Bypass surgery is a surgical method for treating heart disease. Thanks to heart operations, thousands of people can be saved. Coronary artery bypass surgery helps treat people with coronary artery disease, the number one known heart disease that kills people - a disease that causes myocardial infarction.
Coronary artery bypass grafting (CABG) is a complex heart surgery. To perform it, you need to open the chest and connect artificial blood circulation during the operation. Despite the difficulties, cardiac surgeons, performing thousands of operations annually, classify the procedures as operations of not the highest degree of complexity.
More often, the patient requires sufficient patience and determination to go through the rehabilitation period after surgery. Postoperative complications often arise that need to be overcome: pain in the sternum (it takes 4-6 months to heal, swelling of the legs occurs after bypass surgery, anemia, problems in the lungs). But difficulties can be overcome if there is a desire to live fully and actively.
In patients with coronary heart disease, the arteries supplying the heart with blood become blocked. Blockage occurs by plaques that form in the vessels, narrowing the lumen - atherosclerosis. For this reason, the myocardium does not receive the required amount of blood and ceases to function normally. The result is angina and heart attack.
To establish normal blood supply to the heart, shunts (sections of blood vessels) are implanted to bypass blocked arteries and are taken from other parts of the body. Most often, vein sections are taken in the legs. The number of shunts depends on the number of blocked arteries (a number or several).
The body needs time to rebuild the blood supply, small veins are not able to immediately cope with the complete outflow of blood from the legs, and swelling of the lower leg occurs. Venous insufficiency develops, manifested by the symptom of swelling of the legs.
In the case of swelling of the legs immediately after surgery (lasting up to two weeks), urgent manipulations and severe anxiety should not arise. What is happening is considered a normal recovery process after major surgery.
If the process is prolonged and difficulties arise much later, take a closer look at the symptoms:
Signs indicate the need to urgently consult a doctor for examination.
Postoperative edema in a hospital setting can be relieved with special devices “Polyus 1”, “Biomagnetics System” and “Khivamat-200”. The operation of the devices is based on the positive effect of a low-frequency magnetic field and electrostatic alternating field on the tissues and blood vessels of the legs. The procedures last 10 - 15 minutes, the course of treatment takes up to 10 days.
When the body is in a horizontal position (lying down), you should place a pillow or a bolster from a blanket under your feet. High position of the legs promotes good outflow of blood and lymph. If before the operation the patient often liked to sit in a cross-legged position, he will need to completely abandon the position. This body position contributes to the formation of swelling of the legs.
Compression stockings will help in difficult situations. But you can’t wear it on your own without a doctor’s prescription. Compressive tights or stockings can do more harm to patients than benefit them.
The announced rules and medical procedures will help you quickly return to a normal active life without swelling and pain in the legs, with a healthy heart after coronary bypass surgery. You should be patient and fully follow the doctor’s recommendations.
Femoropopliteal Bypass Surgery (Leg Artery Bypass Surgery)
This surgery uses parts of a vein or artificial tubes to create a bypass around the blocked main artery in the legs. Blocked arteries in the legs are usually caused by a buildup of plaque (plaque) on the inner walls of the arteries. This buildup is called peripheral artery disease (PAD).
If surgery is planned, you need to be aware of possible complications, which may include:
The following procedures may be prescribed or performed:
The doctor makes an incision in the skin on the leg. Through this incision, the doctor removes the veins that will be used for bypass. If a vein cannot be used, then artificial veins are used.
Next, an incision will be made in the groin to reach the femoral artery. The doctor will make another incision in the back of the knee to reach the other artery, the popliteal artery.
The doctor will use clamps to block the flow of blood through these two arteries. One end of the bypass vein will be sutured into the femoral artery, and the other end will be sutured into the popliteal artery. Once the procedure is complete, blood will be pumped through the graft again to check the new vessel for leaks. If no leaks are found, the doctor removes the clamps completely. This will allow blood to flow through the graft. The doctor closes the incision with stitches.
In some cases, a vein in the thigh will be used as a graft without having to remove it. In this procedure, part of the vein will be separated from the main vein using a cutting instrument. The vein will then be sutured to the arteries to form a graft.
