The heart muscle is fed with oxygen, which it receives from the coronary arteries coming to it. Due to the narrowing of these vessels, the heart experiences a lack of it and so-called coronary heart disease occurs. IHD is a chronic disease, the basis of which is a violation between the myocardial oxygen needs and the amount delivered by the heart vessels. The most common cause of prolonged narrowing of the coronary arteries is atherosclerosis in their walls.

IHD is a whole group of diseases that, this moment, is one of the leading causes of death in developed countries. Every year, about 2.5 million people die from its complications, of which about thirty percent are people of working age. But in recent years, significant advances have been made in its treatment. In addition to extensive drug therapy (disaggregants, statins, strains, beta-blockers, etc.), surgical methods are now being actively introduced in the Russian Federation. A real breakthrough previously was coronary artery bypass grafting. CABG is still not only one of the most radical operations, but also one of the most tested and proven in clinical practice.

The first is the technique of the operation itself. Thus, it is believed that patients in whom their own artery was used have a lower risk of relapse than those in whom their own vein was used.

The second is the presence of concomitant diseases before surgery, which complicate the course of rehabilitation. These may be diabetes mellitus and other endocrine diseases, hypertonic disease, previous strokes and other neurological diseases.

Third, the interaction between patient and doctor postoperative period, aimed at preventing early complications of CABG and stopping the progression of atherosclerosis. Among the complications of bypass surgery, the most common are pulmonary embolism, deep vein thrombosis, atrial fibrillation and, importantly, infections.

Therefore, in order to quickly return the patient to his usual way of life, physical, medicinal and psychological rehabilitation is carried out, the main principle of which is compliance with the stages. Most doctors agree that patients need to start moving after surgery in the first week. Basic rehabilitation lasts about two months, including sanatorium treatment.

Physical rehabilitation: first week

During the first days after surgery, the patient is in the intensive care ward or intensive care unit, where he is cared for by anesthesiologists and resuscitators. The duration of action of certain anesthetics is longer than the operation itself, so for some time the artificial lung ventilation device (ALV) breathes for the patient. At this time, doctors use it to monitor indicators such as heart rate (HR), blood pressure, and record an electrocardiogram (ECG). A few hours later, the patient is removed from the ventilator and is fully breathing on his own.

It is recommended that the patient lie on his side, changing sides every few hours. Already on the same day you are allowed to sit down, the next day you can carefully get out of bed and do light exercises for your arms and legs. On the third day, the patient can walk along the corridor, but preferably with an escort. The recommended time for walking is from 11 a.m. to 1 p.m. and from five to seven p.m. The walking pace should initially be 60-70 steps per minute with a gradual increase; steps on the stairs should be no faster than 60 steps per minute. During the first three days, a slight increase in body temperature may be observed, which is a normal reaction of the body to the operation.

Also at this time, special attention should be paid to breathing exercises; doctors may prescribe aerotherapy and nebulizer inhalations with bronchodilators. If surgeons used their own vein as a biomaterial, and especially the great saphenous vein, then compression stockings will be needed. Such underwear made of elastic fabric will help relieve swelling on the lower legs. It is believed that you need to wear it for about six weeks.

Physical rehabilitation: second to third week

The patient continues to engage in physical activity in a gentle manner. Among the local treatment methods, physiotherapy is recommended: massage of the cervical-collar area, magnetic therapy on the calf muscles, UHF on the chest and postoperative sutures and scars, aerophytotherapy. Laboratory indicators of the effectiveness of recovery at this time will be the level of troponin in the body, creatine phosphokinase (CPK), activated partial thromboplastin time (APTT), prothrombin and others.

Physical rehabilitation: from 21 days

From this time on, the nature of the patient’s physical activity changes. You can switch to low-intensity strength training, as well as interval training. For each patient, a separate training program is prescribed by a physical therapist or a certified trainer. It is necessary to focus not only on the patient’s level of fitness, but also on the condition postoperative scars. It will be good to start doing health training, jogging, swimming, walking. Among sports disciplines, volleyball, basketball, and tennis are not recommended for life.

Physiotherapy is supplemented with halotherapy, medicinal electrophoresis (with panangin, papaverine) on the cervical-collar area, and electrostatic massage on the surgical area. The duration of the course is just over a month.

To prevent post-infarction cardiosclerosis, it is necessary to repeat this course 1-2 times a year.

How to heal open wounds after CABG surgery?

The leading incision for CABG is made in the middle of the chest. The next one is done on the leg to take a vein (or veins) or on the forearm to take an artery. The first time after surgery, the sutures are treated with antiseptic solutions - chlorhexidine, hydrogen peroxide. By the beginning of the second week, the sutures can be removed, and by the end of it, the area can be washed with soap. Complete healing of the sternum occurs only after several months, which at first causes pain in the operating area. In the lower extremities, burning pain may occur at the site of the vein taken. They disappear during the process of restoring blood circulation.

After discharge

Returning to normal life is necessary for successful rehabilitation, so the sooner the better. Among the recommendations:

— Allowed to drive a car starting from the second month of rehabilitation

— Returning to work is possible in a month and a half. If there is heavy physical work, the period is discussed individually with the doctor; if there is sedentary work, it can be earlier.

— Restoration of sexual activity is also prescribed by a doctor.

Prevention of complications of coronary heart disease largely depends on lifestyle. Patients should quit smoking for life, control blood pressure (for this, doctors teach patients how to measure it correctly), weight, and follow a diet.

Diet

No matter how well the operation goes, if the patient does not follow a diet, the disease will progress and lead to greater vascular occlusion. Not only the coronary artery, which is already affected, but also the shunt can become further blocked, which can lead to death. To prevent this from happening, the patient should limit the intake of any fats in their diet. Recommended food:

- lean red meat, turkey liver, chicken, rabbit

- any types of fish and seafood

- wholemeal bread, whole grain bread

- low-fat dairy products

- cold pressed olive oil

- boiled vegetables

- fruits in any form

– lightly carbonated mineral water

General forecast

After CABG, the patient needs to adjust to long-term use of certain drugs - statins, antiplatelet agents, anticoagulants, b-blockers and others. The patient’s rehabilitation does not end with just the cardiac surgery and cardiology department. It is advisable to go to a cardio-rheumatological sanatorium annually (the average stay is a month). Also, based on the latest world studies, it follows that the average lifespan of patients after CABG is 17-18 years.

Rehabilitation after CABG: video exercises

Coronary artery bypass surgery: life before and after

Cardiac bypass surgery is an operation prescribed for coronary heart disease. When a formation occurs as a result of a formation supplying blood to the heart, this threatens the patient with the most serious consequences. The fact is that if the blood supply to the heart muscle is disrupted, the myocardium ceases to receive enough blood for normal functioning, and this ultimately leads to its weakening and damage. During physical activity, the patient experiences chest pain (). In addition, if there is a lack of blood supply, necrosis of a section of the heart muscle can occur.

For ischemic heart disease, for the prevention of heart attack, as well as to eliminate its consequences, if with the help conservative treatment failed to achieve a positive effect, patients are prescribed coronary artery bypass grafting (CABG). This is the most radical, but at the same time the most adequate way to restore blood flow.

CABG can be performed for single or multiple arterial lesions. Its essence is that in those arteries where blood flow is impaired, new bypass paths are created - shunts. This is done using healthy vessels that are attached to the coronary arteries. As a result of the operation, blood flow is able to bypass the site of stenosis or blockage.

Thus, the goal of CABG is to normalize blood flow and ensure adequate blood supply to the heart muscle.

How to prepare for bypass surgery?

The patient’s positive attitude towards a successful outcome of surgical treatment is of great importance - no less than the professionalism of the surgical team.

It cannot be said that this operation is in any way more dangerous than other surgical interventions, but it also requires careful preliminary preparation. As before any cardiac surgery, before undergoing cardiac bypass surgery, the patient is referred to full examination. In addition to the laboratory tests and studies necessary in this case, assessment of the general condition, he will need to undergo (). This is a medical procedure that allows you to determine the condition of the arteries that supply the heart muscle, identify the degree of narrowing and the exact location where the plaque has formed. The study is carried out using X-ray equipment and involves the introduction of a radiopaque substance into the vessels.

Part necessary research It is carried out on an outpatient basis, and some - inpatiently. In the hospital, where the patient usually goes to bed a week before the operation, preparation for the operation also begins. One of the important stages of preparation is mastering the technique of special breathing, which will be useful to the patient later.

How is CABG performed?

Coronary artery bypass surgery involves using a shunt to create an additional bypass path from the aorta to the artery, which allows you to bypass the area where the blockage occurred and restore blood flow to the heart. The shunt most often becomes the thoracic artery. Due to its unique features, it has high resistance to atherosclerosis and durability as a shunt. However, the great saphenous vein of the femur can be used, as well as the radial artery.

Result of bypass surgery

CABG can be single, as well as double, triple, etc. That is, if narrowing occurs in several coronary vessels, then as many shunts are inserted as necessary. But their number does not always depend on the patient’s condition. For example, with severe ischemic disease, only one shunt may be needed, while less severe ischemic disease, on the contrary, will require double or even triple bypass.

To improve the blood supply to the heart when the arteries are narrowed, there are several alternative methods:

1. Treatment with medications (for example, beta blockers);
2. – non-surgical method treatment, when a special balloon is brought to the site of narrowing, which, when inflated, opens the narrowed canal;
3. – a metal tube is inserted into the affected vessel, which increases its lumen. The choice of method depends on the condition of the coronary arteries. But in some cases, only CABG is indicated.

The operation is performed under general anesthesia on open heart, its duration depends on the complexity and can last from three to six hours. The surgical team usually performs only one such operation per day.

There are 3 types coronary artery bypass surgery:

• With connection of an IR device(artificial blood circulation). In this case, the patient's heart is stopped.
• Without IR on a beating heart— this method reduces the risk of complications, shortens the duration of the operation and allows the patient to recover faster, but requires a lot of experience from the surgeon.
• A relatively new technique - minimally invasive access with or without IR. Advantages: less blood loss; reduction in the number of infectious complications; reduction of hospital stay to 5–10 days; faster recovery.

Any heart surgery involves some risk of complications. But thanks to well-developed techniques, modern equipment and widespread practice, CABG has very high rates of positive results. Still, the prognosis always depends on the individual characteristics of the disease and can only be made by a specialist.

Video: animation of the heart bypass process (eng)

After operation

After CABG, the patient is usually in intensive care, where the primary restoration of the activity of the heart muscle and lungs begins. This period can last up to ten days. It is necessary that the person operated on breathes correctly during this time. Regarding rehabilitation, primary rehabilitation is carried out in the hospital, and further activities continue in the rehabilitation center.

The sutures on the chest and in the place where the material for the shunt was taken are washed with antiseptics to avoid contamination and suppuration. They are removed if the wounds have successfully healed on about the seventh day. There will be a burning sensation and even pain at the wound sites, but it will go away after some time. After 1–2 weeks, when the skin wounds have healed a little, the patient is allowed to take a shower.

The sternum bone takes longer to heal - up to four and sometimes six months. To speed up this process, the sternum must be kept at rest. This is where chest bands designed for this will help. In the first 4–7 weeks, you should wear special shoes on your legs to avoid venous stasis and prevent thrombosis, and you should also avoid heavy physical exertion during this time.

Due to blood loss during surgery, the patient may develop, but some special treatment she doesn't demand it. It is enough to follow a diet that includes foods high in iron, and within a month your hemoglobin will return to normal.

After CABG, the patient will have to make some efforts to recover normal breathing, and also to avoid pneumonia. At first, he needs to do the breathing exercises that he was taught before the operation.

Important! There is no need to be afraid of coughing after CABG: coughing is an important part of rehabilitation. To make coughing easier, you can press a ball or palms to your chest. Frequent changes in body position speed up the healing process. Doctors usually explain when and how to turn and lie on your side.

The continuation of rehabilitation becomes gradual increase physical activity. After the operation, the patient is no longer bothered by angina attacks, and he is prescribed the necessary motor regimen. At first it is walking along hospital corridors for short distances (up to 1 km per day), then the loads gradually increase, and after some time most restrictions on the motor mode are removed.

When the patient is discharged from the clinic for final recovery, it is advisable that he be sent to a sanatorium. And after one and a half to two months the patient can return to work.

Two to three months after bypass surgery, a stress test may be performed to evaluate the patency of the new pathways and also to see how well the heart is supplied with oxygen. If there is no pain or changes on the ECG during the test, recovery is considered successful.

