Coronary heart disease is the true scourge of the 21st century. Almost every second person suffers from this disease. Some may treat this disease with medication, but some may need surgical intervention. One of the main operations that restore blood flow in the vessels of the heart is coronary bypass surgery.
What it is?
This term began to appear in many medical sources for quite some time. Currently, this operation is almost one of a kind. According to statistics, around a million such interventions are performed annually around the world.
As has been said, most patients with coronary artery disease require coronary artery bypass grafting. Unfortunately, few people know what it is.
The operation of coronary artery bypass grafting involves the imposition of detours on the vessels of the heart.
The operation is extensive and quite difficult.
According to statistics, this operation is carried out only to 12 percent of all those in need. Some have contraindications to its implementation, while others do not always seek medical help.
As soon as the operation appeared, many eminent scientists showed considerable interest in it, however, two years after its creation, the operation was banned. It was reintroduced only a few years later, when this operation began to appear in world publications. Since then, its use has become almost everyday, and many doctors have no other way to cure ischemic heart disease, except for the operation.
Pathogenesis of IHD
Coronary heart disease develops when coronary vessels begin to experience oxygen deficiency. This occurs due to the narrowing of their clearance. There are many reasons leading to narrowing - from congenital malformations and pathological narrowing from birth to a decrease in clearance due to proliferation of atherosclerotic plaques.
Normally, the symptoms of coronary heart disease do not manifest themselves until the lumen is narrowed by more than 70 percent. The clinic can only appear in case of significant physical exertion.
The main signs of coronary heart disease are chest pain, accompanied by shortness of breath and a sense of fear. With a significant narrowing of the coronary vessel, the risk of developing a heart attack increases.
With the ineffectiveness of conservative therapy (taking vasodilator drugs), coronary artery bypass surgery is performed .
Operation progress
The operation is performed on an open heart, i.e. it is necessary to open the chest. An incision is usually made along the costal cartilage on the left.
The patient is connected to a heart-lung machine for the duration of the intervention .
The operation is performed under general anesthesia.
Usually superficial vessels are used to create a shunt (saphenous vein of the leg or internal thoracic artery). The resulting shunt, after its extraction, impose above and below the level of narrowing of the coronary artery and hem inside the vessel. This facilitates blood flow through the affected artery and allows to remove myocardial ischemia.
In some cases, they resort to a transplant of a radial artery, since blood flow through the arteries passes much better.
Currently, they are more inclined to perform operations without the use of cardiopulmonary bypass, since the passage of blood through this unit contributes to damage to red blood cells and hemolysis.
Indications for surgery
Coronary artery bypass grafting is indicated in the following cases:
- Reduced blood patency in the left coronary artery by at least 50 percent. This vessel is the main in the nutrition of the myocardium. Most of the blood flows through it, which is why a block at the level of this vessel is fraught with severe ischemia and myocardial infarction.
- Decreased clearance of all coronary vessels up to 70 percent.
- The presence of stenosis of the anterior interventricular artery (especially at the site of its bifurcation).
These indications are essential for coronary bypass surgery.
In addition to them, side, symptomatic indications can be distinguished. They are caused by frequent bouts of angina pectoris (pain, a feeling of constriction in the chest) and are usually stopped with medication. However, the problem becomes more serious when drug therapy is no longer effective and seizures become more frequent. It is in this case that the issue of bypass should already be raised.
Contraindications
Thanks to the widespread use of information technology, it is not difficult to find out about coronary artery bypass grafting - what it is, what its indications are. Everything is somewhat more complicated with contraindications.
Unlike indications for surgery, all contraindications are relative, since for each patient the question of surgery should be considered on the basis of his specific data.
It was believed that the age of the patient, especially older than 70 years, was a prohibitive factor for the intervention. Currently, many older patients tolerate heart surgery well (this is due to the absence of concomitant chronic diseases that affect hemodynamics). For those who have such diseases, doctors are more likely to transplant a heart and blood vessels (if there are no decompensated conditions).
Previously, coronary artery bypass grafting was not performed in patients with renal failure or an active oncological process. Now you can find information about fairly successful interventions in such patients with a favorable outcome and prolongation of life by more than 10 years.
Patient rehabilitation
Since the operation is quite extensive and difficult, the correct management of patients undergoing coronary artery bypass grafting is of no small importance. After the operation, complications quite often develop, such as impaired lung ventilation (due to the patient’s long presence on mechanical ventilation) and infectious complications.
Prevention of respiratory disorders is carried out by inflating a ball or a special toy. It is more difficult to prevent the development of infectious complications - not always a thorough and timely change of dressings helps to prevent the infectious process.
Be sure to monitor the patient's blood counts, since due to the massiveness of the operation, significant blood loss can often be observed. In this case, the patient simply needs a blood transfusion to make up for its lack.
All patients who underwent this operation - coronary bypass surgery - must undergo rehabilitation for a long time and avoid stress. This is done to prevent the divergence of metal staples placed on the sternum.
Patient opinions regarding surgery
An increasing number of patients undergo intervention on the vessels of the heart. If you look at various sites and forums dedicated to this problem, you can see that many people who have undergone coronary artery bypass grafting have quite positive reviews. The quality of life is significantly improved, and many patients can return to full activity (only after a period of rehabilitation). The number of angina attacks is reduced, which significantly affects daily activity.
Many people ask - how much does this operation cost?
It all depends on the state of health of the patient at the time the indications for surgery are determined. If coronary artery bypass grafting is shown to you, the price will consist of factors such as the amount of intervention, the qualification of the operating surgeon, but almost all such operations are free. Money for their implementation is allocated by the state budget (in private clinics the cost of the operation ranges from 7 to 10 thousand dollars, which is quite expensive).
Should I do this operation?
Many patients with long-term angina pectoris are shown coronary bypass surgery. What is it - few know, because of which they definitely need a detailed explanation of the doctor. Some are scared and refuse the operation, since the procedure is quite complicated and difficult, and the risk of complications is extremely high. Others deliberately take risks, realizing that without intervention everything can turn out much worse.
Is it worth it to do the operation - the choice is purely individual. However, if the operation is indicated, then it is better to carry out it, since with a favorable outcome (mortality during the operation is less than 2 percent), the condition and quality of life are significantly improved.