal wire staples 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 remains 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 monitor him for some more time. The bandages of the operated patient are removed after the sutures have healed. The percentage of successful outcomes with coronary artery bypass surgery is quite high.

Rehabilitation in the postoperative period and possible complications

After CABG, any water procedures are contraindicated. The sutures on the legs and arms (the place where the veins are taken) can become infected, so it is necessary to treat them daily with bactericides and bandage them. To quickly heal the chest, it is recommended to wear a special bandage on the chest. If this condition is not observed, the seams may come apart and complications may arise.

Often in the period after CABG there is pain, which lasts up to a year and usually disappears spontaneously. Complications occur quite rarely.

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

• inflammation of the heart sac;
• 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, mortality statistics among those operated on are the same as among healthy people. Much depends on how the operation was performed and how many total operations were performed on the patient.

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

Cardiac rehabilitation

After a few months and in subsequent years, a series of examinations are carried out to identify complications in a timely manner:

• ECG (bicycle ergometry);
• tonometry;
• blood chemistry;
• EchoCG;
• Magnetic resonance imaging;
• coronary angiography;
• chest x-ray.

Advice! Many patients wonder whether it is possible to have an MRI 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 performed.

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

The lifespan of the shunt is approximately 7-9 years in older people, and 8-10 in younger people. At the end of its lifespan, repeat heart bypass surgery will be required, but new complications may arise after this.

Shunts

If the intervention is successful, patients recover completely. However, if the operation is performed poorly, they live after heart bypass with a complex of complications that require additional treatment.

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

Coronary artery bypass surgery qualitatively changes the life and well-being of the patient. Blood flow in the heart muscle and a number of other things are normalized:

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

CABG returns patients to a full, healthy life. In 60% of patients, cardiovascular symptoms disappear after surgery, in 40% they change, and 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. Vascular 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 surgery

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 availability of multidisciplinary specialists determine the cost of this treatment. The price depends on the number of shunts, the complexity of the operation for 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 location of the 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 preventing atherosclerosis

Certain preventative measures can prevent blood clots from recurring. General recommendations to help keep your arteries healthy:

1. Add vitamins to your diet. According to research data 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 releases anandamide in the brain, a naturally occurring cannabinoid. Endocannabinoids have cardioprotective effects in small doses. Regular aerobic exercise trains the cardiovascular system.
3. Develop a dynamic stereotype. Try to go to bed, eat, exercise and study at a specific time. A dynamic stereotype is a series of changing useful stereotypes that streamline behavior and relieve unnecessary stress.
4. Add unsaturated fatty acids omega-3 and omega-6 to your food.
5. Limit your intake of fast carbohydrates, salt, fatty and spicy foods.
6. Visit your cardiologist regularly for timely treatment of complications that arise and measure your blood pressure.

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

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

Heart bypass surgery: history, first operation

What is heart bypass surgery? 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 surgery is an operation performed on blood vessels. It is this that allows you to normalize and restore blood circulation throughout the body and in individual organs. The first such surgical intervention was performed 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 essence of surgery?

Bypass surgery 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 require surgical intervention. In particular, for this purpose, doctors use either the radial artery in the arm or the large vein in the leg.

This is how it happens. What is this? How long people live after it is the main question that interests those suffering who are faced with problems of the cardiovascular system. We will try to answer them.

In what cases should heart bypass surgery be performed?

According to many experts, surgical intervention is a last resort, 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, which has similar symptoms.

Let us remember that this disease is also associated with excess cholesterol. However, unlike ischemia, this disease 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 whether it is worth doing such an operation for people in old age? To do this, we have collected answers and advice from experts that 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 blood 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 functioning, doctors usually recommend heart bypass surgery. How long do patients live after surgery, how does it go, how long does the rehabilitation process last, how the daily routine of a person who has undergone bypass surgery changes - all this needs to be known to those who are just thinking about possible surgical intervention. And most importantly, you need to get a positive psychological attitude. To do this, future patients, shortly before surgery, should enlist the moral support of close relatives and have a conversation with their attending physician.

What is heart bypass surgery?

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

• single;
• double;
• triple.

In particular, this division into types 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 requires the introduction of a single bypass, then this is a single, with two - double, and with three - triple heart bypass. What it is and how long people live after surgery can be judged from some reviews.

What preparatory procedures are carried out before bypass surgery?