Possible complications with CABG

Complications from cardiac bypass surgery are rare and usually involve inflammation or swelling. Even less often, bleeding from the wound occurs. Inflammatory processes can be accompanied by high fever, weakness, pain in the chest, joints, and heart rhythm disturbances. In rare cases, bleeding and infectious complications are possible. Inflammation may be associated with the manifestation autoimmune reaction– the immune system can react this way to its own tissues.

Rare complications of CABG:

1. Non-union (incomplete fusion) of the sternum;
2. Myocardial infarction;
3. Keloid scars;
4. Memory loss;
5. Kidney failure;
6. Chronic pain in the area where the surgery was performed;
7. Postperfusion syndrome.

Fortunately, this happens quite rarely, and the risk of such complications depends on the patient's condition before surgery. To reduce possible risks, before performing CABG, the surgeon must evaluate all factors that may negatively affect the course of the operation or cause complications of coronary artery bypass grafting. Risk factors include:

• Smoking;
• Physical inactivity;
• Obesity;
• Kidney failure;

In addition, if the patient does not comply with the recommendations of the attending physician or stops following the prescribed medications, recommendations on nutrition, exercise, etc. during the recovery period, a relapse is possible in the form of the appearance of new plaques and re-occlusion of a new vessel (restenosis). Usually in such cases they refuse to perform another operation, but stenting of new narrowings can be performed.

Attention! After surgery, you must follow a certain diet: reduce your intake of fat, salt, and sugar. Otherwise, there is a high risk that the disease will return.

Results of coronary bypass surgery

The creation of a new section of the vessel during bypass surgery qualitatively changes the patient’s condition. Due to the normalization of blood flow to the myocardium, his life after heart bypass surgery changes for the better:

1. Angina attacks disappear;
2. The risk of heart attack is reduced;
3. Physical condition improves;
4. Working ability is restored;
5. The safe amount of physical activity increases;
6. The risk of sudden death is reduced and life expectancy increases;
7. The need for medications is reduced only to a preventive minimum.

In short, after CABG, a sick person can enjoy normal life. healthy people. Reviews from patients at cardio clinics confirm that bypass surgery returns them to a full life.

According to statistics, in 50–70% of patients after surgery, almost all disorders disappear, in 10–30% of cases the patient’s condition significantly improves. New blockage of blood vessels does not occur in 85% of those operated on.

Of course, any patient who decides to undergo this operation is primarily concerned with the question of how long they will live after heart bypass surgery. This is a rather complex issue, and not a single doctor will take it upon himself to guarantee any specific period. The prognosis depends on many factors: the general health of the patient, his lifestyle, age, bad habits, etc. One thing is certain: a shunt usually lasts about 10 years, and may last longer in younger patients. Then a repeat operation is performed.

Important! After CABG, it is necessary to give up such a bad habit as smoking. The risk of recurrence of coronary artery disease for an operated patient increases many times if he continues to “indulge” in cigarettes. After the operation, the patient has only one choice - to forget about smoking forever!

Who is the operation indicated for?

If percutaneous intervention cannot be performed, angioplasty or stenting are unsuccessful, then CABG is indicated. Main indications for coronary artery bypass grafting:

• Damage to part or all of the coronary arteries;
• Narrowing of the lumen of the left artery.

The decision to operate is made on a case-by-case basis, taking into account the degree of damage, the patient’s condition, risks, etc.

How much does cardiac bypass surgery cost?

Coronary artery bypass grafting is a modern method of restoring blood flow to the heart muscle. This operation is quite high-tech, so its cost is quite high. How much the operation will cost depends on its complexity, the number of shunts; the current condition of the patient, the comfort that he wants to receive after the operation. Another factor on which the price of the operation depends is the level of the clinic - bypass surgery can be performed in a regular cardiology hospital, or in a specialized private clinic. For example, the cost in Moscow varies from 150 to 500 thousand rubles, in clinics in Germany and Israel - on average 0.8–1.5 million rubles.

Independent patient reviews

Vadim, Astrakhan:“After the coronary angiography, from the doctor’s words, I realized that I wouldn’t last more than a month - naturally, when I was offered CABG, I didn’t even think about whether to do it or not. The operation was carried out in July, and if before it I could not do without nitrospray, then after the bypass I have never used it. Many thanks to the team of the cardiac center and my surgeon!”

Alexandra, Moscow:“After the operation it took some time to recover - it doesn’t happen instantly. I can’t say that there was very strong pain, but I was prescribed a lot of antibiotics. At first it was hard to breathe, especially at night, and I had to sleep half-sitting. I was weak for a month, but I forced myself to walk, then it became better and better. The most important thing that stimulated it was that the pain behind the sternum immediately disappeared.”

Ekaterina, Ekaterinburg:“In 2008, CABG was performed free of charge, as it was declared the year of the heart. In October, my father (he was 63 years old at the time) had surgery. He tolerated it very well, spent two weeks in the hospital, then was sent to a sanatorium for three weeks. I remember that they forced him to inflate a ball so that his lungs would work properly. He still feels good, and compared to what he felt like before the operation, he’s doing great.”

Igor, Yaroslavl:“I had CABG in September 2011. They did it on a beating heart, they installed two shunts - the vessels were on top, and there was no need to turn the heart over. Everything went fine, there was no pain in the heart, at first the sternum ached. I can say that several years have passed and I feel on par with healthy people. True, I had to quit smoking.”

Coronary artery bypass surgery is an operation that is often vital for the patient; in some cases, only surgical intervention can prolong life. Therefore, despite the fact that the price of coronary artery bypass surgery is quite high, it cannot be compared with the priceless human life. If done on time, the operation helps prevent a heart attack and its consequences and return to a full life. However, this does not mean that after bypass surgery you can again indulge in excesses. On the contrary, you will have to

With the help of the created pressure, the intercostal muscles are unloaded. The pressure on the internal organs is redistributed, which allows increasing the rate of healing of bones and soft tissues and speeding up rehabilitation.

The need for a postoperative bandage

Wound healing after abdominal surgery is a long process associated with the characteristics of the thoracic spine.

The participation of the ribs in breathing, their connection with the diaphragm, causes an effect on the spine, cervical region, lower back and abdominal cavity.

The bandage is necessary to temporarily fix the chest and reduce pain during breathing.

Fixed tissues heal faster and become scarred. The muscles that have weakened during the postoperative period cannot support the spine, so the bandage effectively relieves some of the load from them.

After surgery, it is important to hold the internal organs in place to prevent suture dehiscence and hernias.

The bandage is a vest made of dense elastic material with fasteners with wide Velcro, which allow you to adjust it to the volume of the chest.

After bypass surgery for men, the corset is equipped with supporting straps. Women's orthoses have a cutout for the chest, and Velcro connects under the collarbone, providing a snug fit.

Why is fixation needed after surgery?

In coronary artery bypass surgery, the sternum is cut and stapled. A bone that can withstand significant loads is mobile. It does not grow together completely, but only becomes overgrown with soft tissues over the course of six months.

It will take several weeks for the skin to heal. A medical bandage eliminates postoperative risks:

• cutting staples;
• sternal discrepancies;
• the appearance of severe pain.

The pain after surgery persists for a long time and radiates to the arm. Bandage, along with painkillers, massage relaxation techniques and light exercise, serves to reduce pain.

A cardiac surgeon talks about how to wear a corset after bypass surgery. Some patients are recommended to wear it at night, and are allowed to sleep for 2-3 months only on their back to avoid chest deformation.

The mobility of the ribs decreases after three months, which is why this period is important. The surgeon determines how long to wear a corset based on the patient’s condition, taking into account age, activity, and the process of tissue scarring.

Patients usually do not want to wear a corset for a long time, since it is noticeable under clothing, especially in the summer. If the work is physical, then after a long hospital stay or sanatorium treatment, a bandage is a daily necessity.

Physical therapy begins in the hospital with light leg movements to increase the outflow of venous blood. Breathing exercises are needed to straighten lung tissue and prevent stagnation. During gymnastics using balls, the chest corset is sometimes removed.

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Life after heart surgery

How to properly spend the postoperative period, what to be prepared for and what to be wary of.

Heart surgery is a chance for a successful continuation of a normal, full life. The realization of this chance largely depends on a properly conducted postoperative period. It will not be easy for the patient and his family at first, but if everything is done correctly, the result will exceed all expectations. The main principle is not to make sudden movements: all “pre-operative” activity will have to be restored calmly and slowly.

Almost everyone experiences mood swings after open heart surgery. Joyful excitement after recovery from anesthesia is often replaced by depressive irritation. Memory weakens, concentration decreases, and absent-mindedness appears. Neither the patient nor his relatives need to worry about this. These symptoms usually go away within a month after surgery.

Usually you are discharged from the hospital 7-14 days after surgery. The patient must remember that even if everything was successful, it will take him from 2-3 months to a year to fully recover after the operation. You need to start taking care of yourself right outside the hospital. There are many cases where the patient had to be returned by ambulance within 3-6 hours after discharge. If the journey home takes more than an hour, you must stop and get out of the car. Otherwise, serious problems with blood circulation in the vessels are possible.

At home, we must try to build relationships in such a way that the postoperative period is as smooth as possible for both the patient and his family members. Family members should treat the patient with understanding and make efforts for his recovery, but this does not mean that their entire life from this period should be subordinated only to him. Neither the patient himself nor his loved ones need codependency.

It is imperative that the patient is constantly monitored by the attending physician after discharge - Family doctor, therapist or cardiologist.

Immediately after surgery, your appetite is most likely not very good, and healing physical and mental wounds requires good nutrition. Therefore, it is possible that for 2-4 weeks doctors will not set food restrictions at all. However, within a month, serious dietary restrictions will begin - on fats, cholesterol, sugar, salt, and calories. It is advisable to eat food with a high amount of easily digestible carbohydrates (vegetables, fruits, sprouted grains) and fiber. To combat anemia, you will most likely have to eat foods high in iron: spinach, raisins, apples, and moderately lean red meat.

• Lots of vegetables and fruits
• Porridge, possibly with bran, or muesli and cereal for breakfast
• Sea fish as a main course at least 2 times a week
• Fermented yogurt or juice instead of ice cream
• Only dietary dressings, olive oil and mayonnaise for salads
• Herbal and vegetable spices instead of salt
• Reduce weight to normal, but not quickly. 1-2 kilograms lost per month is ideal
• Move!
• Check your sugar and cholesterol regularly
• Smile at life!

There will definitely be discomfort at the incision site after the operation and will only go away with time. When the stitches are overgrown, pain-relieving ointments and moisturizing lotions can be used to relieve discomfort. It is best if the patient consults his surgeon before using any ointments. If you are concerned about the cosmetic consequences of the operation, then it is advisable to see a plastic surgeon immediately after removing the stitches.

If the postoperative sutures heal normally, 2 weeks after the operation you can take a shower (not a bath, especially not a jacuzzi!). But at the same time: no expensive shampoos and contrasting changes in water temperature. Wash with plain soap and get wet (do not wipe, but blot with a clean towel). It is best that the first after the operation " water procedures" was accompanied by someone close to him: you never know what could happen...

You should call your surgeon immediately if you experience the following symptoms:

• temperature above 38°C
• severe swelling and redness of the sutures, discharge of fluid from them
• severe pain at the surgery site

From the first day after the hospital, you can try to calmly walk meters on a flat surface. You need to stop - stop! You should go for a walk when it is convenient and when the weather permits. But not immediately after eating! By the end of the first month after the operation, you can slowly walk 1-2 kilometers.

At the end of the first week of staying at home, you can independently and slowly walk 1-2 flights up and down the stairs. Start wearing light items - up to 3-5 kilograms. If everything went ok with the stairs, you can gradually (!) start thinking about sex

Light housework won't hurt: dusting, setting the table, washing dishes, or helping family members cook.

After one and a half to two months, the sutures should heal completely, and then most likely cardiologists will conduct a functional stress test, based on the results of which it will be possible to judge the acceptable rate of increase in motor and psychological activity. Gradually, you can begin to lift and move heavier things, swim, play tennis, and do light (physically) work in the garden and/or office. A repeat test is usually performed 3-4 months after surgery.

The most important thing here is the complete lack of independence. Medicines are always at hand and are taken only as prescribed by a doctor, and are not canceled without his prescription. Particular attention should be given to medications to prevent blood clots, such as aspirin and medications to normalize blood pressure. Don’t forget about medications and dietary supplements that reduce bad cholesterol levels.