The pain may last for weeks or even months. Ask your doctor about pain medications to reduce pain. Keep in mind that the leg may remain swollen for 2-3 months.
While recovering in hospital, you may be provided with:
When you return home, follow these steps to ensure a normal recovery:
After leaving the hospital, you should consult a doctor if the following symptoms appear:
Atherosclerotic plaques can affect any artery in the human body, but are most often found in the arteries of the lower extremities. Such a lesion leads to the development of obliterating atherosclerosis of the lower extremities, the progression of which can have the most severe consequences and even result in gangrene.
With the formation of atherosclerotic plaques and the resulting disruption of blood flow in the peripheral vessels of the legs, patients experience pain in the thighs, legs, feet and buttocks when walking. Among men, this problem occurs 8 times more often than among women, and is observed in the majority of people in the middle age group. This situation is caused by the main risk factors for atherosclerosis - smoking, excessive consumption of fatty foods, and a sedentary lifestyle, which are more characteristic of the male sex.
In case of segmental narrowing of arterial sections, an endovascular treatment method is used to restore blood flow in the vessels - stenting of the arteries of the lower extremities. A catheter with a balloon is inserted through a puncture into the lumen of the affected artery and brought to the site of narrowing. The narrowed segment is expanded by inflating the balloon, as a result of which blood flow is restored. If necessary, a stent is installed in the affected segment of the artery - a special device that prevents the narrowing of this section of the artery in the future.
Stenting is a very effective and least traumatic method of treating vascular diseases of the legs, which allows you to restore blood supply to the lower extremities without surgical intervention. The procedure is carried out in an X-ray operating room, which is equipped with special equipment. After completion of the procedure, a pressure bandage is applied to the patient’s leg to avoid bleeding, and bed rest is prescribed for 12-18 hours.
Swelling of the leg after the stenting procedure is observed in 40% of all cases. It is caused by a sharp restoration of arterial blood flow in a previously ischemic area of the vessel. Immediately after the patency of the affected artery is restored, segmental pressure increases in the arteries of the foot, and the pulse is restored in the underlying arterial segments. If the lower limb has been exposed to insufficient blood supply for a long time, the resumption of blood flow can provoke the so-called reperfusion syndrome. An unusually large volume of blood passing through a vessel exposed to hypoxia for a long time can cause swelling of the limb and its redness, and sometimes pain. The problem is more likely and pronounced the longer the vessels are exposed to ischemia.
This condition in itself is not a problem; it goes away a few days after the lower limb adapts to the new conditions of blood supply.
Information on treatment under compulsory medical insurance Medical licenses Order of the Ministry of Health and Social Development No. 406 Free medical care guarantee program Intensive care Principles of vascular operations Risks of vascular operations
Secondary lymphostasis after vein sampling. Contact a lymphologist.
Correspondence with the doctor | Other questions Ask your question
Enter login and password
+7 495 940 96 14
Moscow, Leninsky Prospekt, 102 (metro station Prospekt Vernadskogo)
Make an appointment
Hello, my aunt’s foot was amputated above the knee! It healed well, but the other one immediately started to hurt. A month later we were taken to the hospital; I couldn’t stand the pain because of the pain, is it possible to save the leg? They told us we needed to clean it.
Answer: Hello. Your aunt needs to come to us in person for a consultation. If this is not possible, then send a photo of your leg, data from all examinations (especially ultrasound of the arteries) in the “Correspondence with the doctor” section.
Help with a question
I wrote the essence of my question above, you answered that surgical treatment is needed, the question is what kind of treatment can be given to older people, please tell me
Answer: Treatment depends on the extent of the vascular lesion, and it can be either endovascular intervention or bypass. Ultrasound scanning of the arteries of the lower extremities will help answer this question. Age in this case neither.
My grandmother has a cold and bluish, and sometimes burgundy leg, she is lying in the surgical department, drips of Sulodexide, rhinopolyglucin are dripping, the leg sometimes gets warm up to the foot
Answer: Your grandmother needs to have an ultrasound scan of the arteries of the lower extremities, and if she has critical ischemia of the leg: pain at rest, cold skin of the foot, trophic changes in the leg, then it is necessary.
