Month after aksh. Nutrition and water balance rules

Today, medicine has stepped far forward, now surgeons perform complex operations that save the lives of those patients who have lost all hope of recovery. One of these operations is bypass surgery of the heart vessels.

What is the meaning of surgery

The operation, which is performed on the vessels, is called bypass surgery. Such an intervention allows you to restore the function of blood circulation, normalize the work of blood vessels, ensure the flow of blood to the main vital organ. The first operation on the vessels was carried out in 1960 by the American specialist Robert Hans Goetz.

The operation allows you to pave a new path for blood flow. When we are talking about heart surgery, vascular shunts are used for this.

When should a heart bypass be performed?

Surgical intervention in the work of the heart is an extreme measure, which cannot be dispensed with. An operation is used in severe cases, with coronary or coronary disease, it is possible with atherosclerosis, which is characterized by similar symptoms.

Atherosclerosis is a chronic disease characterized by elevated cholesterol levels. The substance is deposited on the walls of blood vessels, while the lumen narrows, blood flow becomes more difficult.

The same effect is typical for coronary disease - the supply of oxygen to the body decreases. To ensure normal life, a heart bypass is performed.

There are three types of cardiac bypass surgery (CABG) (single, double and triple). The type of operation depends on how complex the disease is and on the number of clogged vessels. If the patient has a broken one artery, then the introduction of one shunt (single CABG) is required. Accordingly, for large violations - double or triple. It is possible to carry out an additional operation to replace the valve.

Before the start of the operation, the patient compulsory examination. It is necessary to pass a lot of tests, conduct a coronography, make an ultrasound and a cardiogram. The examination should be carried out in advance, as a rule, 10 days before the start of the operation.

The patient should undergo a certain course in teaching a new breathing technique, which will be needed after surgery for a quick recovery. The operation takes place under general anesthesia and lasts up to six hours.

What happens to the patient after surgery

After the operation, the patient is transferred to the intensive care unit. There is a restoration of breathing with the help of special procedures.

The stay of the operated patient in intensive care lasts up to 10 days, depending on his condition. After that, the patient undergoes recovery in a rehabilitation center.

The sutures are treated with antiseptics, after healing (on the seventh day) the sutures are removed. A person after the removal procedure may feel a pulling pain and a slight burning sensation. After one or two weeks, the operated person is allowed to bathe.

How long do they live after surgery (reviews)

Before surgery, many patients are interested in what is the life expectancy after CABG. With severe heart disease, bypass surgery can significantly prolong life.

The created shunt can serve without blockage for more than ten years. But much depends on the quality of the operation and the qualifications of specialists. Before deciding on such an operation, you should get the opinion of patients who have already resorted to bypass surgery.

In developed countries, such as Israel, implants are actively implanted to normalize blood circulation, which last 10-15 years. The result of most operations is an increase in life expectancy after heart bypass surgery.

Many patients who underwent CABG report normalization of breathing, absence of pain in the chest area. Other patients claim that they had a hard time recovering from anesthesia, the recovery process was difficult. But after 10 years, they feel quite well.

The opinion converges on one thing - much depends on the qualifications and experience of the specialist. Patients respond well to operations performed abroad. But domestic surgeons are also working quite successfully, achieving a significant increase in life expectancy after CABG.

According to experts, the patient can live more than 20 years after the operation. But it depends on a number of factors. After the operation, you should regularly visit a cardiologist, monitor the condition of the implanted implant. You need to lead a healthy and active lifestyle, eat right.

Not only elderly people resort to surgery - young patients, for example, with heart disease, may also need surgery. A young body recovers faster. But even in adulthood, one should not refuse such a chance: according to experts, CABG will prolong life by 10-15 years.

Lifestyle after CABG

After the patient has undergone surgery and returned home, there is work to restore the body. It is necessary to strictly follow the doctor's instructions, gradually increase physical activity. You should start reducing scars using the means prescribed by your doctor to reduce scars.

US - sex

Carrying out CABG does not affect the quality of sex in any way. It will be possible to fully return to intimate relationships after the permission of the attending physician.

As a rule, the recovery of the body takes 6 to 8 weeks. But each case is individual, so you should not be embarrassed to ask such questions to the observing doctor.

It is not advisable to use postures that can create an excessive load on the heart muscle. It is better to use positions in which the load on the chest is minimal.