Before the operation, the patient is required to undergo coronary angiography (a method for diagnosing the coronary heart vessels), undergo a series of tests, receive 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 after the operation.

How long does the operation take?

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

Such work is very labor-intensive and exhausting, so a team of specialists can only perform one heart bypass. How long they live after surgery (the statistics given in the article allow you to find out this) 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 surgery?

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 person, a stay in intensive care may well last for 10 days. Next, the operated patient is sent for subsequent recovery to a special rehabilitation center.

The seams, as a rule, are carefully treated with antiseptics. If healing is successful, they are removed approximately 5-7 days later. Often there is a burning sensation and nagging pain in the area of ​​the sutures. After about 4-5 days, all side symptoms disappear. And after 7-14 days the patient can take a shower on his own.

Shunt Statistics

Various studies, statistics and sociological surveys of both domestic and foreign specialists speak about 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. This analysis was based on the medical records of approximately 60,000 patients.

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

In this study, experts also used data from medical records. This time, 1041 people took part in the experiment. According to the test, approximately 200 patients studied 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 for severe cardiac anomalies, surgery can be an acceptable solution 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 erroneous belief, the shunt created during surgery does not become blocked even after ten years. According to Israeli experts, implanted implants can last 10-15 years.

However, before agreeing to such an operation, you should not only consult with a specialist, but also study in detail the reviews of those people whose relatives or friends have already used the unique bypass method.

For example, some patients who have undergone heart surgery claim that after CABG they experienced relief: it became easier to breathe, and the pain in the chest area disappeared. Hence, they benefited greatly from heart bypass surgery. How long they live after surgery, reviews of people who actually received a second chance - you will find information about this in this article.

Many claim that their relatives took a long time to come to their senses after anesthesia and recovery procedures. There are patients who say that they had surgery 9-10 years ago and are currently feeling well. However, the heart attacks did not recur.

Would you like to know how long people live after bypass surgery? Reviews from people who have undergone a similar operation will help you with this. For example, some argue that everything depends on the specialists and their level of qualifications. Many are satisfied with the quality of such operations performed abroad. There are reviews from 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 those operated on led an active lifestyle more than 16-20 years after their hearts were made. Now you know what it is, how long people live after CABG.

What do experts say about life after surgery?

According to cardiac surgeons, after heart bypass surgery a person can live 10-20 years or more. Everything is purely individual. However, according to experts, for this it is necessary to regularly visit the attending physician and cardiologist, undergo examinations, monitor the condition of the implants, follow a special diet and engage in moderate but daily physical activity.

According to leading doctors, not only older people, but also younger patients, for example, with heart disease, may need surgical intervention. They assure that a young body recovers faster after surgery and the healing process occurs more dynamically. But this does not mean that you should be afraid to undergo bypass surgery in adulthood. According to experts, heart surgery is a necessity that will prolong 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 is an indisputable fact.

Bypass surgery is a surgical intervention during which a new path for blood circulation is created 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 “branch”. This method is used mainly on the heart, however, it can be done on the brain, and if you are overweight, 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 blood flow from functioning normally.

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

Bypass surgery is performed after a heart attack, diagnosed angina, or as a preventive measure for 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 bypass the damaged area. For a shunt, a small section of a healthy artery is taken, this can be the saphenous vein of the 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 pain begins to appear in stressful situations, physical activity, and even at rest, an examination should be performed. After all, these are the first signs of cardiac dysfunction.

Indications for bypass surgery

Bypass surgery can be performed according to the main indications or 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. The left artery is fifty percent damaged.
2. The diameter of all blood vessels is less than thirty percent.
3. With severely damaged anterior interventricular artery, at its beginning.

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

Contraindications to this procedure

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

• Many blood vessels are affected, and the affected area is varied.
• A sharp failure in the left ventricle, when the ejection function from it is less than thirty percent.
• Malfunctions of the heart when it cannot pump the required 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 cancer pathologies. However, each patient is considered individually.

As for old age, 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 carry out the necessary studies and the operation itself.

The examination includes electrocardiography, various tests, and contrast x-rays of the coronary vessels (this will make it possible to determine 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 surgery, a person should eat and drink, this will be the last time before surgery.
• The areas where the incision will be made for the operation and veins to be taken for the shunt will need to be shaved.
• The night before and in the morning, you should empty your intestines of food debris, and take a shower immediately before the operation.
• Medicines should also be taken after the last meal.
• The day before the operation, the doctor who will operate and the staff assisting him draw up a plan for the surgical intervention.

