Aorto-coronary artery bypass grafting (CABG) is an operation prescribed for coronary heart disease. The narrowing of the lumen of the arteries supplying the heart with blood (stenosis), resulting from the formation of atherosclerotic plaques in them, is fraught with serious consequences for the patient. When the blood supply to the heart muscle is disturbed, the myocardium loses the amount of blood necessary for normal functioning, which ultimately leads to its damage and weakening. In this case, during physical activity a person experiences angina (pain behind the sternum).
The most common pathology among all heart diseases is coronary heart disease (CHD). She spares neither women nor men. The lack of blood supply can lead to the necrosis of part of the heart muscle - myocardial infarction, which threatens with the most serious complications, even fatal. Heart bypass after a heart attack in order to eliminate its consequences, for the prevention of heart attack, as well as for other clinical forms of coronary heart disease, is prescribed if, with the help of conservative treatment, a positive effect was not achieved. This is the most radical, but at the same time the most adequate method of restoring blood flow. In our article, we will tell you what the coronary artery bypass grafting consists of and how to prepare for it.
What is the essence of the operation
CABG can be performed with multiple or with a single lesion of the arteries. During the operation, in those vessels where blood flow is disturbed, shunts are created - workarounds. This is done by attaching healthy arteries to the coronary. As a result, blood flow follows a blockage or stenosis. Bypassing the heart, thus, allows for a full supply of blood to the heart muscle.
Preparation for surgery
No less important for the success of CABG than the professionalism of a team of surgeons is a person’s positive attitude towards a favorable outcome of treatment. This operation is not more dangerous than other types of surgical interventions, but it requires thorough thorough preparation. First, as before any cardiac surgery, the patient is referred for an examination, which consists of an ECG, ultrasound, laboratory tests and analyzes, as well as an assessment of the general condition. You will also need to do angiography (ticoronarography). This diagnostic procedure makes it possible to determine the condition of the arteries supplying the heart muscle, to identify the exact place of plaque formation and the degree of narrowing. A study is carried out using X-ray equipment (an X-ray contrast substance is injected into the vessels, and then a picture is taken).
Some of the diagnostic measures are performed in a hospital, and some are performed on an outpatient basis. As a rule, a person is admitted to a hospital a week before surgery, and at the same time, thorough preparation begins. One of its important stages is the development of a special breathing technique, which will subsequently be very useful.
Operation
As already mentioned, coronary artery bypass grafting is performed to create an additional bypass path with a shunt from the aorta to the artery, which will make it possible to bypass the clogged area and restore blood flow. Most often, the thoracic artery becomes a shunt, because due to its unique features it has good resistance to atherosclerosis and has a long life as a shunt. In some cases, the radial artery or saphenous vein of the thigh is used.
Heart bypass surgery can be single, double, triple, and so on. It depends on how many coronary vessels there is a narrowing. By the way, this does not depend on the degree of manifestation of the disease. So, a patient with severe coronary heart disease may require the application of only one shunt, and for a person who has less pathology, two or even three. The operation is performed on an open heart under general anesthesia, depending on the level of complexity, it can last three to six hours.
Three types of CABG
- Using a heart-lung machine. If this option is used, then the patient's heart is stopped.
- On a working heart. This method allows you to complete the operation more quickly and reduces the likelihood of complications, but it requires surgeons to have a lot of experience.
- Minimally invasive access (with or without cardiopulmonary bypass). This is a relatively new technique that makes it possible to reduce blood loss during the intervention, to reduce the risk of infectious complications. After such CABG, the patient recovers faster, the time spent in the hospital is reduced to five to ten days.
I must say that any heart surgery carries certain risks. However, thanks to modern equipment, sophisticated technology and wide application practice, they can be minimized. Heart bypass has very good indicators in terms of positive results. Reviews of most people who underwent such an operation are saturated with words of gratitude to the doctors. Nevertheless, the prognosis depends on the individual characteristics of the patient and the clinical picture of the disease.
Postoperative period
Immediately after surgery, the person is in intensive care, it is there that the initial restoration of the lungs and heart muscle begins. It is very important that the operated person breathes correctly at this time. The period of stay in intensive care can be up to ten days, it depends on how the heart was bypassed. Rehabilitation also begins in a hospital, and then continues in a rehabilitation center. The seams on the chest and where the shunt material was taken from, are washed with antiseptics to prevent decay and pollution. They are removed somewhere on the seventh day if the wounds have successfully healed.
Rehabilitation
In places where there were stitches, for some time pain and burning will be felt. When the wounds are somewhat healed (after one to two weeks), the patient is allowed to take a shower. Healing of the sternum bone will take longer - four to six months. You can wear a chest band to accelerate this process. In the first four to seven weeks, special elastic stockings should be put on your legs to avoid swelling. At this time, you should protect yourself from intense physical exertion.
Due to the blood loss that occurred during the operation, a person may develop anemia. However, no specific treatment is required in this case. It is enough just to follow a diet based on the use of foods containing a large amount of iron, and after a month the hemoglobin level will return to normal. The patient will have to make an effort to restore normal breathing. To do this, carry out special breathing exercises, which he was taught before surgery. Also, with their help, pneumonia can be avoided.
After heart bypass surgery, a cough is observed. Do not be afraid of this. Coughing is an essential part of rehabilitation. You can alleviate it by pressing the palm or ball to the chest. Frequent changes in body position will speed up the healing process. Doctors usually explain how to turn and in which cases it is necessary.
Rehabilitation is accompanied by a gradual increase in physical activity. When the patient stops having angina attacks, he is prescribed the required motor regimen. First, a person is allowed to walk for short distances (up to one kilometer per day) along the hospital corridor, then gradually the load increases, and after a while almost all restrictions are removed.
After discharge
People who have undergone heart bypass surgery are advised to visit the sanatorium after inpatient treatment. After one and a half to two months, you can return to work. At the same time, a stress test should be performed to assess the patency of superimposed shunts and see how well the heart is supplied with oxygen. If there are no changes on the ECG, the patient does not experience pain during the testing process, which means that recovery can be considered successful.
Heart bypass surgery: price
The operation is high-tech, therefore it has a rather high cost, which depends on the required number of shunts, the method of intervention, the current state of the patient’s health, the degree of comfort that will be provided after CABG. Another important price criterion is the level of the clinic where heart bypass surgery will be performed. Of course, an operation in an ordinary cardiology hospital will be cheaper than in a specialized private clinic. On average, in Moscow, the cost of CABG ranges from 150-500 thousand rubles, in Israel - 23-30 thousand dollars, in German clinics the price for such an operation starts from 25 thousand euros.
Heart bypass surgery: patient reviews
Many people note that recovery from CABG is difficult. Patients have difficulty breathing, especially at night. Some say that for some time they were generally forced to sleep half-sitting. But after some time, people cease to feel pain behind the sternum, somewhere in a month there is a significant improvement in the condition, a similar dynamics persists further. Patients who underwent surgery several years ago say they feel good, along with healthy ones. Some complain that they had to reconsider their lifestyle, quit smoking, and diet. But actually, all people should abandon bad habits, and not just those who underwent heart surgery.
Finally
In certain cases, only surgery can save a life. Heart bypass surgery done on time can prevent a heart attack and its serious consequences, return a person to full activity. Be healthy!