Coronary artery bypass grafting: what is it?
Coronary artery bypass grafting (CABG) is an operation that allows to restore the provision of blood to the heart muscle in those places where due to atherosclerosis of the coronary arteries, the blood circulation is poor. Conducting this surgery is necessary to prevent the occurrence of myocardial infarction and other manifestations of coronary heart disease.
Bypass surgery: what is it?
Medicine for a long time already learned to solve the problem of poor circulation by creating a shunt detours. These workarounds are routed from the aorta to the healthy portion of the artery, bypassing the segment most affected by atherosclerosis and, therefore, impassable.
In addition to the bypass surgery of the coronary arteries, similar medical procedures performed in other blood vessels such as the femoral arteries to restore blood supply to the lower extremities (the name of the operation – aortofemoral bifurcation bypass grafting).
As the graft in heart surgery used pieces from our own arterial or venous vessel of the patient. Often use vnutrigrudne and the radial artery or the veins of the lower extremities. These vessels are the least susceptible to atherosclerosis, and in the veins of atherosclerotic plaques, and is not formed.
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Varieties of CABG
There are three main options for CABG:
- With full access to the heart and artificial circulation. This type of surgery is used in severe cases, when heart surgeon is necessary in the course of one intervention to impose multiple grafts, suturing of the aneurysm, to replace the valves and perform other manipulations.
- On a beating heart with the use of «stabilizer» that reduces fluctuations in the body. This method allows to avoid complications arising from the connection of the patient to a heart-lung machine, for example, damage to the blood cells.
- With minimal incisions and using endoscopic techniques. When such operations cut only soft tissue, bone remain intact, greatly shortens the postoperative recovery phase.
Preparing for surgery
The main indications for CABG is coronary heart disease. Patients with this diagnosis is necessarily performed coronary angiography, which allows doctors to assess the condition of the coronary arteries and to determine whether surgery and what method you should choose. If the decision on carrying out surgical treatment adopted, the patient hospitalitynet in the hospital for a few days prior to surgery for preparation. Preparation for surgery usually involves:
- Examination (analyses of blood, urine, ECG, x-rays, ultrasound of internal organs, vessels Doppler ultrasonography and other studies, depending on the situation).
- A conversation with the anesthesiologist and surgeons who will be engaged in patients during and after surgery.
- Meeting with a specialist in breathing therapy, the patient will need to learn how to breathe and to cough, so that post-operative period was most successful.
- Preparation the day before and the day of the surgery, including body hygiene, enema, intake of sedative drugs, etc.
What is the procedure?
Before operative intervention, the patient is administered the anesthesia, is connected to the ventilator. Further action depend on which surgical technique was chosen: the part of the surgical team opens the chest and puts on the heart «stabilizer» or connects the device for cardiopulmonary bypass, other surgeons removed the blood vessels, which will serve as a shunt, etc. the Duration of the entire operation in each case is individual – it could be 2 hours, maybe 6. After surgery, the patient is transported to the intensive care unit where he will remain until stabilized.
After coronary artery bypass grafting
Usually after CABG surgery, the patient is in the hospital for 14 – 16 days. These terms can vary depending on the kind of operation conducted, presence of comorbidities and other factors. Recovery after coronary artery bypass grafting involves the gradual progress of the patient (at first he is allowed to sit, then stand up and do a few steps with support, and eventually to walk independently along the corridor).
All active movement doctors recommend to do special compression stockings and corset for the chest. In addition, in this period, the patient is prescribed a special diet and drug therapy aimed at preventing complications. After removal of all sutures and stabilization of the patient being discharged. Subsequent rehabilitation can take place at home or in special sanatoriums. Important aspects of rehabilitation measures are the following:
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- Diet to prevent progression of atherosclerosis and reduce the load on the heart.
- Taking medicines appointed by the cardiologist.
- Physical activity in amounts allowed by your doctor.
- Gradual return to normal life and work activities (if not contraindicated).
Coronary artery bypass grafting of blood vessels of the heart, like many other operations, carries a risk of complications. When performing CABG you may experience the following undesirable consequences:
- Myocardial infarction.
- Acute disorders of cerebral circulation.
- Infectious and inflammatory processes.
- Insolvency seams, etc.
The frequency of complications and mortality due to CABG is influenced by various factors: the age and sex of patient, type of operation and the shunt, severity of atherosclerotic changes of vessels, transferred shortly before surgery, heart attacks and strokes, diabetes, chronic kidney disease and the lungs.