How does the operation itself take place?

Today, there are several methods of bypass surgery:

• Using artificial blood flow.
• Without artificial blood flow, but with the use of a “stabilizer” for bypass surgery.
• 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 and experiences less pain and discomfort immediately after the intervention.

Usually the first method is used, for this the patient is put under general anesthesia. The sternum is opened, the heart is stopped and the patient is transferred to a cardiopulmonary bypass machine. This means that the patient's blood is now passed through the machine, saturated with oxygen there and returned to the patient's body.

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

But recently, surgeons often practice bypass surgery on a beating heart, without connecting an artificial blood flow machine. But for this you need another device that will help reduce the heart rate.

Such operations have their advantages, for example:

• There are practically no complications after them.
• The patient loses less blood.
• Fast patient rehabilitation.

What happens after surgery

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 remain there for some time, it all depends on the operation performed and its complexity. All this time, medical personnel, in particular a nurse, will be nearby.

Her responsibilities include: monitoring the vital functions of the patient’s body, administering medications, taking the necessary tests, conducting research and making bandages. 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 surgery, the patient must wear special elastic stockings or bandages. This will prevent swelling of the legs. Gradually, depending on the patient’s condition, he is allowed to undergo minor physical stress. The doctor also prescribes a special diet. It is necessary to strictly follow all the doctor’s recommendations so that the rehabilitation period passes quickly and without complications, and the person returns to his normal life.

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

Positive aspects of bypass surgery

We have already figured out what heart bypass surgery 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 performing an operation.

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

• There are contraindications to stenting, and the patient has a severe form of angina, which prevents him from living normally.
• Several blood vessels are affected at the same time.
• Due to atherosclerotic plaques, a cardiac aneurysm develops.

Results of the operation

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

• The blood circulation of the heart is normalized, and accordingly it will receive the required amount of oxygen and nutrients.
• Angina attacks will stop appearing.
• The risk of heart attack will decrease.
• The person’s performance will be restored.
• You will feel better.
• Physical activity increases.
• The risk of death is reduced and life expectancy increases.
• Treatment with drugs is canceled, only taking medications as a preventive measure remains.

After bypass surgery, a person leads a normal lifestyle, except that he should eat right, avoid stressful situations and get rid of bad habits forever. It is the latter that is considered the main requirement for eliminating relapse.

Each person’s body is individual, so the conditions after surgery are different for everyone.

Speaking about the shunt, its service life is approximately ten years, if the patient is young, then longer. After this period has expired, a repeat 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 arise, 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 emergence of an infectious disease.
• Opening bleeding.
• Inflammation and accumulated fluid.
• Pneumonia.

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

To prevent pathologies from developing in the lungs, he is recommended to inflate a balloon up to twenty times a day, thus the lungs will be expanded and 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 patient's condition after surgery largely depends on himself. Therefore, it is necessary to strictly follow all the advice that the doctor gives him.

As already mentioned, you need to quit smoking and drinking alcohol, balance your daily diet, lead a healthy lifestyle, do physical exercise, and take medications prescribed by your 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 continue to feel weak and “broken” for some time. To eliminate this, you need to do physical exercise. But it is worth remembering that the sternum will take a long time to heal after surgery, so you should not put a lot of stress on it. Don't avoid walking outdoors, but you should also monitor your heart rate.

Take only those medications prescribed by your 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 heart disease. Surgery is indicated in cases where conservative (drug) therapy does not have the required effect.

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

Pathological changes in the coronary arteries are a direct consequence and one of the clinical manifestations. As a result of insufficient blood supply to the heart muscle, irreversible pathological processes in it increase, and the entire body 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 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 ischemic heart disease

Until the second half of the 20th century, cardiologists had only medications in their arsenal, which in many cases could not radically change the situation. In this case, the question was only about postponing it for a while.

Before surgery. Algorithm of actions

• Hospitalization in a medical institution, after obtaining the patient’s consent (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-ray).
• Conversation with an anesthesiologist.
• Consultation with a specialist in breathing exercises.
• Doctor's recommendations for physical therapy.
• Conversation with a priest (at the request of the patient).