Smoking after CABG

After shunting, you should forget about bad habits. Do not smoke, drink alcohol and overeat. Nicotine negatively affects the walls of blood vessels, destroying them, provokes the development of coronary heart disease, promotes the formation of plaques.

The operation itself does not cure existing diseases, but only improves the nutrition of the heart muscle. Bypass surgery creates a new pathway for blood circulation, bypassing the clogged aortic vessels. When smoking, the disease will progress, so you need to get rid of the addiction.

Taking medications

After shunting, it is important to strictly follow all the recommendations of the attending physician. One of the main rules is strict adherence to the regimen of taking drugs.

Medications prescribed to patients are aimed at reducing the risk of heart attacks. The types of drugs and dosage are individual for each patient and are prescribed by the attending physician.

Most often, patients are prescribed drugs that thin the blood and prevent the formation of blood clots, cholesterol-lowering drugs, and drugs that normalize blood pressure.

Nutrition after CABG

It is important to change your diet, otherwise you should not count on positive dynamics after CABG. Avoid foods high in trans fats and cholesterol. Such actions will help prevent the formation of plaques and deposits on the walls of blood vessels that block the lumen. After the operation, you can contact a nutritionist to coordinate your usual diet.

Food should be diversified with products containing omega-3 fatty acids, vegetables and fruits, add whole grain cereals. This menu will protect you from high blood pressure and protect against the development of diabetes, but will be able to maintain a normal weight.

No need to limit yourself in everything, for the body it is fraught with stress. It is important to eat in such a way that the food is healthy, but also brings pleasure. This will allow you to effortlessly follow such a diet throughout your life.

After bypass surgery, it is worth going through a cardiac rehabilitation program that involves changing the patient's lifestyle, giving up bad habits and proper nutrition.

Exercise after CABG

It is necessary to resume physical activity gradually, recovery begins even at the time of being in the clinic. After a month and a half, the loads gradually increase, but lifting heavy loads is strictly prohibited. The introduction of new loads is possible only after the permission of the doctor. It takes time for wounds and bone tissue to heal.

Remedial gymnastics is allowed, which helps to reduce the load on the myocardium, regular walking for short distances. Such exercises help to normalize blood flow and lower blood cholesterol levels. Particular attention should be paid to the regularity of classes, exercises should be gentle.

You need to repeat the exercises daily, gradually increasing the load. If after exercise there is shortness of breath, pain in the heart, the load should be reduced. If the patient is in good health and discomfort do not pursue after exercise, you can gradually increase the load. This allows you to restore the work of the lungs and heart muscle.

You need to do it before eating for half an hour or an hour and a half after eating. You should avoid evening workouts, during classes, control your heart rate (should not be above average).

Regular walking for short distances is very useful. Such a load allows you to improve breathing and blood circulation, strengthen the muscles of the heart, and increase the endurance of the body as a whole. Optimal time for hiking in the evening, from 5 to 7 o'clock, or from 11 am to 1 pm. For walks, you need to choose comfortable shoes and loose clothing.

It is allowed to climb / descend the stairs up to 4 times a day. The load must not exceed the norm (60 steps per minute). When lifting, the patient should not experience discomfort, otherwise the load should be reduced.

Attention to diabetes and daily routine

Complications can develop in people with diabetes. You need to treat the disease in the same way as before the operation. As for the routine of the day - good rest and moderate loads. During the day, the patient should sleep at least 8 hours. Worth paying Special attention emotional state patient, avoid stress, be less nervous and upset.

Patients often become depressed after CABG. Many patients refuse to eat and follow the correct regimen. Those operated on do not believe in a successful outcome and consider all attempts to be useless.

But the statistics say: after CABG, people live for decades. It is very important to follow all the recommendations of doctors. In severe, advanced cases, it is possible to prolong life and ensure a normal existence for several years.

Bypass Statistics

According to statistics and the results of sociological surveys, both in our country and abroad, most operations are successful. Only 2% of patients do not tolerate shunting. To derive this figure, 60,000 case histories were studied.

The most difficult period for the patient is postoperative. A year after the operation, restoration of respiratory function and heart function, about 97% of patients survive.

The result of CABG is influenced not only by the professionalism of cardiac surgeons, but also by individual factors, such as tolerance to anesthesia, concomitant diseases and the state of the body as a whole.