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The information published on the site is for informational purposes only. Described methods of diagnosis, treatment, traditional medicine recipes, etc. It is not recommended to use it yourself. Be sure to consult a specialist so as not to harm your health!

Rehabilitation after heart surgery

Immediately after your heart surgery, you will be taken to the intensive care unit, the best place to monitor you closely.

While you are in the intensive care unit, your heart rate, breathing rate, blood pressure, urine output, blood tests, chest x-ray and a variety of other data will be continuously assessed to ensure that no problems arise in the critical first post-operative hours. Nurses, support staff, special doctors called intensivists, and your surgeon will receive minute-by-minute reports of your progress.

Your memory will probably retain some fragments of your time in the intensive care unit, but for most patients, the time spent there is a blur.

If everything goes according to plan, within twenty-four hours your doctor will tell you everything is fine and you will leave the intensive care unit. On the permanent nursing floor, you will be cared for by one nurse (who has several other patients), one technician, and a team of doctors (who do rounds on many patients). They will help you make steady progress towards leaving the hospital in a week.

That's the plan. But sometimes things go wrong. Almost half of patients who have heart surgery will experience a bump in the road to recovery. The most common occurrence is atrial fibrillation, a temporary abnormal heart rhythm that will show up on your heart monitor; it is rarely serious and is easily treated.

Other complications can be insidious and more difficult to recognize. Moving quickly from patient to patient, your nurses and doctors may miss important signs. This is where you, your relatives and friends should come to the rescue. Often the patient himself or his relatives are the first to notice the disorder. Pay attention to the warning signs listed below and speak up if you experience them. Your vigilance can speed up recovery or even save your life.

You should also be alert for signs and symptoms of depression, which often occurs in people with cardiovascular disease. A third of patients develop symptoms of depression after CABG or heart valve surgery. Patients at particular risk are those who were already depressed before surgery and older women. If you have a history of depression, let your doctors know about it before surgery so they can take action to help you avoid it again.

Depressed cardiac surgery patients stay in the hospital longer, return there more often than others, recover more slowly, experience more pain, and have a reduced quality of life. For reasons that are not entirely understood, they are also more likely to have heart attacks and die in the first year after surgery. Poor adherence to medical prescriptions and unhealthy habits (smoking, poor diet, lack of physical activity) that affect blood clotting, inflammation and heart rate may be associated with depression.

The main problem with depression is its diagnosis. Your medical team will regularly take standard medical tests from you, including blood tests, chest x-rays, and ECGs. But a diagnosis of depression requires more than a glance at a computer screen and a five-minute visit to ward rounds. We repeat, this is where your family and friends should come to the rescue.

Depression after heart surgery: signs and symptoms:

• loss of energy, fatigue;
• feelings of hopelessness or worthlessness;
• loss of interest in activities that you previously enjoyed;
• loss of appetite;
• inability to concentrate;
• recurrent thoughts of death or suicide.

Depression usually occurs within the first three months after surgery.

If you develop these symptoms, either in the hospital or in the first few weeks after you come home, tell your doctor. Most depression goes away over time. But if the depression is particularly severe, treatment is required. Whether it's a short-term antidepressant or several visits to a therapist, successful intervention will speed recovery and improve outcomes. So don't ignore depression after heart surgery. This is a common occurrence. Is it dangerous. But it is curable.

Is it worth enrolling in a cardiac rehabilitation group?

You've just made a huge investment in your health. You did it through open heart surgery. You spent several days away from home in the hospital. Now you have a month or two ahead of you until full recovery. Get them right. Join a cardiac rehabilitation group near your home. Follow Nike's motto: "Just Do It!"

You may not realize it, but you have already started a cardiac rehabilitation program. Phase I of cardiac rehabilitation includes walking, climbing stairs and educational activities, which you completed in the hospital.

Phase II cardiac rehabilitation begins one to three weeks after surgery. It is much more than a medically supervised exercise program. It also covers diet, risk factor modification, medication and lifestyle optimization, and counseling. Instructors and other participants provide emotional and psychological support. Patients realize that they are not alone, and hearing the stories of others, they calm down and gain new strength. This feature of the rehabilitation program is especially useful for those who suffer from depression, or for those who have been deeply affected by the feeling that nothing lasts forever, which often accompanies those who have undergone heart surgery. And make it a family affair: Patients tend to make beneficial and lasting changes if their significant other or others they listen to accompany them in their rehabilitation sessions.

Patients participating in a cardiac rehabilitation program after cardiac surgery have increased exercise capacity, improved lipid levels, decreased chest pain and shortness of breath, and return to independence more quickly. With such benefits, the numbers are hard to swallow: only 10 to 20% of Americans and 35% of Europeans participate in a cardiac rehabilitation program after heart surgery. This is especially true for older people and women.

One of the reasons for such low participation in rehabilitation programs is that many people think that their heart has been “fixed” and no additional efforts are needed after the operation. Of course this is not true. Heart surgery is just the beginning of a second chance. Grab this opportunity! Others worry that the rehabilitation program will be expensive. Don't worry about the costs. Medicare and most insurance companies cover cardiac rehabilitation; in fact, it is cost-effective because it improves health, reduces future costs and gets you back to work faster.

The road to recovery after heart surgery

Over the course of two to three months after surgery, you will gradually return to normal, resuming your usual activities. But is this rate of recovery good? What activities are required and when will you be able to participate in them? How soon after surgery can you climb stairs, drive a car, or have sex? Is there a special diet that you should follow? When can you say your recovery is on track? Let's answer these and other commonly asked questions. The answers will help you make sure you stay on the path to recovery.

Exercise after heart surgery

You should exercise daily. Plan a daily walk. For the first two to four weeks, include 20 to 30 minutes of walking per day. You can go up the stairs immediately. Stop all activities if you experience shortness of breath, chest pain, weakness, or dizziness and call your doctor if these symptoms do not go away within 20 minutes. When sitting, raise your feet on an ottoman or chair. If you have had a sternotomy, avoid lifting more than 5 kilograms for six weeks - this is the time it takes for the bone to heal. If you have an incision on the side of your chest, do not lift anything heavy with this arm. Four weeks.

Strenuous exercise can begin three months after surgery. After three months, runners and weightlifters have no restrictions. After this, make sure daily exercise remains important part of your life; they will not harm any “repair work” done on your heart.

Diet after heart surgery

No matter what type of surgery you have had, avoid highly salty foods for two to four weeks. People tend to gain between 1.5 and 5 kilograms from fluid intake during heart surgery. Most of this weight will disappear before you leave the hospital, and limiting salt once you're home will help you shed any remaining excess fluid and prevent post-surgery swelling. In the first few weeks after surgery, there is usually poor appetite and a decreased ability to taste food. This will pass, but make sure you are consuming enough calories to ensure recovery. Many people find it easier to eat little, but often. Milkshakes and high-energy liquid supplements may help. Once your recovery is complete, follow a healthy Mediterranean diet to maintain the benefits of your surgery.

Sex after heart surgery

You can resume sexual activity as soon as you feel able to do so. This usually occurs two or more weeks after leaving the hospital. There may be concerns at first, but don't worry. With your new, well-functioning heart, everything will be fine. Men who take Viagra or other erectile dysfunction medications can resume taking such medications in almost all cases, but check with your doctor first.

Postoperative scar care after heart surgery

You can take a shower; You've probably already taken a shower in a hospital. Wash your grout daily with soap and water. Do not apply any creams or oils. Don't take a bath for the first two weeks after returning home from the hospital. Avoid tanning in the scar area at least twelve months, as sun exposure can cause permanent dark pigmentation of the scar.

Driving after heart surgery

If you have had a sternotomy, we recommend avoiding driving for six weeks from the date of surgery. However, you can ride as a passenger. If your incision was on the side of your chest, you can start driving seven to ten days after surgery. Of course, avoid driving while taking prescription pain medications.

Pain control after heart surgery

Take your painkillers. When you leave the hospital, you will be given a prescription for narcotic pain medication. Use it. Even if you had minimally invasive surgery, it is still a major operation. Limiting your discomfort will allow you to breathe deeper and exercise regularly

This will speed up your recovery and reduce the risk of complications such as pneumonia and blood clots in the veins of your legs. To ensure a good night's rest, consider taking painkillers before bed for the first two to four weeks. Remember that drugs can cause constipation; include fruits and fiber in your diet and. If constipation does occur, ask your doctor to prescribe a mild laxative.

Returning to work after heart surgery

After a sternotomy, it makes sense to stay away from work for six to eight weeks, especially if your job involves strenuous physical activity. Office workers often start by going to work for a couple of hours three or four weeks after surgery. But your main job after heart surgery is to take care of yourself. Before returning to work, make sure your recovery is going according to plan.

Monitoring your recovery after heart surgery

Buy a notebook and write down the following information every day for the first month after surgery.

Daily Checklist: First Month After Returning Home:

Danger signs after heart surgery

Your recovery will be gradual and you may not feel better the next day. Modest changes in how you feel from day to day are normal and there is no cause for concern. However, certain signs or symptoms indicate that you need timely medical attention, either immediately or within twenty-four hours.

Constant vigilance at home will prevent complications and identify problems early, providing prompt treatment that will get your recovery process back on track.

Finally, let's address the most difficult question of all: "When will I feel completely normal?" The answer depends on the specific case. A young person who has minimally invasive surgery may feel quite normal after four to six weeks. After a sternotomy, most patients will take three months to return to normal. After this, they will feel better than before the operation, and many will notice an increase in energy and stamina.

Life goes on after heart surgery, and it is usually of excellent quality. More than 75% of people report a significant improvement in quality of life. By following our recipes, you will find yourself in this majority.

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Recovery period after heart surgery

For most patients, heart surgery is a chance to return to a full life. The success of its implementation largely determines the recovery period after heart surgery. The first time is not easy for the patient and his family and friends, but if you follow all the recommendations of specialists, the result of the operation can exceed your wildest expectations.

So, how to properly conduct the recovery period, what to pay attention to and what to be prepared for? The most important principle here is gradualism. Previous activity must be restored slowly and calmly.

The recovery period after open heart surgery is almost always characterized by sudden mood swings in patients. After recovery from anesthesia, positive emotions are often replaced by irritation and depression. Many patients experience memory impairment, decreased concentration, and absent-mindedness. However, this is not a reason for serious worries. All these symptoms usually disappear within a month after heart surgery.

After the operation, the patient is usually discharged home after 1–2 weeks. However, the recovery period is just beginning. You need to know that even after successful operations, it takes several months to a year for a person to fully recover. And taking care of the patient’s body must begin immediately after he leaves the clinic. There have been a large number of cases where patients had to return to the hospital several hours after discharge. It is worth remembering that if the duration of the trip home exceeds one hour, it is necessary to make stops and get out of the car. Otherwise, the blood circulation of the vessels may be impaired.

At home, relationships between the patient and his family members should be built in such a way that the recovery period is as calm as possible for everyone. Household members should treat a person who has undergone a serious operation with understanding and try to do everything possible to help him recover faster. However, you should not go too far here, since the so-called co-dependence, that is, the complete subordination of your life to the needs of the patient, is not needed either by him or by his close people.

After heart surgery, constant supervision by the attending physician, therapist or cardiologist is required.

The patient's appetite after surgery is often poor, while good nutrition is required to heal physical and psychological wounds. Therefore, doctors often do not restrict the patient’s diet for 3–4 weeks after heart surgery. Then bans are established on the consumption of fats, sugar, salt, cholesterol and caloric content of foods.

The patient is recommended to eat foods that contain large amounts of fiber and easily digestible carbohydrates. These are fruits, vegetables and sprouted grains. And to prevent or combat the development of anemia, it is necessary to include foods rich in iron in your diet: raisins, spinach, apples and small amounts of lean red meat.

Eat more fruits and vegetables.

For breakfast, eat porridge, cereal or muesli, possibly containing bran.

Include in your menu sea ​​fish at least twice a week.

Instead of ice cream, it is good to use juices or fermented milk yoghurts.

Use only olive oil or mayonnaise for salads as salad dressings.

Replace salt with vegetable and herbal spices.

Monitor your weight and gradually reduce it to normal levels, by 1-2 kg per month.

Constantly measure your sugar and cholesterol levels.

Move more and enjoy life!

Healing of postoperative sutures

There may be discomfort at the incision site after surgery. They pass over time. After the seam is completely overgrown, you can use pain-relieving ointments and moisturizing lotions. This helps relieve discomfort. But before using such remedies, you must consult a surgeon.

