The medication elimination of pains in the heart associated with ischemia facilitates the condition of patients. However, such therapy does not solve the problem of vascular blockage with atherosclerotic plaques. Therefore, a more radical solution is required - surgical intervention. As a rule, preference is given to coronary artery bypass grafting. In today's article, we will consider in detail this treatment method, indications for the procedure and the progress of its implementation.
Medical certificate
Coronary artery bypass grafting is a surgical operation on the vessels of the heart, performed to restore their patency and blood circulation. Most often, her help is resorted to in case of atherosclerosis. To this end, new, roundabout vascular pathways are created. As shunts or grafts, sections of the arteries and veins of the patient are used. As a rule, preference is given to the internal mammary arteries. They perfectly carry the load and retain functionality for a long period of time. The radial arteries and leg veins are much less commonly used.
During the intervention, shunts replace insolvent own arteries. One end of such a transplant is sewn from a person’s own tissues into the aorta, and the other is placed in the coronary artery just below the area of its narrowing. As a result, blood can flow freely into various parts of the heart muscle. During one intervention, the number of shunts used can vary from one to three.
The need for such an operation usually occurs with a chronic form of ischemia. It is characterized by the deposition of atherosclerotic plaques inside the coronary arteries. This causes a narrowing of their lumen or complete blockage, which provokes a violation of blood supply in the myocardial cavity. As a result, oxygen starvation or ischemia develops. If full circulation is not restored immediately, the likelihood of a person's working capacity decreasing, a heart attack, and even a fatal outcome increases.
Varieties of operation
Coronary artery bypass grafting is performed using local anesthesia. However, the intervention itself is possible in several ways:
- With the connection of the heart-lung machine (IR), when the functioning of the patient’s heart is intentionally stopped.
- Operation on a working heart. This method of exposure reduces the risk of complications, reduces the duration of the procedure itself. A surgeon needs a lot of experience to conduct it.
- Minimally invasive technique. During the procedure, the specialist makes several incisions through which he introduces tools for surgical manipulations into the body. Thanks to this approach, the wounds heal quickly, and the patient’s recovery period is reduced to several weeks.
The determination of the specific method of the operation remains with the doctor. When choosing, he must take into account the severity of the pathology and the individual characteristics of the patient's body.
Indications for
Coronary artery bypass grafting is recommended for patients with coronary heart disease. This is not the only way to treat pathology. There is an alternative technique - endovascular surgery. It is easier to tolerate by patients, but is considered less radical and does not always eliminate the disease.
Also, an operation is prescribed for the following health problems:
- angina pectoris, poorly drug resistant;
- narrowing of the coronary arteries by 70% or more;
- developing myocardial infarction;
- contraindications to stenting and angioplasty (these procedures are used in cardiology to restore coronary blood flow);
- ischemic pulmonary edema.
Indications for coronary artery bypass grafting are determined on the basis of a clinical examination and agreed with the doctor.
Possible contraindications
Operation is not possible when:
- diffuse lesion of the coronary arteries;
- congestive events accompanying heart failure;
- cicatricial lesions;
- renal failure;
- oncological pathologies.
Old age is not an absolute contraindication to the procedure. In this case, the feasibility of the intervention is determined by operational risk factors.
Preparatory stage
Often, coronary artery bypass grafting is performed urgently if the patient is admitted to the hospital with myocardial infarction. In this case, preliminary preparation and diagnostics are not required. The doctor focuses only on the patient's condition, his blood tests per group and coagulation. The operation itself is carried out through dynamic observation of the ECG.
Preparation for a planned intervention includes a comprehensive examination of the body. The patient is prescribed the following activities to assess his health:
- ECG;
- Ultrasound of internal organs;
- Echocardiography;
- dopplerography of cerebral vessels;
- Ultrasound of the vessels of the legs;
- FGDS;
- coronarography;
- urine and blood tests.
10 days before the date of the proposed operation, the patient must stop taking blood thinners. We are talking about the following medicines: Plavix, Aspirin, Ibuprofen, Warfarin. If necessary, at this time, the doctor may prescribe other means to reduce blood coagulation.
You can’t have breakfast on the day of admission to a medical institution, so that a blood chemistry test shows a reliable result. After this, the patient is examined by a doctor.
On the eve of the operation itself, consultation with an anesthesiologist and specialist in breathing gymnastics is mandatory. Dinner must be no later than 18.00. After this time, only liquids are allowed. Before going to bed, the patient is given a cleansing enema and shaves hair in the area of performing surgical incisions.
Shunting Technique
The traditional coronary artery bypass surgery is performed using an IR device. It consists of the following steps:
- The patient is placed on an operating couch. The specialist administers anesthesia intravenously. To control breathing, an endotracheal tube is installed in the trachea. She delivers gas from the ventilator. A special probe is inserted into the stomach to control its contents and prevent air reflux. A catheter for urine removal is also installed.
- A cardiac surgeon performs a vertical incision along the midline of the sternum, the size of which is 30-35 cm. The chest is opened so as to provide full access to the main muscle of the body.