One study included 1041 patients. According to the results, about 200 patients not only successfully underwent surgery, but also crossed the ninety-year milestone.

With the help of the pressure created, the intercostal muscles are unloaded. pressure on internal organs redistributed, which allows to increase the rate of healing of bones and soft tissues, to speed up rehabilitation.

The need for a postoperative bandage

Wound healing after abdominal surgery- lengthy process associated with features thoracic spine.

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

The bandage is necessary for temporary fixation of the chest, reducing pain during breathing.

Immovable tissues heal faster, their scarring occurs. The muscles weakened in the postoperative period cannot support the spine, therefore the bandage effectively removes part of the load from them.

After surgery, it is important to keep the internal organs in place to prevent suture separation and the appearance of hernias.

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

Corset after shunting for men is supplied with supporting straps. Women's orthoses have a chest cutout and Velcro fasteners connect under the collarbone for a snug fit.

Why is fixation needed after surgery?

During coronary artery bypass grafting, the sternum is dissected and stapled. A bone that can withstand significant loads is mobile. It does not grow together completely, but only overgrows with soft tissues for six months.

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

• cutting staples;
• divergence of the sternum;
• the appearance of a severe pain syndrome.

Pain after surgery persists for a long time, radiating to the arm. The bandage, along with painkillers, massage relaxation techniques and light exercises, serves to reduce pain.

A cardiac surgeon tells how to wear a corset after bypass surgery. Some patients are advised to wear it at night, they are allowed to sleep for 2-3 months only on their backs to avoid chest deformity.

The mobility of the ribs decreases after three months, because this period is important. The surgeon determines how long to walk in a corset according to 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, as it is visible under clothing, especially in summer period. If the work is physical, then after a long hospital, sanatorium treatment, a bandage is a daily necessity.

Physiotherapy exercises begin in the hospital with light leg movements to increase the outflow of venous blood. Breathing exercises are needed to straighten the tissues of the lungs, to prevent stagnation. At the time of gymnastics with the use of balls, the chest corset is sometimes removed.

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Life after heart surgery

How to conduct the postoperative period correctly, what to be prepared for and what to fear.

Heart surgery is a chance for a successful continuation of a normal full life. The realization of this chance largely depends on the correct postoperative period. It will not be easy for the patient and his relatives at first, but if everything is done correctly, the result will exceed all expectations. Main principle- not to do sudden movements: all "pre-operational" activity will have to be restored calmly and slowly.

Mood swings after heart surgery open heart almost everyone has. Joyful excitement after recovery from anesthesia is often replaced by depressive irritation. Memory weakens, concentration of attention decreases, absent-mindedness appears. Neither the patient nor his relatives need to worry about this. These symptoms usually resolve within a month after surgery.

Usually, patients are discharged from the hospital 7-14 days after the operation. The patient must remember that even if everything went well, he will need from 2-3 months to a year to fully recover from the operation. You need to start taking care of yourself right outside the hospital. There are many cases when the patient had to be returned back to the ambulance already 3-6 hours after discharge. If the road home takes more than an hour, you must definitely stop and get out of the car. Otherwise, serious problems with the blood circulation of the vessels are possible.

At home, you should try to build relationships in such a way that the postoperative period goes as smoothly as possible for both the patient and his family members. Households should treat the patient with understanding and make efforts for his recovery, but this does not mean that their whole life from this period should be subordinated only to him. Co-dependence is not needed neither by the patient himself nor by his relatives.

It is imperative that the patient is constantly monitored by the attending physician after discharge - a family doctor, internist or cardiologist.

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

• Lots of vegetables and fruits
• Porridge, can be with bran, or muesli and cereal for breakfast
• Sea fish as a second course at least 2 times a week
• Fermented milk yogurt or juice instead of ice cream
• Only diet dressings, olive oil and mayonnaise for salads
• Herbal and vegetable spices instead of salt
• Reduce weight to normal, but not quickly. Losing 1-2 kilos per month is ideal
• Move!
• Regularly measure sugar and cholesterol
• Smile for life!

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

With normal healing of postoperative sutures, 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 a contrasting change in water temperature. Wash with plain soap and get wet (do not dry yourself, namely get wet with a clean towel). It is best that the first “water procedures” after the operation are accompanied by someone close: you never know what can happen ....