Good afternoon, please help, our dad has a hose instead of an artery, and now he has gangrene, the doctors say to amputate. And on the other leg the joint was replaced, suffering from coxoarthrosis. Help.
Answer: Good afternoon. Send ultrasound data of the arteries of the legs and a photo of the leg to the “Correspondence with the Doctor” section or by email [email protected] . Or come for an in-person consultation.
Vertebral artery stenosis
PA: channel entry level -C6. Deformation of the VA canals with signs of extravasal compression of the VA at the level of C6-c5; c4-C3. Diameter of the RCA - 3.9; LPA-3.0. LPA-ostium with G/d significant stenosis of more than 60% with increased LSC = 220 cm/s is passable.
Answer: it is necessary to perform an MS CT scan of the arteries of the head and neck, and then assess the degree of compensation of cerebral blood flow
Hello, my dad has nicrosis on his leg.
Hello, my dad has nicrosis of the leg of the left lower part of the foot. We were told to urgently amputate, but I understand that you can cure it without amputation, I can’t call you all.
Answer: Good afternoon. Send a photo of your leg in several projections and the ultrasound result to the “Correspondence with the Doctor” section.
vessels of the lower limbs
Hello, I am 27 years old and I was diagnosed with obliterating thrombongitis, now I am worried about my legs, lower limbs, veins, redness, compaction, revenge, blood vessels, it hurts, what do you recommend. I've been taking Xarelto and ketanol for a while now.
Answer: Good afternoon. Do an urgent ultrasound of the veins: it looks like thrombophlebitis
Swollen foot after angioplasty
After angioplasty on the right leg, the foot and toes are swollen and blue-red in color, with severe cutting pain. On the 5th day it became easier, the leg in the morning was almost normal color. After a short walk the leg came back.
Answer: It is difficult to make diagnoses without seeing the patient. Do an ultrasound of the leg arteries to rule out arterial thrombosis; See the operating surgeon.
I have been diagnosed with endatheritis of the lower extremities, antiphospholipid syndrome, all the toes on my left foot have been amputated. Concomitant ischemic heart disease, there were 2 strokes, an attack of epilepsy. Sympathactamia was performed on both legs. Left.
Answer: How is your left leg bothering you? If there are indications, then stenting can be done. But there is no preventative surgery on arteries.
Hello! Please tell me! My husband had CABG surgery in 2016 and now he had a cold. He had a fever and now he feels good, but red spots appeared on the leg where the vein was taken.
Answer: Hello. To exclude any pathological conditions, it is necessary to do an ultrasound of the lower extremities (soft tissues, arteries and veins).
© 2007-2018. Innovative vascular center - vascular surgery at a new level
Bypass surgery is a surgical method for treating heart disease. Thanks to heart operations, thousands of people can be saved. Coronary artery bypass surgery helps treat people with coronary artery disease, the number one known heart disease that kills people - a disease that causes myocardial infarction.
Vein sections for surgery are often taken from the legs; vessels in the extremities are less susceptible to atherosclerotic blockage. The vessels of the legs, compared to others in the body, are of sufficient length and large. By removing a vein from the leg, blood circulation is not impaired, and the recovery process continues painlessly.
Postoperative swelling of the legs is considered normal and goes away within 1-2 weeks after bypass surgery. If the swelling does not go away, additional studies are prescribed, and based on the results, the required drug treatment or special procedures are prescribed.
If postoperative swelling does not go away for a long time and causes great discomfort to the patient, it is recommended to undergo a leg diagnosis and identify the cause of the condition.
To eliminate swelling of the legs immediately after surgery and in the subsequent period, you will have to follow a number of rules and take timely measures.
Postoperative edema in a hospital setting can be relieved with special devices “Polyus 1”, “Biomagnetics System” and “Khivamat-200”. The operation of the devices is based on the positive effect of a low-frequency magnetic field and electrostatic alternating field on the tissues and blood vessels of the legs. The procedures last 10 - 15 minutes, the course of treatment takes up to 10 days.