- The patient’s heart is intentionally stopped, and he himself is connected to the IR device. Another surgeon at this time takes part of the vein, for example, from the patient’s leg. One end of the shunt is sutured to the aorta, the other directly to the coronary artery. Immediately after this procedure, the heart is restored. The patient is disconnected from the IR device.
- After restoration of the heart and the successful functioning of the shunt, the surgeon installs drainage. The chest closes. Doctors suture tissue in the incision area in stages.
The whole operation lasts about 3-4 hours. After the intervention, the patient is left in intensive care. If during the next day there are no complications, the patient's condition gradually normalizes, he is transferred to the ward for further observation.
The minimally invasive technique of coronary artery bypass grafting is somewhat different. Access to the heart is through several punctures in the chest. To perform the operation itself, a thoracoscope is used. This is a miniature camera, the image from which is continuously transmitted to a computer monitor. After eliminating defects and installing a shunt, the incisions are sutured and a sterile dressing is applied. The whole procedure takes no more than two hours.
Recovery period
After coronary artery bypass grafting, the patient is in intensive care, where primary rehabilitation begins. It implies the restoration of the heart and lungs. This period lasts about 10 days. It is necessary that the patient breathes correctly at this time. Further recovery continues already in a specialized rehabilitation center.
Sutures in the area of the breast incision are washed with antiseptic solutions to avoid suppuration. They are removed with the successful healing of wounds on the seventh day. In these places, a burning sensation and even pain may appear, but you should not be afraid of it. After another 1-2 weeks you can take a shower.
The sternum bone usually heals a little longer. This period is up to 6 months. To speed up the process itself, this area should provide complete peace. For this purpose, chest bandages help well. To avoid venous stasis and thrombosis in the legs after surgery for coronary artery bypass grafting, it is recommended to wear compression stockings. You should also completely eliminate physical activity.
Against the background of blood loss during the intervention, the patient may experience anemia. She does not mean specific therapy. Enough to eat a diet rich in high-iron foods. After about a month, hemoglobin should return to normal.
After the operation, the patient will have to make an effort to restore full breathing and prevent pneumonia. At first, it is necessary to do special breathing exercises. During the procedure, a cough may appear, but you should not be afraid of it. To minimize discomfort, you can press the ball to your chest. Accelerates recovery, frequent changes in body position.
A logical continuation of rehabilitation after coronary artery bypass grafting is considered an increase in physical activity. When the patient is no longer bothered by bouts of angina pectoris, the doctor gives instructions on the necessary motor regimen. First, walking along hospital corridors is recommended, then the load is increased. After some time, the restrictions are completely removed.
For a final recovery after discharge from the clinic, it is better to go to a sanatorium. After about 1-2 months, you can return to work. At the same time, the patient is assigned a stress test. It allows you to evaluate the work of the heart. In the absence of pain and significant changes in the ECG during the test, recovery is considered to be successfully completed.
Complications after surgery
Complications after coronary artery bypass grafting are extremely rare. Usually they are associated with an inflammatory process or swelling. Even less often, bleeding occurs at the site of the wound. Inflammation is accompanied by fever, weakness, discomfort in the chest and joints. It may be due to an autoimmune reaction of the body when its protective system "incorrectly" reacts to its own tissues.
Among other rare complications after coronary artery bypass grafting, doctors distinguish:
- incomplete fusion of the sternum;
- stroke / heart attack;
- thrombosis;
- renal failure;
- memory impairment;
- keloid scars.
The risk of these problems depends on the patient’s health status before surgery. To lower it, before the intervention, the doctor must evaluate all the factors that could adversely affect the course of the procedure. These include: smoking, obesity, physical inactivity, high blood pressure, diabetes and high cholesterol.
If the patient does not follow the doctor’s recommendations during rehabilitation, does not take prescribed medications, ignores the diet and load limits, relapse is possible. It manifests itself in the form of plaques and repeated blockage of a new vessel. As a rule, in such cases, the patient is denied bypass surgery.
Operation cost
Coronary artery bypass grafting is a high-tech procedure. Therefore, its cost is quite high. The final price depends on a combination of several factors: the number of shunts used, complexity, patient’s health status, hospital stay. It should also be noted that the cost of the operation is affected by the level of the clinic. It can be performed both in a regular cardiology hospital and in a private medical center. For example, in Moscow, the price of this service varies from 150 to 500 thousand rubles. In foreign medical centers, the cost is much higher and can reach up to 1.5 million rubles.
Reviews of patients and doctors
Patients' opinions about the operation are extremely positive. After coronary artery bypass grafting, rehabilitation is almost painless. The likelihood of complications during this period is up to 6%. To prevent the occurrence of unpleasant consequences in the later stages is quite difficult. The average operating time of shunts is 10 years. Approximately 70% of patients after surgery note a complete disappearance of the signs of the disease; in the remaining cases, the intensity of the disorders decreases significantly. Subject to the recommendations of the doctors, it is possible to avoid the recurrence of atherosclerosis and the need for surgery in 85% of cases.
Doctors also have positive feedback on coronary artery bypass grafting. After the procedure, patients' lives change for the better. They forever disappear attacks of angina pectoris. Gradually improve physical condition and performance. The need for drugs is reduced to a preventive minimum. Thus, after coronary artery bypass grafting, the life of an ordinary healthy individual becomes available to a person.