Call your surgeon immediately if you experience the following symptoms:

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

From the first day after the hospital, you can try to calmly walk meters on a flat surface. You need to stop - stop! 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 already walk 1-2 kilometers at a leisurely pace.

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

Won't hurt light homemade work: dusting, setting the table, washing dishes, or helping households with cooking.

After one and a half to two months, the sutures should completely heal, and then most likely the cardiologists will conduct a functional load test, according to 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, do light (physically) work in the garden and / or in the office. A second test is usually performed 3-4 months after surgery.

The most important thing here is complete absence independence. Medicines are at hand all the time and are taken only as prescribed by a doctor, and without his appointment they are not canceled. Particular attention is given to drugs to prevent blood clots, such as aspirin and drugs to normalize blood pressure. Do not forget about drugs and dietary supplements that reduce the level bad cholesterol.

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Rehabilitation after heart surgery

Immediately after your heart surgery, you will be taken to the intensive care unit, the best place to keep a close eye on you.

While you are in the intensive care unit, your heart rate, respirations, blood pressure, urine count, blood tests, chest x-ray and a host of other data will be continuously assessed to make sure there are no problems during the critical first post-operative hours. Nurses service staff, special doctors called intensivists, as well as your surgeon will receive minute-by-minute reports on your progress.

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

If everything goes according to plan, then within twenty-four hours your doctor will say that everything is in order, and you will leave the intensive care unit. On the nursing floor, you will be looked after by one nurse (who also has a few other patients), one technician, and a team of doctors (who make rounds for many patients). They will help you move smoothly towards being discharged from the hospital in a week.

That's the plan. But sometimes things go wrong. Nearly half of patients who undergo heart surgery will encounter bumps on their road to recovery. The most common is atrial fibrillation, a temporary irregular heartbeat that will show up on your heart monitor; it is rarely serious and is easily treated.

Other complications can be insidious and harder 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 don't be silent if you see them. Your vigilance can speed up recovery or even save your life.

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

Depressed cardiac patients stay longer in the hospital, return there more often than others, recover more slowly, experience more pain, and their quality of life decreases. For reasons that are not entirely understood, they are also more likely to have heart attacks and death within the first year after surgery. Poor adherence to medical prescriptions, unhealthy habits (smoking, unhealthy 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 healthcare 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 round trip. 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;
• recurring thoughts of death or suicide.

Depression usually occurs within the first three months after surgery.

If you develop these symptoms, both in the hospital and in the first few weeks after you arrive home, tell your doctor. Most depressions go away with time. But if the depression is particularly severe, treatment is needed. Whether it's a short-term antidepressant or multiple visits to a psychotherapist, a 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 we can heal.

Should I enroll in a cardiac rehabilitation group?

You have 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 before you fully recover. Get them right. Sign up for a cardiac rehabilitation group near your home. Follow the Nike motto: "Just do it!"

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

Stage 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, drug and lifestyle optimization, and counseling. The instructors and other participants provide emotional and psychological support. Patients realize that they are not alone, and, hearing the stories of others, calm down and draw new strength. This feature of the rehabilitation program is especially helpful for those suffering from depression, or those who have been deeply hurt by the feeling that nothing lasts forever under the moon, which often accompanies those who have undergone heart surgery. And make it a family affair: patients tend to accept beneficial and lasting changes if their significant other or other people they listen to accompany them to rehab sessions.

Patients participating in a cardiac rehabilitation program after heart surgery have increased exercise tolerance, improved lipid levels, decreased chest pain and shortness of breath, and are more likely to return to independence. Such benefits are hard to come by with numbers: only 10 to 20% of Americans and 35% of Europeans participate in a cardiac rehabilitation program after heart surgery. This is especially true for the elderly and women.

One of the reasons for such low participation in rehabilitation programs is that many people think that their heart has been “repaired” 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 fear that the rehabilitation program will be expensive. Don't worry about expenses. Free medical care and most insurance companies cover the cardiac rehabilitation program; in fact, it is cost-effective because it improves health, reduces future expenses, and gets you back to work faster.