If the healing process of the sutures proceeds normally, the patient can take a shower 2 weeks after the operation. Under no circumstances should you take a bath or hot tub. You cannot use shampoos, you must avoid sudden changes in water temperature. It is better to wash with regular soap and pat your skin (do not dry it) with a clean towel.

If the following symptoms appear, you should immediately contact your surgeon:

Increased body temperature above 38 degrees;

Strong fighting sensations at the operation site;

The appearance of redness and swelling of the sutures, as well as the release of fluid from them.

From the first day of discharge from the hospital, the patient may try to walk 100–500 meters. If at the same time he feels that he needs to rest, he needs to stop. You can go for a walk if you feel well and the weather is favorable. You should not go for walks immediately after eating. A month after the operation, you can walk leisurely for a distance of 1–2 km.

A week after discharge, you can try to slowly walk 1-2 flights of stairs and carry light objects weighing up to 3 kg. You can do light housework - wipe the dust, set the table, wash dishes, help family members prepare food.

After 1.5–2 months, as a rule, the sutures heal completely. A cardiologist may prescribe a functional stress test. Its result allows you to select the rate of increase in psychological and motor activity.

Over time, a person may begin to move and carry heavier objects, perform light physical work in the office or, for example, in the garden, and swim. A repeat functional stress test is usually performed 3–4 months after surgery.

CARDIOVASCULAR DISEASES

Reminder for patients undergoing open heart surgery

The primary recovery period lasts approximately a day. During this time, the patient gradually returns to normal activities.

Tempo and Features recovery period are individual for each person. Each patient should increase the load at their own pace.

During the recovery process there may be periods of improvement and deterioration, which are expected and should not cause alarm to the patient.

Daily care of seams is to wash them with soap and water (using a soft washcloth is allowed).

If there is discharge from a postoperative wound, after washing it should be covered with a sterile gauze cloth and sealed with an adhesive plaster on top.

In case of changes in the wound such as redness, heavy discharge or increased body temperature, you should consult your doctor.

It is possible that sensations of loss of sensitivity, itching and pain at the operation site will occur over time.

These symptoms are normal, common, and resolve over time.

If they become severe, prolonged and interfere with everyday life, it is recommended to consult your doctor.

Taking painkillers as directed by your doctor. Massage and relaxation exercises also help.

Instructions about taking medications or stopping them can only be given by a doctor!

If the patient, for any reason, does not take the medicine on time, you cannot take a double dose during the next appointment!

• name of medicine

• medication doses

• how many times a day should you take the medicine and at what hours

• side effects of medications (this data will be reported by the attending physician upon discharge)

• If side effects of medications occur, such as stomach pain, vomiting, diarrhea, rash, etc., you should inform your doctor.

Bandages should be removed at night. This time can be used to wash them for reuse.

The healthy leg must be bandaged for 2 weeks after surgery. If the leg is not swollen, you can stop bandaging at an earlier date.

Instead of an elastic bandage, you can use an elastic golf suitable size, which can be purchased at a pharmacy and worn after the stitches are removed.

It is advisable to avoid eating fried and fatty foods, and also reduce the consumption of salty, sweet and offal foods.

Body weight must correspond to height! (Excess weight is one of the risk factors for cardiovascular disease).

Meal times should be constant. Excessive eating should be avoided.

You will need to contact a cardiologist to obtain permission to drive a car, since after the operation your reactions will be slowed due to weakness and fatigue, as well as under the influence of medications, and rotational movements will remain difficult until the sternum is completely healed.

If you have to travel long distances, you should make stops along the way and let your legs rest and relax to improve blood circulation in them.

You should constantly try to straighten your back and straighten your shoulders.

The energy required for intimate relationships corresponds to the energy required to walk and climb approximately two floors of stairs.

After visiting a cardiologist, undergoing a routine check-up and obtaining his permission, it is possible to enter into an intimate relationship. You may have difficulty in certain poses - you should change them according to your feelings.

It is advisable to reduce visits to young children who may be carriers of various viral infections.

• Each patient returns to the volume of usual activity at his own individual pace. You should not compare yourself to other patients who have undergone heart surgery and compete with them.

• If you have any problems related to your surgery, do not hesitate to contact us directly.

• In a moment of fatigue, leave your guests and lie down to rest. Reduce visiting friends.

• Try to rest at noon.

• For some time, pain in the area of ​​​​the surgical stitches will interfere with your sleep, listen to the radio or music to distract yourself, or get up and walk a little and then try to fall asleep again. Use sleeping pills only as a last resort.

• The recovery period is characterized by frequent shifts moods that pass over time.

• Walking on level ground is recommended. Choose your walking route. Walking should be fun. You should not walk until you get tired. Try to rest while traveling.

• It is recommended to wear cotton or knitted clothing that will not irritate the postoperative suture.

• It is important to tell every doctor you see that you have had open heart surgery.

There are contraindications, consultation with a specialist is required.

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Ministry of Health of the Russian Federation (Krasnoyarsk)

Features of rehabilitation after heart surgery

Successful recovery after surgery is possible provided that the rehabilitation itself after heart surgery is carried out correctly and all conditions and recommendations are met. A clear system of instructions and their complete implementation can significantly reduce the time for a gradual return to normal activity.

Over the course of a month after the operation, there may be a sharp change in emotions, distracted attention, deterioration of memory and the ability to concentrate. Typically, the amplitude of mood swings does not exceed acceptable norms, so relatives and friends should be understanding of sudden changes from a joyful state to irritability and depression of the patient.

The cardiac surgery department carries out all the necessary procedures and tests to carefully monitor the condition. After approximately two weeks, if the recovery dynamics are positive, the patient can be discharged home.

From this moment on, the person himself will have to make every effort for a speedy and complete recovery. Rehabilitation can take a period of time from several months to a year - it all depends on the individual characteristics of the body and the implementation of important recommendations.

Problems and disturbances in the blood circulation of blood vessels should be avoided in the first hours after discharge from hospital. medical institution, trying to moderate physical activity as much as possible and balance the mental state. It is advisable to ensure constant monitoring by a cardiologist or family doctor, who will adjust prescriptions directly depending on the patient’s condition. If necessary, a corset designed specifically for people after surgery can be worn to relieve chest discomfort. Heart surgery introduces numerous changes and disturbances to the body’s condition, so the main goals of treatment are:

• restoration and stable functioning of the cardiovascular system;
• normalization of cardiac muscle activity and cardiac functions;
• active stimulation of recovery processes;
• stable improvement in hemodynamics;
• preventing complications;
• restoration of stable functioning of the central nervous system.

If any complications, inflammatory processes or abnormalities occur, use various ways restoration of the body, among which aerosol methods, the use of Khivamat-200 and Plus-1 devices, and carbon dioxide baths are considered the most effective.

Proper care of sutures and surgical wounds

Discomfort in the chest area after surgery is understandable, but by adhering to the basic rules, you can significantly speed up healing. It is permissible to take a shower, avoiding contrasting changes in water temperature, shampoos and rubbing with a towel.

The seam must always be clean; for this you can only use soap and water. A surgical wound with normal trophism is dry or with a slight secretion of fluid, without swelling with pronounced redness. If there are noticeable changes, you will need to immediately contact a specialist so as not to worsen the condition and not bring it to a critical limit.

After washing the surgical wound, you need to treat it with iodine. Before removing the suture, this procedure must be repeated several times a day, unless there are additional recommendations. General hygiene procedures are also very important, especially oral care.

Prescribed medications can negatively affect the condition of the enamel, so monitoring with a dentist will not be superfluous. It is recommended to limit contact with others to avoid infections and viral diseases.

Any complications can lead to negative consequences, so during the recovery period it is better not to neglect the advice and recommendations of doctors.

Special medications prescribed by your doctor can relieve pain, reduce itching and inflammation. Changing medications or changing the dosage of medications is strictly prohibited. If a bypass is performed, there may be pain in the leg.

Moderate physical activity and short walks will help cope with discomfort.

Slight swelling of the leg is acceptable norm, the use of compression bandages and keeping the limb in a slightly elevated position will help improve the condition.

Physical activity

Proper and sufficient physical activity will help speed up recovery. Daily walks should not last more than 30 minutes at first. At the first symptoms of shortness of breath, sharp pain in the chest, or dizziness, you should immediately stop any activity and see a doctor. It is not advisable to lift weights exceeding five kilograms. After three months of daily moderate physical activity, you can gradually increase the intensity of exercise, but with the obligatory supervision of your doctor.

There are quite a few special exercises that significantly improve muscle trophism and the general condition of the body. Fatigue and weakness after surgery negatively affect posture, so correct body position will relieve not only tension, but also pain. Breathing techniques return the chest to its former shape and help cope with difficulty breathing and discomfort. By alternately relaxing and tensing the chest, you can get rid of tension and develop calm and rhythmic breathing.

A full range of different activities will help you recover in the shortest possible time, which together are guaranteed to provide the best result. Medical Physical Culture, special massage, medication, diet and physiotherapy, when used correctly and wisely, will quickly restore lost strength, return activity, and improve well-being.

It is possible to determine clear dynamics of recovery only by carefully monitoring your well-being. Observations are especially important in the first month after returning home. Every day at the same time you need to record your body temperature, weight, duration of walk, check the swelling of your legs and the condition of your stitches.

Healthy and balanced diet

Diet and proper nutrition have a positive effect on overall well-being and promote recovery.

Regardless of the type and type of surgical intervention, it is highly recommended not to eat dishes and foods with an excess of salt. Weight gain after heart surgery is caused by fluid accumulation in the body and usually disappears almost completely before discharge from the hospital. The remaining liquid will disappear at home quite naturally, thanks to the restrictions on salt.

At first, for several weeks after heart surgery, patients experience a decrease or complete absence of appetite. Gradually, the ability to taste food will return, but during rehabilitation you should definitely take care of a sufficient amount of nutrients and vitamins for the body.

Many people find fractional meals suitable, which allows them to eat in small portions, but often. It is also permissible to enrich the diet with special high-energy supplements and cocktails.

The result of the operation can be secured by using the correct nutrition system in the future. The Mediterranean type of diet is recognized as the most suitable option, thanks to healthy and tasty dishes rich in plant fiber. In the absence of individual recommendations, it is advisable to drink one and a half liters of liquid during the day. Products with a high caffeine content, such as strong tea, Coca-Cola, coffee, are strictly prohibited, as they can cause disruption of the aortocoronary circulation, increasing the load on the heart.

After the rehabilitation period, you can return to work and normal activities. But in some cases it is necessary to make adjustments to life.

For example, if the work is directly related to physical activity, you should seek additional advice from your doctor, who will extend the appointment until the body is completely restored. Smoking can also negatively affect aortocoronary circulation, so you will have to completely give up this bad habit. It is imperative to save all medical documents and examination results for systematic observations in medical institutions.

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After heart surgery

Coronary artery bypass grafting has been used in cardiology for more than half a century. The operation consists of creating an artificial path for blood to enter the myocardium, bypassing the thrombosed vessel. In this case, the heart lesion itself is not affected, but blood circulation is restored by connecting a new healthy anastomosis between the aorta and coronary arteries.

Synthetic vessels can be used as a material for coronary artery bypass grafting, but the patient’s own veins and arteries have proven to be the most suitable. The autovenous method reliably “solders” the new anastomosis and does not cause a rejection reaction to foreign tissue.

Unlike balloon angioplasty with stent installation, the idle vessel is completely excluded from the blood circulation and no attempts are made to open it. A specific decision on the use of the most effective method in treatment is made after a detailed examination of the patient, taking into account age, concomitant diseases, and the preservation of coronary circulation.

Who was the “pioneer” in the use of aortic bypass?

The most famous cardiac surgeons from many countries worked on the problem of coronary artery bypass grafting (CABG). The first operation on a human was performed in 1960 in the USA by Dr. Robert Hans Goetz. The left thoracic artery, branching from the aorta, was selected as an artificial bypass. Its peripheral end was attached to the coronary vessels. Soviet surgeon V. Kolesov repeated a similar method in Leningrad in 1964.

Autovenous bypass surgery was first performed in the United States by Argentinean cardiac surgeon R. Favaloro. A significant contribution to the development of intervention techniques belongs to the American professor M. DeBakey.

Currently, similar operations are performed in all major cardiac centers. The latest medical equipment has made it possible to more accurately determine indications for surgery, operate on a beating heart (without a heart-lung machine), and shorten the postoperative period.

How are indications for surgery selected?