Hospitals often use ultraviolet irradiation of problem areas on the legs. The procedure is done every other day and lasts no more than 6 sessions.
Often, surgeons who performed bypass surgery prescribe manual lymphatic drainage to relieve swelling of the legs. The procedure is performed by a trained massage therapist. You cannot do it yourself; it is possible to aggravate the situation with swelling and pain after bypass surgery. The massage is carried out according to a special technique, consisting first of lightly stroking the legs, then of intense pressure in the locations of the lymph nodes.
In the postoperative period, doctors advise you to adhere to a diet for several months. Avoid eating fried, spicy and fatty foods and drink less fluids. Do not overuse salt; the seasoning interferes with the normal elimination of excess fluid in the body.
Drug treatment is prescribed exclusively by the operating surgeon or a doctor specializing in vascular diseases. The doctor will select the drugs correctly and calculate the dosage. The above applies to the situation of detecting blood clots in the veins. The only doctor prescribes blood thinning drugs to eliminate postoperative thrombosis of the blood vessels in the legs.
By adhering to a list of simple rules, it is possible to make the postoperative rehabilitation period less painful and reduce swelling of the legs. You should not take a hot bath or shower until your body is completely restored. A contrast shower is extremely useful in the mentioned cases. The procedure improves blood supply to the body and prevents excess fluid from accumulating in the legs.
Do not suddenly put excessive stress on the body and legs. This will cause more swelling. During walks, it is useful to alternate walking with rest (you are allowed to sit on a bench).
In the summer, there is no need to spend a lot of time in the sun - the heat increases swelling, and the patient notices that the leg swells more. During the rehabilitation period, you need to wear loose clothing that will not put too much pressure on the body and will not interfere with normal blood circulation, which will make it possible to remove excess fluid from the body.
Today, few people think about what heart bypass surgery is after a heart attack, how long they live after heart bypass surgery, and other important points until the disease begins to progress.
Coronary heart disease today is one of the most common pathologies of the circulatory system. Unfortunately, the number of patients increases every year. As a result of coronary artery disease, damage occurs due to insufficient blood supply to the heart muscle. Many leading cardiologists and therapists in the world tried to combat this phenomenon with the help of pills. But nevertheless, coronary artery bypass grafting (CABG) still remains, albeit radical, but the most effective way to combat the disease, which has proven its safety.
After coronary artery bypass surgery, the patient is placed in the intensive care unit or intensive care unit. Typically, the effect of some anesthetics continues for some time after the patient has woken up from anesthesia. Therefore, he is connected to a special apparatus that helps with the breathing function.
In order to avoid uncontrolled movements that could damage the sutures on the postoperative wound, pull out catheters or drains, or disconnect the IV, the patient is fixed using special devices. Electrodes are also connected to it, which record the state of health and allow medical personnel to control the frequency and rhythm of contractions of the heart muscle.
On the first day after this heart surgery, the following manipulations are performed:
Also on the first day, the breathing tube is removed, but the gastric tube and drains in the chest remain. The patient is already breathing completely on his own.
Advice: at this stage of recovery, it is important that the operated person stays warm. The patient is wrapped in a warm down or wool blanket, and to avoid stagnation of blood in the vessels of the lower extremities, special stockings are worn.
To avoid complications, do not engage in physical activity without consulting your doctor.
On the first day, the patient needs peace and care from medical personnel who, among other things, will communicate with his relatives. The patient just lies down. During this period, he takes antibiotics, painkillers and sedatives. A slightly elevated body temperature may be observed for several days. This is considered a normal reaction of the body to surgery. In addition, heavy sweating may occur.
As you can see, after coronary artery bypass surgery the patient needs third-party care. As for the recommended level of physical activity, in each individual case it is individual. At first, you are allowed to just sit and walk around the room. After some time, you are already allowed to leave the room. And only at the time of discharge the patient can walk along the corridor for a long time.