Road to recovery after heart surgery

Within two to three months after surgery, you will gradually return to normal, resuming your usual activities. But are such rates of recovery good? What activities are needed and when can you participate in them? How soon after surgery will you be able to climb stairs, drive a car, or have sex? Is there a special diet that you must follow? When can you tell that your recovery is going according to plan? 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 must exercise daily. Plan a daily walk. For the first two to four weeks, consider walking 20 to 30 minutes a day. You can climb the stairs right away. Stop any activity if you feel short of breath, chest pain, weakness or dizziness, call your doctor if these symptoms do not go away within 20 minutes. In a sitting position, raise your legs 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 in the side of your chest, do not lift anything heavy with this arm. Four weeks.

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

Diet after heart surgery

No matter what kind of surgery you have, avoid highly salty foods for two to four weeks. People tend to gain 1.5 to 5 kilograms from fluids during heart surgery. Most of this weight disappears before you leave the hospital, and limiting salt when you're at home will help you shed any remaining excess fluid and prevent swelling after surgery. In the first few weeks after surgery, there is usually a poor appetite and a reduced ability to taste food. This will pass, but make sure you are eating enough calories to ensure recovery. Many find it easier to eat little, but often. Milkshakes and high energy liquid supplements can help. After your recovery is complete, follow a healthy Mediterranean diet to maintain the effect of your surgery.

Sex after heart surgery

You can resume sexual activity as soon as you feel you are able to. This usually happens two or more weeks after being discharged from the hospital. At first there are fears, but do not worry. With your new, well-functioning heart, everything will be fine. Men who take Viagra or other erectile dysfunction medications can resume taking such drugs 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 the hospital. Wash your stitch daily with soap and water. Do not apply any creams or oils. Do not take a bath for the first two weeks after returning home from the hospital. Avoid sunburn in the scar area for at least twelve months, as sun exposure can lead to permanent dark pigmentation of the scar.

Driving after heart surgery

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

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've had minimally invasive surgery, it's 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 your leg veins. To ensure a good night's rest, consider taking pain pills 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.

Return to work after heart surgery

After a sternotomy, it makes sense not to start work for six to eight weeks, especially if your work 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 labor activity make sure your recovery is going according to plan.

Monitoring your recovery after heart surgery

Buy notebook and record the following data 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 nothing to worry about. However, certain signs or symptoms indicate that you need prompt medical attention, either immediately or within twenty-four hours.

Staying vigilant at home will prevent complications and detect problems early, and provide prompt treatment that will get your recovery back on track.

Finally, let's get to the hardest question of all: "When will I feel completely normal?" The answer depends on the specific case. A young person with minimally invasive surgery may feel quite normal in four to six weeks. After a sternotomy, most patients will take three months to return to normal. After that, they will feel better than before the operation, 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 their quality of life. Following our recipes, you will find yourself in this majority.

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Recovery period after heart surgery

Heart surgery for most patients is a chance to return to a full life. The success of its implementation largely determines the recovery period after heart surgery. At first, the patient and his family and friends have a hard time, but if all the recommendations of specialists are followed, the result of the operation can exceed the wildest expectations.

So, how to spend the recovery period correctly, what to pay attention to and what to be prepared for? The most important principle here is gradualness. The former activity must be restored slowly and calmly.

The recovery period after open heart surgery is almost always characterized by dramatic mood swings in patients. After recovery from anesthesia, positive emotions are often replaced by irritation and depression. Many patients experience memory impairment, decreased concentration, absent-mindedness. However, this is not a reason for serious worries. All of 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. It is necessary to know that even after successful operations, it takes from several months to a year for a person to fully recover. And it is necessary to start taking care of the patient's body immediately after he leaves the clinic. A large number of cases have been recorded when patients had to return to the hospital a few hours after discharge. It is worth remembering that if the duration of the trip home exceeds one hour, it is necessary to make stops, get out of the car. Otherwise, the blood circulation of the vessels may be disturbed.

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

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

The patient's appetite after surgery is most often poor, while the healing of physical and psychological wounds requires good food. Therefore, doctors often do not limit the patient's diet for 3-4 weeks after heart surgery. Then bans are set on the use of fats, sugar, salt, cholesterol and caloric content of products.

The patient is advised to consume those foods that contain a large amount of fiber and easily digestible carbohydrates. These are fruits, vegetables and sprouted grains. And to prevent or fight anemia, include iron-rich foods such as raisins, spinach, apples, and small amounts of lean red meat in your diet.