Coronary artery bypass grafting is performed when balloon angioplasty and conservative treatment are impossible or there are no results. Before surgery, coronary angiography of the coronary vessels is mandatory and the possibilities of using a shunt are studied.

The success of other methods is unlikely if:

• severe stenosis of the left coronary artery in the area of ​​its trunk;
• multiple atherosclerotic lesions of coronary vessels with calcification;
• the occurrence of stenosis inside the installed stent;
• inability to pass the catheter into a too narrow vessel.

The main indications for the use of coronary artery bypass grafting are:

• confirmed degree of obstruction of the left coronary artery by 50% or more;
• narrowing of the entire bed of the coronary vessels by 70% or more;
• a combination of the above changes with stenosis of the interventricular anterior artery in the area of ​​its branch from the main trunk.

There are 3 groups of clinical indications, which are also used by doctors.

Group I includes patients who are resistant to drug therapy or who have a significant ischemic area of ​​the myocardium:

• with angina pectoris of functional classes III–IV;
• with unstable angina;
• with acute ischemia after angioplasty, impaired hemodynamic parameters;
• at developing heart attack myocardium up to 6 hours from the onset of pain (later if signs of ischemia persist);
• if the ECG stress test is strongly positive and the patient needs elective surgery on abdominal cavity;
• with pulmonary edema caused by acute heart failure with ischemic changes (accompanies angina pectoris in elderly people).

Group II includes patients who need very likely prevention of acute infarction (without surgery the prognosis is unfavorable), but are difficult to treat with drugs. In addition to the main reasons already given above, the degree of dysfunction of the heart’s ejection function and the number of affected coronary vessels are taken into account:

• damage to three arteries with a decrease in function below 50%;
• damage to three arteries with function above 50%, but with severe ischemia;
• damage to one or two vessels, but with a high risk of heart attack due to the large area of ​​ischemia.

Group III includes patients for whom coronary artery bypass grafting is performed as a concomitant operation with a more significant intervention:

• during operations on valves, to eliminate anomalies in the development of the coronary arteries;
• if the consequences of a severe heart attack (aneurysm of the heart wall) are eliminated.

International Heart Associations recommend putting clinical signs and indications first, followed by anatomical changes. It is estimated that the risk of death from a possible heart attack in a patient significantly exceeds mortality during and after the operation.

When is surgery contraindicated?

Cardiac surgeons consider any contraindications relative, since additional vascularization of the myocardium cannot harm a patient with any disease. However, the potential risk must be taken into account fatal outcome, which increases sharply, and inform the patient about it.

Classic general contraindications for any surgery are considered to be those the patient has:

• chronic lung diseases;
• kidney disease with signs of renal failure;
• oncological diseases.

The risk of mortality increases sharply with:

• coverage of atherosclerotic lesions of all coronary arteries;
• a decrease in left ventricular ejection function to 30% or lower due to massive cicatricial changes in the myocardium in the post-infarction period;
• the presence of severe symptoms of decompensated heart failure with congestion.

What is the additional bypass vessel made of?

Depending on the vessel chosen for the role of bypass, bypass operations are divided into:

• mammarocoronary - the internal mammary artery serves as a shunt;
• autoarterial - the patient’s own radial artery is isolated;
• autovenous - the great saphenous vein is selected.

The radial artery and saphenous vein can be removed:

• openly through skin incisions;
• using endoscopic technology.

The choice of technique affects the duration of the recovery period and the residual cosmetic defect in the form of scars.

What is the preparation for the operation?

Upcoming CABG requires a thorough examination of the patient. Standard tests include:

• clinical blood test;
• coagulogram;
• liver tests;
• blood glucose, creatinine, nitrogenous substances;
• protein and its fractions;
• Analysis of urine;
• confirmation of the absence of HIV infection and hepatitis;
• Dopplerography of the heart and blood vessels;
• fluorography.

Special studies are carried out in the preoperative period in the hospital. A coronary angiography (an X-ray of the vascular pattern of the heart after the administration of a contrast agent) is required.

Complete information will allow you to avoid complications during the operation and in the postoperative period.

To prevent thromboembolism from the veins in the legs, 2-3 days before the scheduled operation, tight bandaging is performed from the foot to the thigh.

It is forbidden to have dinner the night before and have breakfast in the morning to prevent possible regurgitation of food from the esophagus and its entry into the trachea during the period of narcotic sleep. If there is hair on the skin of the anterior chest, it is shaved off.

An examination by an anesthesiologist consists of an interview, measuring blood pressure, auscultation, and re-examining previous diseases.

Pain relief method

Coronary artery bypass grafting requires complete relaxation of the patient, so general anesthesia is used. The patient will only feel the prick of the intravenous needle as the IV is inserted.

Falling asleep occurs within a minute. A specific anesthetic drug is selected by the anesthesiologist taking into account the patient’s health status, age, functioning of the heart and blood vessels, and individual sensitivity.

It is possible to use different combinations of painkillers for introductory and main anesthesia.

Specialized centers use equipment for monitoring and control of:

• pulse;
• blood pressure;
• breathing;
• alkaline blood reserve;
• oxygen saturation.

The question of the need for intubation and transfer of the patient to artificial respiration is decided at the request of the operating physician and is determined by the technique of the approach.

During the intervention, the anesthesiologist informs the chief surgeon about life support indicators. At the stage of suturing the incision, the administration of the anesthetic is stopped, and by the end of the operation the patient gradually wakes up.

How is the operation performed?

The choice of surgical technique depends on the capabilities of the clinic and the experience of the surgeon. Currently, coronary artery bypass grafting is performed:

• through open access to the heart with an incision in the sternum, connection to a heart-lung machine;
• on a beating heart without artificial circulation;
• with a minimal incision - access is used not through the sternum, but through a mini-thoracotomy through an intercostal incision up to 6 cm long.

Bypass surgery with a small incision is only possible to connect to the left anterior artery. Such localization is considered in advance when choosing the type of operation.

It is technically difficult to perform the approach on a beating heart if the patient has very narrow coronary arteries. In such cases, this method is not applicable.

The advantages of surgery without the support of a blood pump include:

• virtual absence of mechanical damage to blood cellular elements;
• reducing the duration of the intervention;
• reduction of possible complications caused by the equipment;
• faster postoperative recovery.

In the classical method, the chest is opened through the sternum (sternotomy). Special hooks are used to move it apart, and the device is attached to the heart. During the operation, it works like a pump and moves blood through the vessels.

Cardiac arrest is induced using a cooled potassium solution. When choosing a method of intervention on the beating heart, it continues to contract, and the surgeon enters the coronary arteries using special devices (anticoagulators).

While the first one is engaged in access to the heart area, the second one ensures the release of autovascular vessels to transform them into shunts, and injects a solution with heparin into them to prevent the formation of blood clots.

A new network is then created to provide a circumferential route for blood delivery to the ischemic area. The stopped heart is restarted using a defibrillator, and artificial circulation is turned off.

To stitch the sternum, special tight staples are applied. A thin catheter is left in the wound to drain blood and control bleeding. The entire operation lasts about four hours. The aorta remains clamped for up to 60 minutes, artificial circulation is maintained for up to 1.5 hours.

How does the postoperative period proceed?

From the operating room the patient is taken on a gurney under a drip to the intensive care unit. Usually he stays here for the first 24 hours. Breathing is carried out independently. In the early postoperative period, monitoring of pulse and pressure and control of blood flow from the installed tube continue.

The frequency of bleeding in the coming hours is no more than 5% of all operated patients. In such cases, repeated intervention is possible.

It is recommended to start exercise therapy (physical therapy) from the second day: make movements with your feet that imitate walking - pull your socks towards you and back so that you can feel the work calf muscles. Such a small load makes it possible to increase the “pushing” of venous blood from the periphery and prevent thrombus formation.

During the examination, the doctor pays attention to breathing exercises. Taking deep breaths straightens the lung tissue and protects it from congestion. For training, balloon inflation is used.

After a week it is deleted suture material at the sites where the saphenous vein is taken. Patients are recommended to wear an elastic stocking for another 1.5 months.

It takes up to 6 weeks for the sternum to heal. Heavy lifting and physical work are prohibited.

Discharge from the hospital is carried out after a week.

In the first days, the doctor recommends a slight unloading due to light food: broth, liquid porridge, fermented milk products. Taking into account the existing blood loss, it is proposed to include dishes with fruits, beef, and liver. This helps restore hemoglobin levels within a month.

The motor mode is expanded gradually, taking into account the cessation of angina attacks. You shouldn’t force the pace and chase sports achievements.

The best way to continue rehabilitation is transfer to a sanatorium directly from the hospital. Here the patient’s condition will continue to be monitored and an individual regimen will be selected.

How likely are complications?

Studying Statistics postoperative complications indicates a certain amount of risk for any type of surgical intervention. This should be clarified when deciding whether to consent to surgery.

The fatal outcome during planned coronary artery bypass surgery is now no more than 2.6%, in some clinics it is lower. Experts point to the stabilization of this indicator due to the transition to trouble-free operations for older people.

It is impossible to predict in advance the duration and degree of improvement of the condition. Observations of patients show that coronary circulation indicators after surgery in the first 5 years sharply reduce the risk of myocardial infarction, and in the next 5 years do not differ from patients treated with conservative methods.

The “lifetime” of a bypass vessel is considered to be from 10 to 15 years. Survival after surgery is 88% for five years, 75% for ten years, and 60% for fifteen years.

From 5 to 10% of cases among the causes of death are acute heart failure.

What complications are possible after surgery?

The most common complications of coronary artery bypass grafting are:

Less common ones include:

• myocardial infarction caused by a detached blood clot:
• incomplete fusion of the sternal suture;
• wound infection;
• thrombosis and phlebitis of the deep veins of the legs;
• stroke;
• renal failure;
• chronic pain in the surgical area;
• formation of keloid scars on the skin.

The risk of complications is associated with the severity of the patient’s condition before surgery and concomitant diseases. Increases in case of emergency intervention without preparation and sufficient examination.

Coronary bypass surgery is a fairly common procedure these days. Surgical intervention is necessary for patients suffering from coronary heart disease when drug treatment is ineffective and the pathology progresses.

Coronary artery bypass surgery is an operation on the blood vessels of the heart, during which arterial blood flow is restored. In other words, bypass surgery is the creation of an additional path to bypass the narrowed section of the coronary vessel. The shunt itself is an additional vessel.

Table of contents: What is coronary heart disease? Coronary artery bypass surgery Coronary artery bypass grafting: postoperative period Mortality statistics after coronary artery bypass grafting

What is coronary heart disease?

Coronary heart disease is an acute or chronic decrease in the functional activity of the myocardium. The cause of the development of pathology is insufficient supply of arterial blood to the heart muscle, resulting in oxygen starvation of tissues.

In most cases, the development and progression of the disease is caused by a narrowing of the coronary arteries, which are responsible for supplying the myocardium with oxygen. Vessel patency decreases against the background of atherosclerotic changes. Insufficient blood supply is accompanied by a pain syndrome, which in the initial stages of the pathology appears with significant physical or psycho-emotional stress, and as it progresses, even at rest. Pain in the left side of the chest or behind the sternum is called angina pectoris (“angina pectoris”). They usually radiate to the neck, left shoulder or angle of the lower jaw. During an attack, patients feel a lack of oxygen. The appearance of a feeling of fear is also characteristic.

Important:in clinical practice there are so-called “painless” forms of pathology. They pose the greatest danger because they are often diagnosed in late stages.

The most dangerous complication of coronary artery disease is myocardial infarction. With a sharp restriction of oxygen supply in the area of ​​the heart muscle, necrotic changes develop. Heart attacks are the leading cause of death.

The most accurate method for diagnosing coronary artery disease is a radiopaque study (coronary angiography), in which a contrast agent is injected into the coronary arteries through catheters.

Based on the data obtained during the study, the question of the possibility of stenting, balloon angioplasty or coronary artery bypass grafting is decided.

Coronary artery bypass surgery

This operation is planned; the patient is usually admitted to the hospital 3-4 days before the intervention. In the preoperative period, the patient undergoes a comprehensive examination and is taught deep breathing and coughing techniques. He has the opportunity to get to know the surgical team and receive detailed information about the nature and progress of the intervention.

The day before, preparatory procedures are carried out, including a cleansing enema. An hour before the start, premedication is given; The patient is given medications that reduce anxiety.

A timely operation prevents the development of irreversible changes in the myocardium. Thanks to the intervention, the contractility of the heart muscle increases significantly. Surgical treatment can improve the patient’s quality of life and increase its duration.