Advice: the patient is recommended to remain in a supine position for several hours, and it is necessary to change his position, turning from side to side. Lying on your back for long periods of time without physical activity increases the risk of developing congestive pneumonia due to the accumulation of excess fluid in the lungs.
When using the saphenous vein of the thigh as a graft, swelling of the lower leg may be observed in the corresponding leg. This happens even if the function of the replaced vein has been taken over by smaller blood vessels. This is the reason that the patient is recommended to wear support stockings made of elastic material for 4-6 weeks after surgery. In addition, when sitting, this leg must be raised slightly so as not to disrupt blood circulation. After a couple of months, the swelling resolves.
During the recovery process after surgery, patients are prohibited from lifting weights exceeding 5 kg and performing vigorous physical exercise.
Sutures from the leg are removed a week after the operation, and from the chest - immediately before discharge. Healing occurs within 90 days. The patient is not recommended to drive for 28 days after surgery to avoid possible damage to the sternum. Sexual activity can be carried out if the body is in a position that minimizes the load on the chest and shoulders. You can return to your workplace one and a half months after the operation, and if the work is sedentary, then even earlier.
In total, after coronary artery bypass grafting, rehabilitation takes up to 3 months. It involves gradually increasing the load during physical exercise, which must be done three times a week for one hour. At the same time, patients receive recommendations on the lifestyle that needs to be followed after surgery in order to reduce the likelihood of progression of coronary heart disease. This includes quitting smoking, losing weight, special nutrition, and constant monitoring of blood cholesterol and blood pressure.
Even after discharge from the hospital, while at home, you must adhere to a certain diet, which will be prescribed by your doctor. This will significantly reduce the chances of developing heart and vascular disease. Some of the main foods that you need to minimize your consumption of are saturated fats and salt. After all, the operation performed does not guarantee that problems with the atria, ventricles, blood vessels and other components of the circulatory system will not appear in the future. The risks of this will increase significantly if you do not adhere to a certain diet and lead a carefree lifestyle (continue to smoke, drink alcohol and do not engage in recreational exercises).
It is necessary to strictly follow the diet and then you will not have to face again the problems that led to surgery. There will be no problems with transplanted veins replacing coronary arteries.
Advice: in addition to diet and exercise, you need to monitor your own weight, excess of which increases the load on the heart and, accordingly, increases the risk of recurrent disease.
Deep vein thrombosis
Despite the fact that this operation is successful in most cases, the following complications may occur during the recovery period:
Tip: Taking statins (drugs that lower blood cholesterol) before CABG significantly reduces the risk of scattered atrial contractions after surgery.
However, perioperative myocardial infarction is considered one of the most serious complications. Complications after CABG may occur due to the following factors:
Women, the elderly, diabetics and patients with renal failure are most at risk for complications in the postoperative period. Careful examination of the atria, ventricles and other parts of the person's most important organ before surgery will also help reduce the risk of complications after CABG.
There are only three prognostic conditions when a cardiologist should suggest coronary artery bypass surgery to a patient:
In cardiology, there are three groups of indications for coronary artery bypass grafting:
This includes patients with large amounts of ischemic myocardium, as well as patients with angina pectoris with indicators of myocardial ischemia and lack of a positive response to drug therapy.
The operation is indicated for patients with severe angina or refractory ischemia, in whom coronary artery bypass grafting can improve the long-term prognosis by preserving the pumping function of the left ventricle of the heart and preventing myocardial ischemia.
This group includes cases when the patient will need additional support in the form of coronary artery bypass grafting for an upcoming heart operation.
Indications for coronary artery bypass surgery are always established on the basis of a clinical examination of the patient, as well as on the basis of indicators of coronary anatomy in each specific case.
As before any other surgical intervention in cardiology, before coronary artery bypass surgery, the patient is prescribed a full examination, including coronary angiography, electrocardiography and cardiac ultrasound .
During the operation, a part of the vein from the lower limb . less commonly, part of the internal mammary or radial arteries. This in no way impairs blood circulation in this area and is not fraught with complications.
Coronary artery bypass surgery is performed under general anesthesia . Preparation for this operation is no different from preparation for any other cardiac surgery.