Eat more fruits and vegetables.

For breakfast, there are cereals, cereals or muesli, it is possible with the content of bran.

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

Instead of ice cream, it is good to use juices or sour-milk yogurts.

As dressings for salads, use only olive oil, or mayonnaise for salads.

Replace salt with vegetable and herbal spices.

Control your weight and gradually reduce it to the normal level, by 1-2 kg per month.

Constantly measure the level of sugar and cholesterol.

Move more and enjoy life!

Healing of postoperative sutures

Discomfort occurs at the incision site after surgery. They pass over time. After the seam is completely overgrown, you can use anesthetic ointments and moisturizing lotions. This helps relieve discomfort. But before using such funds, it is necessary to consult a surgeon.

If the sutures heal normally, the patient can take a shower 2 weeks after the operation. In no case should you take a bath or jacuzzi. Shampoos should not be used, sudden changes in water temperature should be avoided. It is better to wash with regular soap and blot the skin (do not wipe it) with a clean towel.

When the following symptoms you should immediately contact the surgeon:

An increase in body temperature above 38 degrees;

Strong combat sensations at the site of surgery;

The appearance of redness and swelling of the seams, 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, it is necessary to stop. Walking is possible with good health and favorable weather. Do not take walks immediately after eating. A month after the operation, you can slowly walk for a distance of 1-2 km.

A week after discharge, you can try to slowly walk 1-2 flights of stairs, move light objects weighing up to 3 kg. Can be practiced light homemade work - dusting, setting the table, washing dishes, helping family members cook food.

After 1.5–2 months, as a rule, the sutures completely heal. A cardiologist may prescribe a functional stress test. Its result allows you to choose 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, swim. A repeat functional exercise test is usually performed 3-4 months after surgery.

CARDIOVASCULAR DISEASES

Reminder for patients undergoing open heart surgery

The initial recovery period lasts approximately days. During this time, the patient gradually returns to their usual activities.

The pace and characteristics of the recovery period are individual for each person. Each patient should increase the load at their own pace.

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

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

If there is discharge from operating wound- after washing, cover it with a sterile gauze cloth and seal it with adhesive tape on top.

In the case of such changes in the wound as redness, profuse discharge or fever, you should consult your doctor.

There may be sensations of loss of sensitivity, itching and pain at the surgical site that pass over time.

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

If they become pronounced, prolonged and interfere Everyday life- It is recommended to consult your doctor.

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

An indication to take medication or to cancel it is given only by a doctor!

If the patient, for whatever reason, did not take the medicine on time, do not take a double dose during the next dose!

• drug name

• drug doses

• how many times a day should the medicine be taken, and at what hours

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

• if side effects of drugs occur, such as stomach pain, vomiting, diarrhea, rash, etc., you should inform your doctor about this.

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

The healthy leg should 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 stocking of a suitable size, which can be purchased from a pharmacy and put on after the stitches have been removed.

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

Body weight must match the height! (Overweight is one of the risk factors for cardiovascular disease).

Meal times should be consistent. Excessive food intake should be avoided.

You will need to see a cardiologist to get a license to drive a car, because after the operation your reactions will be slowed down due to weakness and fatigue, as well as under the influence of drugs, and rotational movements will remain difficult until the sternum has completely healed.

If you have to make long trips, 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 for walking and climbing stairs about two floors.

After visiting a cardiologist, a routine check and obtaining his permission, it is possible to enter into an intimate relationship. You may have difficulty in certain positions - 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 normal activity at their own pace. You should not compare yourself with other patients who have undergone heart surgery and compete with them.

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

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

• Try to rest at noon.

• For some time, pain in the area of ​​postoperative sutures 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 mood swings that pass over time.

• Walking on level ground is recommended. Choose your walking route. Walking should be fun. You should not walk to the point of exhaustion. Try to rest along the way.

• It is recommended to wear cotton or knitwear that does not irritate the postoperative suture.

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

There are contraindications, you need to consult a specialist.

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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, all conditions and recommendations are met. A clear system of instructions and their full implementation can significantly reduce the time of a gradual return to the usual activity.

For a month after the operation, there may be a sharp change in emotions, distracted attention, memory impairment and the ability to concentrate. Usually, the amplitude of mood swings does not exceed acceptable limits, so relatives and friends should be sympathetic to sudden changes from a joyful state to irritability and depression of the patient.