The average duration of the operation is from 3 to 5 hours. In most cases, it is necessary to connect the patient to a heart-lung machine, but in some situations, intervention on the beating heart is also possible.

Surgical treatment without connecting the patient to a heart-lung machine has a number of advantages, including:

• shorter duration of intervention (up to 1 hour);
• reduction of recovery time after coronary artery bypass surgery;
• eliminating possible damage to blood cells;
• absence of other complications associated with connecting the patient to the IR device.

Access is through an incision made in the middle of the chest.

Additional incisions are made in the area of ​​the body from which the graft is taken.

The progress and duration of the operation depend on the following factors:

• type of vascular damage;
• severity of pathology (number of shunts created);
• the need for parallel repair of aneurysms or reconstruction of heart valves;
• some individual characteristics of the patient’s body.

During the operation, the graft is sutured to the aorta, and the other end of the graft is sutured to a branch of the coronary artery, bypassing the narrowed or obstructed area.

To create a shunt, fragments of the following vessels are taken as a graft:

• great saphenous vein (from the lower limb);
• internal mammary artery;
• radial artery (from the inner surface of the forearm).

Note:the use of a fragment of an artery makes it possible to create a more functionally complete shunt. Preference is given to fragments of the saphenous veins of the lower extremities for the reason that these vessels are usually not affected by atherosclerosis, i.e. they are relatively “clean”. In addition, the collection of such a transplant does not subsequently lead to health problems. The remaining leg veins take on the load, and blood circulation in the limb is not impaired.

The ultimate goal of creating such a bypass is to improve blood supply to the myocardium to prevent angina attacks and heart attacks. After coronary bypass surgery, the life expectancy of patients with coronary artery disease increases significantly. Patients' physical endurance increases, performance is restored and the need for taking pharmacological drugs is reduced.

Coronary artery bypass grafting: postoperative period

After the operation is completed, the patient is placed in the intensive care unit, where he is monitored around the clock. Anesthetics have a negative effect on respiratory function, therefore, the operated person is connected to a special device that supplies oxygen-enriched air through a special tube in the mouth. With rapid recovery, the need to use this device usually disappears within the first 24 hours.

Note:in order to avoid uncontrolled movements that can lead to bleeding and disconnection of the IVs, the patient’s hands are fixed until they fully regain consciousness.

Catheters are placed in the vessels in the neck or thigh, through which medications are administered and blood is collected for tests. Tubes are removed from the chest cavity to suck out accumulated fluid.

In the postoperative period, special electrodes are attached to the body of a patient who has undergone coronary artery bypass surgery, allowing monitoring of cardiac activity. Wires are fixed to the lower part of the chest, through which, if necessary (in particular, with the development of ventricular fibrillation), electrical stimulation of the myocardium is carried out.

Note:While the effects of drugs for general anesthesia continue, the patient may be in a state of euphoria. Disorientation is also common.

As the patient's condition improves, the patient is transferred to a regular ward in a specialized department of the hospital. During the first days after bypass surgery, there is often an increase in general body temperature, which is not a cause for concern. This is a normal reaction of the body to extensive tissue damage during surgery. Immediately after coronary bypass surgery, patients may complain of discomfort at the incision site, but the pain syndrome is successfully relieved by the introduction of modern analgesics.

In the early postoperative period, strict control of diuresis is necessary. The patient is asked to enter in a special diary data on the amount of liquid drunk and the volume of urine excreted. To prevent the development of such complications as postoperative pneumonia, the patient is introduced to the complex breathing exercises. Lying on your back contributes to fluid stagnation in the lungs, so the patient is recommended to turn on his side a few days after surgery.

To prevent the accumulation of secretions (to improve coughing), a careful local massage with tapping in the projection of the lungs is indicated. The patient must be informed that coughing will not cause suture dehiscence.

Note:A thoracic corset is often used to speed up the healing process.

The patient can consume liquid within one and a half to two hours after removal of the breathing tube. At first, the food should be semi-liquid (mashed). The period of transition to a normal diet is determined strictly individually.

Restoration of motor activity should be gradual. Initially, the patient is allowed to occupy sitting position, a little later - walk briefly around the ward or corridor. Shortly before discharge, it is allowed and even recommended to increase the time of walking and climbing a flight of stairs.

During the first days, the bandage is changed regularly and the seams are washed with an antiseptic solution. As the wound heals, the bandage is removed as air promotes drying. If tissue regeneration proceeds normally, the sutures and stimulation electrode are removed on the 8th day. 10 days after surgery, the incision area can be washed with regular warm water and soap. As for general hygiene procedures, you can take a shower only a week and a half after removing the stitches.

The sternum is completely restored only after a few months. While it grows together, the patient may experience pain. In such cases, the use of non-narcotic analgesics is indicated.

Important:Until the sternum bone is completely healed, lifting heavy objects and making sudden movements is prohibited!

If the graft was taken from the leg, then at first the patient may be bothered by a burning sensation in the incision area and swelling of the limb. After some time, these complications disappear without a trace. While symptoms persist, it is advisable to use elastic bandages or stockings.

After coronary bypass surgery, the patient remains in the hospital for another 2-2.5 weeks (provided there are no complications). The patient is discharged only after the attending physician is completely confident that his condition has stabilized.

To prevent complications and reduce the risk of developing cardiovascular diseases, dietary correction is required. The patient is advised to reduce consumption table salt and minimize foods containing saturated fat. Persons suffering nicotine addiction, you should completely stop smoking.

Exercise therapy complexes will help reduce the risk of relapse. Moderate physical activity (including regular walking) promotes rapid rehabilitation of the patient after coronary artery bypass surgery.

Mortality statistics after coronary artery bypass surgery

According to data obtained during long-term clinical observations, 15 years after successful surgery, mortality among patients is the same as in the general population. Survival largely depends on the extent of surgery.

The average life expectancy after the first bypass surgery is about 18 years.

Note:At the time of the completion of a large-scale study, the purpose of which was to compile mortality statistics after coronary artery bypass surgery, some patients who underwent surgery in the 70s of the last century had already celebrated their 90th anniversary!

Plisov Vladimir, medical observer

1. Stable angina pectoris of 3-4 functional classes, difficult to respond to drug therapy (multiple attacks of chest pain during the day, not relieved by taking short- and / or long-acting nitrates),
2. Spicy coronary syndrome, which can stop at the stage unstable angina or develop into acute myocardial infarction with or without ST segment elevation according to ECG (large-focal or small-focal, respectively),
3. Acute myocardial infarction no later than 4-6 hours from the onset of an intractable pain attack,
4. Reduced exercise tolerance, revealed during exercise testing - treadmill test, bicycle ergometry,
5. Severe painless ischemia, detected during 24-hour blood pressure monitoring and Holter ECG,
6. The need for surgical intervention in patients with heart defects and concomitant myocardial ischemia.

Contraindications

Contraindications for bypass surgery include:

Preparing for surgery

Bypass surgery can be performed electively or as an emergency. If a patient is admitted to the vascular or cardiac surgery department with acute myocardial infarction, he immediately, after a short preoperative preparation, undergoes coronary angiography, which can be extended to stenting or bypass surgery. In this case, only the most necessary tests— determination of blood group and blood coagulation system, as well as ECG in dynamics.

In case of planned admission of a patient with myocardial ischemia to the hospital, a full examination is carried out:

1. Echocardioscopy (ultrasound of the heart),
2. X-ray of the chest organs,
3. General clinical blood and urine tests,
4. Biochemical blood test to determine blood clotting ability,
5. Tests for syphilis, viral hepatitis, HIV infection,
6. Coronary angiography.

How is the operation performed?

After preoperative preparation, which includes intravenous administration of sedatives and tranquilizers (phenobarbital, phenazepam, etc.) to achieve a better effect from anesthesia, the patient is taken to the operating room, where the operation will be performed over the next 4-6 hours.

Bypass surgery is always performed under general anesthesia. Previously, surgical access was carried out using sternotomy - dissection of the sternum; recently, operations are increasingly being performed from a mini-access in the intercostal space on the left in the projection of the heart.

In most cases, during surgery, the heart is connected to a heart-lung machine (CAB), which during this period of time carries blood through the body instead of the heart. It is also possible to perform bypass surgery on a beating heart, without connecting an artificial blood pump.

After clamping the aorta (usually for 60 minutes) and connecting the heart to the device (in most cases for an hour and a half), the surgeon selects a vessel that will serve as a shunt and brings it to the affected coronary artery, suturing the other end to the aorta. Thus, the blood flow to the coronary arteries will be carried out from the aorta, bypassing the area in which the plaque is located. There can be several shunts - from two to five, depending on the number of affected arteries.

After all the shunts have been sutured into the right places, metal wire staples are applied to the edges of the sternum and sutured soft fabrics and superimposed aseptic dressing. Drains are also removed, through which hemorrhagic (bloody) fluid flows out of the pericardial cavity. After 7-10 days, depending on the rate of healing of the postoperative wound, the sutures and bandage can be removed. During this period, daily dressings are performed.

How much does bypass surgery cost?

CABG surgery is a high-tech type of medical care, so its cost is quite high.

Currently, such operations are carried out according to quotas allocated from the regional and federal budgets, if the operation is carried out as planned for persons with coronary artery disease and angina pectoris, and also free of charge compulsory medical insurance policies in case the operation is performed urgently in patients with acute myocardial infarction.

To receive a quota, the patient must undergo examination methods confirming the need for surgical intervention (ECG, coronary angiography, cardiac ultrasound, etc.), supported by a referral from the attending cardiologist and cardiac surgeon. Waiting for a quota can take from several weeks to a couple of months.

If the patient does not intend to wait for a quota and can afford the operation for paid services, then he can contact any public (in Russia) or private (abroad) clinic that performs such operations. The approximate cost of bypass surgery is from 45 thousand rubles. for the surgical intervention itself without the cost of consumables up to 200 thousand rubles. with the cost of materials. When combined with heart valve replacement and bypass surgery, the price ranges from 120 to 500 thousand rubles, respectively. depending on the number of valves and shunts.

Complications

Postoperative complications can develop both from the heart and other organs. In the early postoperative period, cardiac complications are represented by acute perioperative myocardial necrosis, which can develop into acute myocardial infarction. Risk factors for the development of a heart attack lie mainly in the time of operation of the heart-lung machine - the longer the heart does not perform its contractile function during surgery, the greater the risk of myocardial damage. Postoperative infarction develops in 2-5% of cases.

Complications from other organs and systems develop rarely and are determined by the patient’s age, as well as the presence of chronic diseases. Complications include acute heart failure, stroke, exacerbation of bronchial asthma, decompensation diabetes mellitus etc. Prevention of the occurrence of such conditions is a full examination before bypass surgery and comprehensive preparation of the patient for surgery with correction of the function of internal organs.

Lifestyle after surgery

The postoperative wound begins to heal within 7-10 days after bypass surgery. The sternum, being a bone, heals much later - 5-6 months after the operation.

In the early postoperative period Rehabilitation measures are carried out with the patient. These include:

• Diet food,
• Breathing exercises - the patient is offered a similar balloon, by inflating which, the patient straightens the lungs, which prevents the development of venous stagnation in them,
• Physical gymnastics, first lying in bed, then walking along the corridor - nowadays they try to activate patients as early as possible, unless this is contraindicated due to overall severity conditions, to prevent blood stagnation in the veins and thromboembolic complications.

In the late postoperative period (after discharge and subsequently) continues to perform exercises recommended by a physical therapy doctor (physical therapy doctor), which strengthen and train the heart muscle and blood vessels. Also, for rehabilitation, the patient must follow the principles of a healthy lifestyle, which include:

1. Complete cessation of smoking and drinking alcohol,
2. Compliance with the basics of a healthy diet - excluding fatty, fried, spicy, salty foods, eating more fresh vegetables and fruits, dairy products, low-fat varieties meat and fish,
3. Adequate physical activity - walking, light morning exercises,
4. Achieving the target blood pressure level using antihypertensive drugs.

Registration of disability

After cardiac bypass surgery, temporary incapacity for work (on sick leave) is issued for up to four months. After this, patients are referred to MTU ( medical and social examination), during which it is decided to assign a particular disability group to the patient.

III group assigned to patients with an uncomplicated course of the postoperative period and with 1-2 classes (FC) of angina, as well as without or with heart failure. Work in the field of professions is allowed, not threatening cardiac activity to the patient. Prohibited professions include working at heights, with toxic substances, in field conditions, and being a driver.