• enema;
• treatment of the surgical area (shaving);
• taking prescribed medications.

On the eve of the operation, you should not eat, drink only clean water, no later than midnight if the operation is scheduled for the morning of the next day.

Day of surgery. Preparatory activities

• Delivery to the operating room.
• Placement on the operating table.
• Next, the anesthesiologist carries out the necessary manipulations (introducing the necessary drugs, connecting to monitors and lines for intravenous administration of drugs).
• Effect of medications and sleep.
• The doctor, making sure that the patient is deeply asleep, gives the signal for intubation.
• Intubation (insertion of an endotracheal tube into the respiratory tract) is performed only after the administration of anesthetics.
• Next, a tube is inserted into the stomach to control gastric secretion.
• A Foley catheter is installed to drain urine.
• Various medications prescribed by the doctor are also used.
• The surgical field must be treated with special antibacterial solutions.
• The patient's body is covered with sterile sheets, and the area of ​​surgical intervention is limited.

Result of the operation

After successful bypass surgery, the following results are achieved:

Saving in many cases of life.

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

Return after a certain period of time to normal activity.

Rehabilitation period

The time required for recovery may be different for everyone; 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 occurs gradually, although the patient may feel relief immediately after the operation. Almost complete recovery occurs within a few weeks or months.

The essence of the operation and indications

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

• Laboratory data.
• Functional examinations.
• X-rays and other instrumental studies.

The essence of the operation

Creation of an optimal bypass path during surgery, as a result of which the blood supply to the heart muscle will be restored.

Anastomosis

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

How is the operation performed?

1. Natural biological material is used, usually your 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 an area that is slightly below the site of stenosis (an area of ​​narrowing or blockage) in the coronary artery.

Features of veins on the legs

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

Common complaints after surgery concerning the lower extremities

During the first time after surgery, patients complain of leg pain. The pain especially intensifies during active exercise (walking long distances, standing for long periods of time).

Attention! In the past few years, cardiac surgeons have increasingly used arteries rather than veins as bypass grafts. A fragment of the artery is taken either from the area of ​​the inner surface of the chest or from the area of ​​the forearm. The use of both venous and arterial vessels has its pros and cons. Therefore, the choice of material for a shunt is the prerogative of the doctor, who will make the optimal 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 bypass, suturing it to the aorta is not required, since the surgeon separates it from the patient’s ribs and sternum, then cuts off its lower part, which is sutured to the coronary artery.

After a successful operation, blood flow is distributed to the heart muscle from the sternum and ribs. The term “coronary artery bypass grafting” refers to this case, since here the artery (internal thoracic) does not depart from the aorta.

In the medical literature, both terms are generally freely used; the authors do not set out to strictly adhere to the strict formulation. Both methods can be called this or that, although this is not entirely accurate.

Advantages of the artery during coronary artery bypass surgery

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

Reference. Medical literature provides the following information:

Vein shunt. Able to work for at least ten years from the date of surgery (at least 65% of cases). In 80-90% service life (guaranteed risk of clogging) is about a year.

Artery shunt. 12 months after surgery, almost 100% of cases - there are no malfunctions (fragment taken from the chest). 10 years – about 90% of cases.

Shunt from the forearm area. Flawless operation for 12 months in 92-93.5% of cases, 5 years - about 82-84% of cases.

Coronary artery bypass surgery (CABG). Is cardiac arrest necessary?

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

How is the choice made?

Taken into account:

• Results of coronary angiography.
• Expert assessment of the degree of damage to the coronary arteries.
• Individual characteristics of the patient.

Attention! If a diagnosis of “multifocal lesion of 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 surgery must be performed with the heart stopped and artificial circulation provided.

Use of a heart-lung machine

The first options, which were done at the beginning of the introduction of this method, were carried out purely on a stopped heart. In this case, almost complete opening 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).

The essence:

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

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

The machine fills the blood with oxygen.

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

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

Result:

During cardiopulmonary bypass, the cardiac surgeon creates an anastomosis, which is located between the vein and the coronary artery. Anastamosis is located below the narrowing of the coronary artery. After cardiac activity is restored, the other end of the vein is sutured 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.
• Livers, etc.

Fortunately, in the vast majority of cases such processes are reversible. The listed complications do not have a negative impact on 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 area is significant and a certain period is required for its restoration. Therefore, rehabilitation can take several months.