You can find a video of coronary artery bypass surgery on the Internet.
The main stages of coronary artery bypass surgery:
The patient is placed on the operating table. The anesthesiologist administers an anesthetic drug intravenously, and the patient falls asleep. To control the patient's breathing during surgery, an endotracheal tube is inserted into his trachea, which supplies breathing gas from a ventilator (artificial lung ventilation).
Angina pectoris - cardiac treatment in Moscow, Europe and Israel - Рopmed.ru - 2008
Stress tests are usually performed four to six weeks after surgery to determine the start of a cardiac rehabilitation program.
Sutures from the chest are removed before the patient is discharged, and from the leg (if using the saphenous vein of the leg) - after 7-10 days. Even if the function of the saphenous vein is replaced by small veins in the leg, as a rule, slight swelling of the lower leg is observed. Patients are advised to wear elastic support stockings during the day for the first four to six weeks after surgery and to keep the leg elevated while sitting. The tumor usually resolves within six to eight weeks.
Healing of the sternum occurs within six weeks. Patients are not recommended to lift weights exceeding 5 kg or perform strenuous exercise during the recovery period. It is not recommended to drive for four weeks after surgery to avoid possible damage to the chest. Patients can return to normal sexual activity as soon as they can minimize body positions that place stress on the chest and shoulders. You can return to work after six weeks of recovery, and with passive, sedentary work this can happen much faster.
The rehabilitation program takes 12 weeks and includes gradually increasing and supervised exercise for an hour three times a week. During the rehabilitation program, patients are given recommendations on how to change their lifestyle to reduce the likelihood of developing coronary artery disease in the future. These include: getting rid of bad habits (smoking), losing weight, changing your diet, constantly monitoring blood pressure and diabetes, lowering blood cholesterol levels.
Possible complications of coronary artery bypass grafting
The probability of death associated with CABG is 3-4%. During and shortly after CABG surgery, 5 to 10% of patients experience heart attacks, which is the leading cause of death. 5% of patients require exploratory surgery (diagnostic surgery) due to bleeding. This repeated surgery increases the risk of chest infection and pulmonary complications. Sudden attacks occur in 1-2% of patients, mostly in older people.
The likelihood of death and complications increases in the following cases:
In women, the likelihood of death is greater due to their advanced age at the time of the operation and smaller coronary arteries. In women, coronary heart disease develops 10 years later than in men due to hormonal “immunity” - regular menstruation (although women who are predisposed to developing coronary heart disease, especially smokers, with high lipid levels and diabetes, are more likely to develop coronary heart disease even at a young age is very large). Due to the fact that women are smaller than men, their coronary arteries are also smaller. These small arteries complicate CABG surgery and increase its duration. Small vessels also reduce the short-term and long-term effect of the implant.
Long-term results of coronary artery bypass surgery
There is a small chance that some vein grafts may become blocked due to blood clotting during the first two weeks after surgery. Typically, blood clots form in implants because small arteries outside the implant site carry blood very slowly. Another 10% of vein grafts may become blocked between two weeks and one year after CABG surgery. The use of aspirin prevents blood clotting and reduces implant blockage by 50%.
After five years, the implants become narrower as cells stick to the inside and multiply, leading to scar formation (intimal fibrosis) and atherosclerosis. After 10 years, only 2/3 of the venous implants remain unoccluded, and ½ of them have minor narrowing. Among internal breast implants, a much higher percentage (90%) are unoccluded 10 years after surgery. This difference is due to a shift in surgical practice toward greater use of internal mammary and other arteries instead of venous ones in bypass surgery.
Recent studies have shown that if AOS patients with elevated LDL (low-density lipoprotein) cholesterol levels take medications that lower LDL cholesterol levels to 80 (mainly statin drugs), this will significantly increase the longevity of the implant and prevent clogged arteries and will also reduce the likelihood of a heart attack.
Patients are advised to make lifestyle changes to reduce the possibility of developing atherosclerosis in the coronary arteries in the future. These recommendations include:
Frequent monitoring of CABG patients and performing physiological testing may reveal early problems in the implants. PTA (angioplasty) can significantly reduce the need for repeat CABG surgery in the future. Repeat CABG surgery is sometimes necessary, but the risk of complications is very high.