Group II assigned to patients with a complicated course of the postoperative period.

Group I assigned to persons with severe chronic heart failure requiring care from others.

Forecast

The prognosis after bypass surgery is determined by a number of indicators such as:

Based on the above, it should be noted that CABG surgery is an excellent alternative to long-term drug treatment of coronary artery disease and angina pectoris, as it reliably reduces the risk of myocardial infarction and the risk of sudden cardiac death, as well as significantly improves the patient’s quality of life. Thus, in most cases of bypass surgery, the prognosis is favorable, and patients after cardiac bypass surgery live for more than 10 years.

Video: coronary artery bypass grafting - medical animation

operaciya.info

Indications for coronary artery bypass surgery

The presence of stenosis of the trunk of the left coronary artery by 50% or more.
Damage to the two main coronary arteries with involvement of the anterior interventricular branch.
Damage to the three main coronary arteries in combination with left ventricular dysfunction (left ventricular ejection fraction 35-50% according to echocardiography).
Damage to one or two coronary arteries, provided that angioplasty is impossible due to complex vascular anatomy (severe tortuosity)
Complication during percutaneous coronary angioplasty. Dissection (cut) or acute occlusion (blockage) of a coronary artery is also an indication for urgent coronary artery bypass grafting.
Angina pectoris of high functional class.
Myocardial infarction, when it is impossible to perform angioplasty.
Heart defects.

In patients with diabetes mellitus, extensive occlusions (blockage) of the arteries, severe calcification, damage to the main trunk of the left coronary artery, and the presence of severe narrowings in all three main coronary arteries, preference is given to coronary artery bypass grafting rather than balloon angioplasty.

Contraindications for surgery

Obstruction of the left coronary artery is more than 50%.
Diffuse damage to the coronary vessels, when it is not possible to install a shunt.
Decreased contractility of the left ventricle (left ventricular ejection fraction less than 40% according to echocardiography).
Kidney failure.
Liver failure.
Heart failure.
Chronic nonspecific lung diseases

Preparing the patient for coronary artery bypass surgery

If coronary artery bypass surgery is performed routinely, then an outpatient examination is necessary before hospitalization in the hospital to perform the operation. A clinical blood test, general urine test, biochemical analysis blood (transaminases, bilirubin, lipid spectrum, creatinine, electrolytes, glucose), coagulogram, electrocardiography, echocardiography, chest radiography, ultrasonography vessels of the neck and lower extremities, fibrogastroduodenoscopy, ultrasound examination of the abdominal organs, results of coronary angiography (disc) are required, testing for hepatitis B, C, HIV, syphilis, examination by a gynecologist for women, a urologist for men, sanitation of the oral cavity.

After the examination, hospitalization is carried out in the cardiac surgery department, usually 5-7 days before the operation. In the hospital, the patient meets his attending physician - a cardiac surgeon, cardiologist, and is examined by an anesthesiologist. Even before the operation, it is necessary to learn the technique of special deep breathing and breathing exercises, which will be very useful in the postoperative period.

On the eve of the operation, you will be visited by the attending physician and anesthesiologist, who will clarify the details of the operation and anesthesia. In the evening, they will cleanse the intestines, perform hygienic treatment of the body, and give you sedatives (calming) medications at night to ensure deep and restful sleep.

How is the operation performed?

On the morning of the operation you will give nurse for storage of your personal belongings (glasses, contact lenses, removable dentures, jewelry).

After all preparatory measures have been carried out, an hour before the operation, the patient is administered sedatives (calming) drugs and given tranquilizers (phenobarbital, fenozypam) to better tolerate anesthesia and taken to the operating room, where the intravenous system is connected, several injections are made into the vein, sensors of the continuous monitoring system are applied. pulse, blood pressure, electrocardiogram, and you fall asleep. Coronary artery bypass surgery is performed under general anesthesia, so the patient does not feel any sensations during the operation and does not notice how long it lasts. The average duration is 4-6 hours.

After putting the patient under anesthesia, access to the chest is made. Previously, this was achieved by sternotomy (dissection of the sternum, this is a classic technique), but recently endoscopic surgery with a small incision in the left intercostal space, in the projection of the heart, is increasingly being used. Next, the heart is connected to an infrared apparatus, or surgery is performed on a beating heart. This is determined in advance by surgeons when discussing the progress of the operation.

Next, shunts are taken, one or more, depending on the number of affected vessels. Shunts can be the internal mammary artery, radial artery, or great saphenous vein. An incision is made on the arm or leg (depending on where the doctor decided to cut out the vessel), the vessels are cut off, and their edges are clipped. Vessels can be isolated with surrounding tissues and in the form of complete skeletonization of the vessel, after which surgeons check the patency of the excised vessels.

The next step is to install drains in the pericardial area (outer lining of the heart) to eliminate complications in the form of hemopericardium (accumulation of blood in the pericardial cavity). After this, one edge of the shunt is sutured to the aorta by incising its outer wall, and the other end is sutured to the affected coronary artery below the site of narrowing.

This creates a bypass around the affected area of ​​the coronary artery and restores normal blood flow to the heart muscle. The main coronary arteries and their large branches are subject to bypass surgery. The extent of the operation is determined by the number of affected arteries supplying blood to the viable myocardium. As a result of the operation, blood flow should be restored in all ischemic areas of the myocardium.

After applying all the necessary shunts, drains are removed from the pericardium and metal staples are applied to the edges of the sternum, if access to the chest was made by sternotomy, and the operation is completed. If the operation was performed through small incisions in the intercostal space, then sutures are applied.

After 7-10 days, the sutures or staples can be removed, and dressings are performed every day.

After the operation, on the first day the patient is allowed to sit down, on the second day he is allowed to carefully stand near the bed and perform simple exercises for the arms and legs.

Starting from 3-4 days, it is recommended to perform breathing exercises, respiratory therapy (inhalations), and oxygen therapy. The patient's activity regimen gradually expands. During dosed physical activity, it is necessary to keep a self-monitoring diary, where the pulse is recorded at rest, after exercise and after rest after 3-5 minutes. The pace of walking is determined by the patient’s well-being and heart performance. All patients in the postoperative period are required to wear a special corset.

Even though the role of the removed vein (which was taken as a shunt) is taken over by small veins in the leg or arm, there is always some risk of swelling. Therefore, patients are advised to wear an elastic stocking for the first four to six weeks after surgery. Swelling in the lower leg or ankle usually goes away within six to seven weeks.

Rehabilitation after coronary artery bypass surgery takes on average 6-8 weeks.

Rehabilitation after surgery

An important stage after coronary artery bypass surgery is rehabilitation measures, which include several main aspects:

Clinical (medical) – postoperative medication intake.

Physical - aimed at combating physical inactivity (inactivity). It has been established that dosed physical activity leads to positive results in the recovery of patients.

Psychophysiological – restoration of psycho-emotional status.

Social and labor – restoration of the ability to work, return to the social environment and family.

The vast majority of studies have proven that surgical treatments for coronary heart disease are in many ways superior to medications. Patients after coronary artery bypass grafting had a more favorable course of the disease and a significant decrease in the number of myocardial infarctions and re-hospitalizations within 5 years after surgery. But, despite the successful operation, it is necessary to pay special attention to lifestyle modifications and streamline the use of medications in order to prolong a good quality of life as long as possible.

Forecast.

The prognosis after a successful coronary artery bypass surgery is quite favorable. The number of deaths is minimal, and the percentage of absence of myocardial infarction and signs of ischemic heart disease is very high; after the operation, anginal attacks disappear, shortness of breath and rhythm disturbances decrease.

A very important point after surgical treatment is modification of lifestyle, elimination of risk factors for the development of coronary artery disease (smoking, overweight and obesity, high blood pressure and cholesterol in the blood, physical inactivity). Measures that need to be taken after surgical treatment: stopping smoking, strict adherence to a low-cholesterol diet, mandatory daily physical activity, reducing stressful situations, regularly taking medications.

It is very important to understand that a successful operation and the absence symptoms of ischemic heart disease do not cancel the regular use of drugs, namely: lipid-lowering drugs (statins) are taken to stabilize existing atherosclerotic plaques, prevent their growth, reduce the level of “bad” cholesterol, antiplatelet drugs - reduce blood clotting, prevent the formation of blood clots in shunts and arteries, beta -adrenergic blockers – help the heart work in a more “economical” mode; ACE inhibitors stabilize blood pressure, stabilize the inner layer of arteries, and prevent heart remodeling.

The list of necessary medications can be supplemented based on the clinical situation: diuretics may be required for prosthetic anticoagulant valves.

However, despite the progress achieved, one cannot ignore negative consequences standard operation coronary artery bypass grafting under conditions of artificial circulation, such as the negative impact of IR on the function of the kidneys, liver, and central nervous system. With emergency coronary artery bypass surgery, as well as with concomitant conditions such as emphysema, kidney pathology, diabetes mellitus or diseases of the peripheral arteries of the legs, the risk of complications is higher than with a planned operation. About a quarter of patients experience heart rhythm disturbances in the first hours after bypass surgery. This is usually temporary atrial fibrillation, and it is associated with trauma to the heart during surgery and can be treated with medication.

At a later stage of rehabilitation, anemia, impaired respiratory function, and hypercoagulation (increased risk of thrombosis) may appear.

In the long-term postoperative period, stenosis of the shunts cannot be ruled out. The average duration of autoarterial shunts is more than 15 years, and autovenous shunts are 5-6 years.

Recurrence of angina occurs in 3-7% of patients in the first year after surgery, and after five years it reaches 40%. After 5 years, the percentage of angina attacks increases.

Doctor Chuguntseva M.A.

www.medicalj.ru

This brochure gives general information about coronary artery disease or so-called coronary heart disease (CHD). Surgical method treatment of the myocardium is called coronary artery bypass surgery. This operation is the most effective treatment for coronary artery disease and allows patients to return to a normal active life. This brochure is written for patients, but family and friends may also find useful information.

1. Advances in the treatment of coronary artery diseases.
2. Heart and its vessels
   • How do they work
3. • How coronary arteries fail
   • Diagnosis of coronary artery diseases
   • How is IHD treated?
   • Coronary artery bypass grafting (CABG)
4. Surgical methods of treatment
   • Traditional CABG
   • How to improve artificial circulation
   • CABG without cardiopulmonary bypass
   • Minimally invasive cardiac surgery
   • Advantages of operations without cardiopulmonary bypass
   • Benefits of minimally invasive cardiac surgery
5. Operation CABG
   • Before surgery
   • Day of surgery: preoperative period
   • During surgery
   • Day after surgery: postoperative period
   • Postoperative period: 1−4 days
   • After operation

Advances in the treatment of coronary artery diseases (CAD).

Coronary artery disease (one of the clinical manifestations of general atherosclerosis) leads to insufficient blood supply to the heart muscle and, as a result, to its damage. Currently, the number of patients suffering from coronary artery disease is constantly increasing - millions of people around the world suffer from it.
For decades, physicians and cardiologists have tried to improve the blood supply to the heart using drugs that widen the coronary arteries. Coronary artery bypass grafting (CABG) is a generally accepted surgical method treatment of the disease. This method has long been proven to be safe and effective. Over the decades, much experience has been accumulated and significant success has been achieved in performing these operations. CABG is a widespread and fairly simple operation today.
Constant improvement of surgical techniques and the use of the latest advances in medicine allows surgeons to perform operations with less trauma to the patient. All this helps reduce the length of time the patient stays in a hospital bed and speeds up his recovery.

Heart and its vessels

How do they work?

The heart is a muscular organ that constantly pumps blood rich in oxygen and nutrients through the body to the cells. To perform this task, the heart cells themselves (cardiomyocytes) also need oxygen and nutrient-rich blood. This blood is delivered to the heart muscle through the vascular network of the coronary arteries.

The coronary arteries supply the heart with blood. The size of the arteries is small, however, they are vital vessels. There are two coronary arteries that arise from the aorta. The right coronary artery divides into two main branches: the posterior descending and colic arteries. The left coronary artery also divides into two main branches: the anterior descending and circumflex arteries.

Coronary artery diseases (CAD)

How do coronary arteries fail?

Coronary arteries can be blocked by fatty cholesterol build-ups called atherosclerotic plaques. The presence of plaque in the artery makes it uneven and reduces the elasticity of the vessel.
There are both single and multiple growths of varying consistency and location. This variety of cholesterol deposits causes different effects on the functional state of the heart.
Any narrowing or block in the coronary arteries reduces the blood supply to the heart. Heart cells use oxygen when working and are therefore extremely sensitive to the level of oxygen in the blood. Cholesterol deposits reduce oxygen delivery and reduce heart muscle function.