Beating heart surgery

A less traumatic option that is widely used today. This technique became possible thanks to the achievements of modern medicine and the use of endoscopic technology.

The essence:

An incision is made in the intercostal space.

A special expander is introduced.

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

Advantages of beating heart surgery

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

Main two advantages:

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

Reference. This 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 rate of 0.5% for coronary bypass surgery).

The operation on a stopped heart, although it takes longer, is much easier for the doctor. The following medically confirmed fact is also interesting.

Surgery on a beating heart is less traumatic for the patient in terms of its 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 artificial circulation).

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

Is repeat coronary artery bypass surgery necessary?

In some cases (about 1-2%), repeat surgery is required after a certain time.

Rehabilitation period after coronary artery bypass surgery. What should you 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 follow a certain diet aimed at anti-atherosclerotic measures.
• Be sure to give up smoking tobacco and other bad habits.
• Stabilize the work and rest schedule.
• Take prescribed supportive medication.
• Regularly visit a cardiologist at your place of residence, who will monitor the patient over time.
• Carry out examinations prescribed by your doctor and follow all instructions given by specialists.

Bypass surgery is a panacea that eliminates coronary heart disease once and for all. In the vast majority of cases, surgery can save lives, but it does not eliminate the underlying 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 turn over from side to side to avoid the formation of bedsores.

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

To eliminate swelling in the leg where the shunt was taken, it is recommended to use special compression hosiery (compression stocking).

When are stitches removed?

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

Rules of behavior after discharge

• Prohibition on lifting weights weighing more than five kilograms (the period is discussed with the doctor).
• Permission to drive a car - usually 60-70 days after discharge.
• Return to work - after six weeks (mental work), after two to three weeks in the case of sedentary, uncomplicated activities.
• Sexual life - terms are discussed 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 by the patient can lead to death. The diet must be followed throughout life, regularly undergoing laboratory tests (lipids and cholesterol).

Forecasts

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

The next five years. Scar tissue may form. Risk of developing atherosclerosis.

The next ten years. There is a possibility of blockage, therefore it is necessary to tune in to the constant use of special medications recommended by the doctor.

President's medical history

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 medical history of the President of America is very typical for any unknown layman, be he a resident of a prosperous power, or the outback in Russia, or some regional center that has never been heard of in America.

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

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

Now many other countries, including Russia, are going through a similar path. Food in bags that has no nutritional value, all kinds of crackers, chips and all kinds of garbage in bright attractive wrappers with an abundance of fats, carbohydrates, chemical ingredients in the form of sweeteners, taste improvers, dyes, flavors, etc. etc. All this can’t help but “shoot”!

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

Clinton's examination showed that blood flow disturbances had already occurred in four coronary arteries, and the narrowing was 90%. Four anastomoses were necessary.

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

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

Presidents are not celestial beings, 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 during his entire medical practice in only ten people (out of 6,000 cases).

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

What can be concluded?

It is much simpler and easier to prevent any pathology than to then go to doctors’ offices. Moreover, if there is a genetic predisposition, it is worth paying attention to every little thing in your life - what you ate, what you drank, how you rested, how you worked, how much you spent in the fresh air and how many packs of cigarettes you smoked the day before.

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

Bypass surgery is an extremely complex operation that is performed on blood vessels. Its purpose is to normalize and restore blood circulation throughout the entire 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 a person to return to life. Until recently, it was available only to patients with large financial resources. Everyone else had to be content with only vague hopes. At the moment, the picture is completely different, but many still have no idea what heart bypass surgery is.

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  The essence of the operation

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

  

  Indications for use

  The main indication for bypass surgery 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, which are responsible for feeding the heart muscle. It is in these arteries that cholesterol deposits occur. At a certain stage, these deposits lead to a narrowing of the lumen inside the vessel, and, as a result, a deterioration in blood access to the heart muscle, as well as a subsequent oxygen deficiency.

  

  According to patients, chronic coronary heart disease is often associated with painful sensations behind the sternum, next to the heart muscle. In advanced cases, there is a possibility of necrosis of tissues and the muscle itself. In this case, the diagnosis is usually angina pectoris (“angina pectoris”). The work of the heart in conditions of damaged blood vessels leads to the fact that it wears out very quickly and may require renewal.