Coronary angiography | CABG – Coronary artery bypass grafting
CABG – CORONARY BYPASS
Coronary artery bypass grafting (CABG) is an operation that allows you to restore blood flow in the arteries of the heart by bypassing the site of narrowing of the coronary vessel using shunts.
Coronary artery bypass surgery aims to prevent the development of irreversible changes in the myocardium (heart muscle), improve (if possible) its contractility and thereby increase the quality of life and its duration.
This operation is the most effective treatment for coronary artery disease and allows patients to return to a normal active life.
The purpose of this surgical intervention is to apply bypass anastomoses (shunts) between the affected coronary vessel and the aorta to restore normal blood supply to the affected area of the heart muscle.
The internal mammary artery, which arises from the subclavian artery, as well as the radial artery and veins of the lower extremities, in particular the saphenous vein of the leg, are currently used as shunts.
If there are indications, the patient can undergo complete arterial revascularization, when both internal mammary arteries, the radial artery from the forearm, or one of the arteries supplying the stomach are used as autografts.
Today, triple, quadruple, or quintuple anastomoses are the generally accepted approach.
TECHNIQUES FOR CARRYING OUT CORONARY BYPASS GRAFT
A standard coronary artery bypass surgery lasts three to four hours on average and requires maximum concentration from the surgeon and his team.
Access to the heart is carried out as follows: first, soft tissue is dissected in the middle of the chest, then the sternum is sawed through - a so-called median sternotomy is performed.
In order to minimize the damage associated with a decrease in blood flow during the intervention, cardioplegia is performed, that is, temporary cardiac arrest: it is cooled with ice-cold salt water and a special preservative solution is injected into the cardiac arteries.
Before starting the process of coronary bypass surgery, a heart-lung machine is connected and the aorta is blocked in order to minimize blood loss and attach shunts to it. The aorta is clamped for sixty minutes, and the heart-lung machine is connected for an hour and a half. Plastic tubes are placed in the right atrium to drain venous blood from the body and pass it through a plastic sheath (membrane oxygenator) in the ventilator. After this, oxygenated blood enters the body again.
Vascular bypass involves the insertion of implant vessels into the coronary (coronary) arteries beyond the area of stenosis or blockage. The other end of the shunt is sutured to the aorta.
Nowadays, arteries of the chest wall are increasingly used as vascular bypass anastomoses, especially the left internal mammary artery, which usually joins either directly to the left anterior descending artery or to one of its main branches outside the occlusion zone.
The length of arterial autografts is very limited, so their use is only permissible for bypassing those affected areas that are localized at the beginning of the coronary vessels.
If we are talking about using the internal mammary arteries, you need to be prepared for the fact that coronary artery bypass surgery will take more time, since it will be necessary to separate the arteries from the chest wall. In this regard, it is likely that if emergency intervention is necessary, the use of these vessels as an autograft will have to be abandoned.
At the end of the operation, the chest is secured with a stainless steel wire, the soft tissue incision is sutured, and chest tubes are installed to remove the remaining blood from the pericardial space.
About 5% of patients require exploratory surgery because of bleeding, which may continue for 24 hours after surgery.
Chest tubes are usually removed the day after surgery. The breathing tube is usually removed immediately after surgery. Patients are usually able to get out of bed the day after surgery and are transferred out of the intensive care unit.
In 25% of patients, the heart rhythm is restored within the first three to four days after surgery. Heart rhythm disturbances are temporary atrial fibrillation and should be treated as a consequence of surgery. Arrhythmia is treated within one month after surgery using standard methods of conservative therapy.
The average length of hospital stay for CABG surgery has dropped from a week to three to four days for most patients. Many young patients can go home after just two days.
Thanks to new advances, patients have the opportunity to undergo CABG without the use of a heart-lung machine, with a beating heart. This significantly minimizes possible memory impairment and other complications that may occur after CABG, and is a significant success.
+7(925) 005 13 27 — information about coronary angiography