Signal symptoms.

A patient with single or multiple lesions of the coronary vessels may experience chest pain (angina pectoris). Pain in the heart area is a warning signal that tells the patient that something is wrong.
The patient may experience intermittent discomfort in the chest area. The pain can radiate to the neck, leg or arm (usually on the left side), and can occur during physical activity, after eating, with changes in temperature, during stressful situations and even at rest.

If this condition lasts for some time, it can lead to disruption of the nutrition of heart muscle cells (ischemia). Ischemia can cause cell damage that leads to what is called “myocardial infarction,” commonly known as a “heart attack.”

Diagnosis of coronary artery diseases.

The history of the development of symptoms of the disease, risk factors (the patient's weight, smoking, high blood cholesterol and family history of coronary artery disease) are important factors determining the severity of the patient's condition. Such instrumental studies How electrocardiography and coronary angiography help the cardiologist in diagnosis.

How is IHD treated?

According to statistics from the Ministry of Health of the Russian Federation published in 2000, it was found that mortality from coronary heart disease amounted to 26% of all cases. In 1999, data on repeated acute infarctions were obtained for the first time. During the year, 22,340 cases were registered (20.1 per 100 thousand adults). Every year, the number of patients with coronary artery disease who require treatment aimed at increasing blood flow to the heart muscle is growing. This treatment may include drug therapy, angioplasty, or surgery.
Drugs cause dilatation (widening) of the coronary arteries, thereby increasing the delivery of oxygen (through the blood) to the surrounding tissues of the heart. Angioplasty is a procedure that uses a catheter to crush plaque in a clotted artery. A small device called a stent may also be placed in the artery after angioplasty. This coronary stent provides confidence that the artery will remain open.
Coronary artery bypass grafting (CABG) is a surgical procedure aimed at restoring blood supply to the myocardium. Its essence will be outlined below.

Coronary artery bypass grafting (CABG)

CABG is a surgical intervention that restores blood flow to the heart below the site of narrowing of the vessel. In this surgical procedure, another path for blood flow is created around the narrowing site to the part of the heart that is not supplied with blood.
Shunts to bypass the blood path are created from fragments of other arteries and veins of the patient. Most often, the internal mammary artery (IMA), which is located on the inside of the sternum, or the great saphenous vein, which is located on the leg, is used for this. Surgeons may choose other types of shunts. To restore blood flow, venous shunts are connected to the aorta and then sutured to the vessel below the narrowing site.

Surgical methods of treatment

Traditional CABG.

Traditional CABG is performed through a large incision in the middle of the chest, called a median sternotomy. (Some surgeons prefer to perform a ministernotomy.) During the operation, the heart may be stopped. In this case, the patient’s blood circulation is supported using artificial circulation (CPB). Instead of a heart, a heart-lung apparatus (heart-lung machine) works, which ensures blood circulation throughout the body. The patient's blood enters the heart-lung machine, where gas exchange occurs, the blood is saturated with oxygen, as in the lungs, and then delivered to the patient through tubes. In addition, the blood is filtered, cooled or warmed to maintain the required temperature of the patient. However, artificial circulation can also have a negative effect on the patient’s organs and tissues.

How to improve artificial circulation.

Since IR negatively affects some organs and tissues of the patient, it is necessary to reduce these negative consequences of the operation. To do this, surgeons can choose equipment for performing IR that can minimize these harmful consequences for the patient:

• Centrifugal blood pump for less traumatic blood flow control
• A system for artificial blood circulation with a bicompatible coating to reduce the reaction of blood interaction with a large foreign surface.

CABG without artificial circulation.

Good surgical technique and medical equipment allow the surgeon to perform CABG on a beating heart. In this case, it is possible to do without the use of artificial blood circulation during traditional surgery on the coronary arteries.

Minimally invasive cardiac surgery.

Minimally invasive cardiac surgery is a new approach to heart surgery. This does not mean that the patient receives less care. This refers to the surgical approach to the operation and means that the surgeon tries to perform CABG in a less traumatic way. This type of surgery may include the following: a smaller surgical incision, incisions various localizations and/or avoidance of cardiopulmonary bypass. Traditional heart surgery is performed through a 12-14″ incision, but the new minimally invasive approach includes the following: thoracotomy (a small 3-5″ incision between the ribs), several small incisions (called “keyholes”), or sternotomy.
The advantages of minimally invasive surgery are, on the one hand, smaller incisions, on the other hand, the avoidance of artificial circulation and the ability for the surgeon to perform operations on a beating heart.

Advantages of performing CABG through a smaller incision:

• The patient's best opportunity to clear their throat and breathe more deeply after surgery.
• Less blood loss
• The patient experiences less pain and discomfort after surgery
• Reduces the likelihood of infection
• Faster return to normal activity

Advantages of CABG operations without artificial circulation:

• Less blood trauma
• Reducing the risk of developing harmful effects of IR
• Faster return to normal activity

Advantages of performing CABG surgery

Patients often feel much better after coronary artery surgery because they are no longer bothered by symptoms of coronary artery disease. Patients experience gradual improvement after surgery, with the most significant changes in their condition occurring after several weeks or months.

Advantages of minimally invasive CABG surgery

The surgeon can choose to perform a mini-invasive CABG operation with or without IR. Such positive results of traditional CABG as restoration of adequate blood flow to the heart, improvement of the patient’s condition and improved quality of life can also be achieved when using CABG with minimally invasive access.
In addition to this, minimally invasive CABG leads to the following.

• Shortening the time of hospital stay: the patient is discharged from the hospital 5-10 days earlier than with traditional CABG surgery
• Faster recovery: the patient returns to normal life activities faster than with traditional surgery (6-8 weeks for the patient to recover)
• Less blood loss: during surgery, all the patient’s blood passes through the extracorporeal circuit; to prevent it from clotting in the tubes, the patient is administered anti-clotting drugs. Blood cells may be damaged during CPB, which also leads to impaired blood clotting after surgery.
• Reduced number of infectious complications: the use of a smaller incision leads to less tissue trauma and reduces the risk of postoperative complications.

CABG surgery

Patient care is varied. A cardiologist or methodologist in a hospital helps the patient understand the essence of the operation and explains to the patient what happens to the body after the operation. However, different hospitals have different protocols for individual work with the patient. Therefore, the patient himself, without being embarrassed by any questions, should ask the nurse or doctor to help him understand the complex issues of the operation and discuss with them the problems that concern him most.

Before surgery

The patient is hospitalized in the hospital. After receiving the patient’s written consent to conduct research and surgery, which is filled out according to special form, various tests, electrocardiography and x-rays are performed.
Before the operation, an anesthesiologist, a specialist in breathing exercises and physical therapy speaks with the patient. At the request of the patient, a clergyman can visit him.
Before the operation, the doctor gives recommendations on carrying out sanitary and hygienic measures (showering, giving an enema, shaving the surgical site) and taking the necessary medications.
The night before surgery, the patient's dinner should consist of only clear liquids, and after midnight the patient is not allowed to take food or liquids.
The patient and his family members receive information and educational materials on heart surgery.

Day of surgery: preoperative period

The patient is transported to the operating room and placed on the operating table, monitors and an intravenous line are connected to him. The anesthesiologist administers medications and the patient falls asleep. After anesthesia, the patient is given a breathing tube (intubation), a gastric tube (to control gastric secretion) and a Foley boat is installed (to evacuate urine from the bladder). The patient is given antibiotics and other medications prescribed by the doctor.
The patient's surgical field is treated with an antibacterial solution. The surgeon covers the patient's body with sheets and selects the area of ​​intervention. This moment can be considered the beginning of the operation.

During surgery

The surgeon prepares the selected site on the chest to perform CABG. If necessary, a segment is taken from the saphenous vein in the leg and used as a conduit for selective coronary artery bypass grafting. In other cases, the internal mammary artery is used, which is isolated and sutured to a coronary artery (usually the left anterior descending artery) below the site of the block. When the preparation of the conduit is completed, the patient's circulatory support (artificial circulation) is gradually begun in cases where traditional CABG is performed. If a surgeon performs manipulations on a beating heart, he will use a special stabilizing system. This system allows you to stabilize the required area of ​​the heart.
After bypassing all coronary arteries, artificial circulation, if used, is gradually stopped. Drains are installed in the chest to facilitate the evacuation of fluid from the surgical site. Careful hemostasis of the postoperative wound is carried out, after which it is sutured. The patient is disconnected from the monitors in the operating room and connected to portable monitors, then transported to the intensive care unit (ICU).
The length of a patient's stay in the intensive care unit depends on the extent of the surgical intervention and its individual characteristics. In general, he is in this department until his condition is completely stabilized.

Day after surgery: postoperative period

While the patient is in intensive care, blood tests are taken, electrocardiographic and X-ray examinations are performed, which can be repeated if additionally necessary. All vital signs of the patient are recorded. After completion of respiratory support, the patient is extubated (the breathing tube is removed) and transferred to spontaneous breathing. The chest drains and gastric tube remain. The patient is given special stockings that support blood circulation in the legs, and is wrapped in a warm blanket to maintain body temperature. The patient remains in a supine position and continues to receive fluid therapy, analgesia, antibiotics, and sedatives. The nurse provides ongoing care to the patient, helps him turn over in bed and perform routine procedures, and also communicates with the patient's family.

Day after surgery: postoperative period - 1 day

The patient may remain in the intensive care unit or be transferred to a special room with telemetry, where his condition will be monitored using special equipment. Once fluid balance is restored, the Foley catheter is removed from the bladder.
Remote cardiac monitoring is used, drug pain relief and antibiotic therapy are continued. The doctor prescribes dietary nutrition and instructs the patient about physical activity (the patient should begin to sit down on the bed and reach for a chair, gradually increasing the number of attempts).
It is recommended to continue wearing support stockings. Nursing staff are wiping down a patient.

Postoperative period - 2 days

On the second day after surgery, oxygen support is stopped, and breathing exercises continue. The drainage tube is removed from the chest. The patient's condition is improving, but parameters continue to be monitored using telemetry equipment. The patient's weight is recorded and the administration of solutions and medications continues. If necessary, the patient continues pain relief, and also follows all the doctor’s prescriptions. The patient continues to receive dietary nutrition and his activity level gradually increases. He is allowed to carefully stand up and, with the help of an assistant, move to the bathroom. It is recommended to continue wearing support stockings, and even begin to perform simple physical exercises for the arms and legs. The patient is advised to take short walks along the corridor. The staff constantly conducts explanatory conversations with the patient about risk factors, instructs how to process the suture, and talks with the patient about the necessary measures that prepare the patient for discharge.

Postoperative period - 3 days

Monitoring of the patient's condition stops. Weight recording continues. If necessary, continue pain relief. Follow all doctor's orders and breathing exercises. The patient is already allowed to take a shower and increase the number of movements from bed to chair up to 4 times, this time without assistance. It is also recommended to increase the duration of walks along the corridor and do this several times, remembering to wear special support stockings. The patient continues to receive all the necessary information about dietary nutrition, about taking medications, about physical exercise at home, about the full restoration of vital activity and about preparing for discharge.

Postoperative period - 4 days

The patient continues to perform breathing exercises several times a day. The patient's weight is checked again. Dietary nutrition continues (restriction of fatty, salty foods), but food becomes more varied and portions become larger. You are allowed to use the bathroom and move around without assistance. Make an assessment physical condition patient and give latest instructions before discharge. If the patient has any problems or questions, he must resolve them before discharge.
A nurse or social worker will help you resolve any issues related to your discharge. Typically, discharge from the hospital occurs around noon.

After operation

From the above, it follows that CABG surgery is the main step towards returning the patient to normal life. CABG surgery is aimed at treating coronary artery diseases and relieving the patient of pain. However, it cannot completely rid the patient of atherosclerosis.
The most important goal of the operation is to change the patient’s life and improve his condition by minimizing the effect of atherosclerosis on the coronary vessels.
As is known, many factors directly influence the formation of atherosclerotic plaques. And the cause of atherosclerotic changes in the coronary arteries is a combination of several risk factors. Gender, age, heredity are predisposing factors that cannot be changed, but other factors can be changed, controlled and even prevented:

• High blood pressure
Drugs for cerebral vascular spasms Aortic valve insufficiency