  Coronary artery bypass surgery performed on the recommendation of doctors usually helps bring the body back to normal. To ensure moral readiness for the upcoming operation, the patient should talk with his loved ones, feel their support, and also have a thorough conversation with his doctor.

  

  Intervention for atherosclerosis

  According to most experts, the use of surgery is a last resort measure that can be used only when all other treatment methods can no longer provide the required effect. Such cases include ischemic or coronary heart disease (CHD), as well as atherosclerosis, which has similar symptoms.

  

  Cholesterol is also of particular importance in the formation of atherosclerosis, but in this case, deposits of this compound not only narrow the vessels, but completely block them. Therefore, the likelihood of developing CAD or atherosclerosis directly depends on the amount of cholesterol accumulated inside the body. Excessive amounts of it are 100% likely to cause narrowing and blocking of the blood vessels of the heart. As a result, oxygen does not reach the heart (or does, but very poorly), and myocardial hypoxia forms.

  

  Types of heart bypass surgery

  Conventionally, there are three options for coronary artery 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 vascular damage: if only one artery is not functioning and only one shunt needs to be inserted, then this is a single type of bypass, two arteries are blocked - double, and three - respectively, triple heart bypass.

  Preparatory stage

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

  

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

  Operation duration

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

  

  The bypass process is very labor-intensive 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 operation was performed, as well as the body’s own ability to recover.

  Postoperative period

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

  

  Taking into account certain individual factors, 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, with the goal of subsequent final recovery.

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

  Forecast of a successful outcome

  Accurate information about how many bypass operations were completed successfully, as well as about how many people returned to normal life after that, or were able 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 the topic of CABG, the probability of death is only 2% of the totalsick. These results were obtained through the analysis of medical histories over, than 60 thousand studied.

  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 his body’s defenses are and whether he has pathologies or diseases of other organs and systems.

  

  Another study conducted by experts based on 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 or problems, but were able to live to their ninetieth birthday.

  Lifespan

  In most cases, heart bypass surgery after a heart attack “gives” the patient who suffered from coronary heart disease at least several more years of life. Despite widespread beliefs, a shunt installed by a surgeon will not become blocked even after 10-15 years of life, these are the data of Israeli doctors.

  

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

  It happens that operated patients note a general relief of their condition: the breathing process becomes easier, pain in the chest area disappears. In this case, one can judge the extreme effectiveness of the operation. Sometimes, the patient’s relatives note that recovery after anesthesia and other procedures can take quite a long time. There are also reviews of previously operated people who have lived for ten years and have no complications, especially since they have not had any cases of recurrence of heart attacks.

  Experts' 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 he does not take his health too seriously. In addition, it is recommended to visit your doctor and cardiologist with some regularity, undergo examinations, monitor the condition of the implants, do not deviate from the prescribed diet and devote time to physical activity.

  In most cases, doctors refer not only elderly people for surgery, but also younger patients if they have a heart defect. According to them, surgical intervention is tolerated much easier by young people, 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 this will increase your life expectancy by one and a half decades.

  

  Popular questions

  Duration of operation of the shunt: Each medical institution has its own data on this matter. As a result, data from Israeli heart surgeons indicate that the shunt can remain in working order for more than a decade. However, venous substitutes last much less.

  • What is a shunt: The term shunt refers to a portion of a vein used as an alternative branch for blood flow, allowing blood to bypass the diseased and blocked artery. At a certain moment, deformation of the vessel walls occurs, individual areas expand, and an accumulation of blood clots of atherosclerotic plaques forms in these areas. An arterial shunt allows you to bypass these accumulations.
  • Is it possible to perform cardiac catheterization after bypass surgery?: Yes, this is quite acceptable. In this case, 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 balloon angioplasty services for other arteries or bypasses.
  • Does pain in the heart after surgery mean that it was unsuccessful?: If a patient experiences heart pain after recovering from surgery or in the later stages of recovery, they should consult a cardiac surgeon to assess the likelihood of a blocked shunt. If the suspicion of this problem is confirmed, then urgent measures will need to be taken, or the patient will soon experience the first symptoms of angina.
  • Should you take medications long after bypass surgery?: surgical intervention for heart bypass surgery is an event in which concomitant diseases are not cured. Taking medications is mandatory. They will stabilize blood pressure, maintain a certain level of glucose in the bloodstream, regulate cholesterol and triglyceride.