In the Department of Cardiac Surgery, all necessary procedures and tests to closely monitor the condition. Approximately after two weeks, with a positive dynamics of recovery, the patient can be discharged home.

Starting from this moment, the person himself will have to make every effort for a speedy and complete recovery. Rehabilitation can take a time period 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 blood circulation should be avoided already in the first hours after discharge from 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 a family doctor who will adjust the appointments in direct proportion to the patient's condition. If necessary, a brace designed specifically for people after surgery can be worn to relieve chest discomfort. Cardiac surgery brings numerous changes and disorders to the state of the body, so the main objectives of treatment are:

• restoration and stable operation of the cardiovascular system;
• normalization of the activity of the heart muscles and heart functions;
• active stimulation of recovery processes;
• stable improvement of hemodynamics;
• prevention of complications;
• resumption of stable work of the central nervous system.

In the event of any complications, inflammatory processes and deviations, various methods of restoring the body are used, among which aerosol methods, the use of Khivamat-200 and Plus-1 devices, and carbonic baths are recognized as the most effective.

Proper care of sutures and surgical wound

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

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

After washing the surgical wound, treat it with iodine. Before suture removal this procedure must be repeated several times a day, if not additional recommendations. General hygiene procedures are also very important, especially oral care.

The prescribed drugs can adversely affect the condition of the enamel, so the supervision of a dentist will not be superfluous. It is recommended to limit contact with others in order 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.

To relieve pain, reduce itching and inflammation can be special drugs that a doctor will prescribe. Changing drugs, changing the dosage of medications is strictly prohibited. In the case of bypass surgery, there may be pain in the leg.

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

A slight swelling of the leg is an acceptable norm, the use of compression bandages and finding the limb in a slightly elevated position.

Physical activity

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

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 the correct position of the torso will relieve not only tension, but also pain. Breathing techniques return the chest to its former shape and help to cope with shortness of breath and discomfort. By alternately relaxing and tightening the chest, you can get rid of tension and develop calm and rhythmic breathing.

Recover in the most short time a full range of various activities will help, which in combination are guaranteed to provide the best result. Therapeutic physical culture, special massage, medication, diet and physiotherapy, if used correctly and reasonably, will quickly restore lost strength, restore activity, and improve well-being.

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

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 foods and foods with an excess of salt. Weight gain after heart surgery is caused by the accumulation of fluid in the body and usually disappears almost completely before discharge from the hospital. The rest of the liquid will leave already at home quite naturally, thanks to salt restrictions.

The first time for several weeks in patients after heart surgery, there is a decrease or complete lack of appetite. Gradually, the ability to feel the taste of food will return, but during the rehabilitation period, you should definitely take care of enough nutrients and vitamins for the body.

Fractional nutrition is suitable for many, which allows you to eat in small portions, but often. It is also permissible to enrich the diet with special high-energy supplements and cocktails.

You can fix the result of the operation by applying 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 vegetable fiber. In the absence of individual recommendations during the day, it is advisable to drink one and a half liters of liquid. Products with a high content of caffeine, such as strong tea, Coca-Cola, coffee, are under the strictest ban, as they can cause a violation of the coronary circulation, increasing the load on the heart.

After rehabilitation period you can return to work, to your usual life. But in some cases it is necessary to make adjustments in 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 fully restored. Smoking can also adversely affect the coronary circulation, so this bad habit will have to be completely abandoned. It is imperative to keep 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 in creating an artificial way for blood to enter the myocardium, bypassing the thrombosed vessel. At the same time, the heart lesion itself is not touched, but blood circulation is restored by connecting a new healthy anastomosis between the aorta and the coronary arteries.

Synthetic vessels can be used as a material for a coronary artery bypass graft, but the patient's own veins and arteries turned out to be the most suitable. The autovenous method reliably "solders" the new anastomosis, does not cause a rejection reaction to foreign tissue.

In contrast to balloon angioplasty with a stent, the non-functioning 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 the treatment is made after a detailed examination of the patient, taking into account the age, concomitant diseases, and the safety of the coronary circulation.

Who was the "pioneer" in the use of aortic bypass surgery?

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

Autovenous shunting was the first to be performed in the United States by a cardiac surgeon from Argentina, R. Favaloro. A significant contribution to the development of intervention techniques belongs to the American professor M. DeBakey.

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

How are indications for surgery selected?

Coronary artery bypass grafting is performed when balloon angioplasty results are impossible or absent, conservative treatment. Before surgery in without fail coronary angiography of the coronary vessels is performed and the possibilities of using a shunt are being studied.

The success of other methods is unlikely with:

• severe stenosis of the left coronary artery in the area of ​​its trunk;
• multiple atherosclerotic lesions of the coronary vessels with calcification;
• the occurrence of stenosis within the installed stent;
• the impossibility of passing the catheter into a vessel that is too narrow.

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

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

There are 3 groups clinical indications also used by physicians.

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

• with angina pectoris III-IV functional classes;
• with unstable angina;
• with acute ischemia after angioplasty, impaired hemodynamic parameters;
• at developing heart attack myocardium up to 6 hours from the onset of the pain syndrome (later, if signs of ischemia persist);
• if the ECG stress test is strongly positive and the patient needs planned operation 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 a very likely prevention of acute infarction (the prognosis is unfavorable without surgery), but who are poorly amenable to drug therapy. In addition to the main reasons already given above, it takes into account the degree of dysfunction of the heart's ejection function and the number of affected coronary vessels:

• damage to three arteries with a decrease in function below 50%;
• damage to three arteries with a function above 50%, but with severe ischemia;
• damage to one or two vessels, but with high risk infarction due to extensive 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 associations of cardiologists recommend putting clinical signs and indications first, and then taking into account anatomical changes. It is estimated that the risk lethal outcome from a probable heart attack in a patient significantly exceeds mortality during the operation and after.

When is surgery contraindicated?

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

The classic general contraindications for any operations are considered to be available to the patient:

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

The risk of mortality increases dramatically with:

• coverage of atherosclerotic lesions of all coronary arteries;
• a decrease in the ejection function of the left ventricle to 30% or less 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 shunt vessel made of?

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

• mammarocoronary - the internal thoracic artery serves as a bypass;
• autoarterial - the patient has his own radial artery;
• autovenous - a large saphenous vein is selected.

The radial artery and saphenous vein can be removed:

• openly through skin incisions;
• using endoscopic techniques.

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?

The upcoming CABG requires a thorough examination of the patient. Standard analyzes include:

• clinical blood test;
• coagulogram;
• liver tests;
• the content of glucose in the blood, 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. Be sure to do coronary angiography (X-ray image of the vascular pattern of the heart after the introduction of a contrast agent).

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

To prevent thromboembolism from the veins of the legs, 2–3 days before the scheduled operation, a tight bandage is performed from the foot to the thigh.

It is forbidden to have dinner the night before, breakfast in the morning to exclude 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, they are shaved off.

An anesthesiologist's examination consists of an interview, pressure measurement, auscultation, and re-evaluation of past diseases.

Anesthesia method

Coronary artery bypass surgery requires complete relaxation of the patient, so general anesthesia is used. The patient will feel only a prick from the intravenous entry of the needle when the dropper is inserted.

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

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

Specialized centers use equipment for monitoring and control of:

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

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

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 carried out?

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 when cutting the sternum, connecting to a heart-lung machine;
• on a beating heart without cardiopulmonary bypass;
• with a minimal incision, access is used not through the sternum, but by mini-thoracotomy through an intercostal incision up to 6 cm long.

Shunting with a small incision is possible only for connection with the left anterior artery. Such localization is considered in advance when choosing the type of operation.

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

The advantages of surgery without the support of an artificial blood pump include:

• practical absence mechanical damage cellular elements of blood;
• 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). With special hooks it is bred to the sides, and the apparatus is attached to the heart. For the duration of the operation, it works like a pump and distills blood through the vessels.

Cardiac arrest is induced with a chilled potassium solution. When choosing a method of intervention on a beating heart, it continues to contract, and the surgeon enters the coronaries with the help of special devices (anticoagulators).

While the first is accessing the zone of the heart, the second ensures the release of autovessels to turn them into shunts, injects a solution with heparin into them to prevent the formation of blood clots.

A new network is then created to provide a circuitous route for blood delivery to the ischemic site. The stopped heart is started with a defibrillator, and artificial circulation is turned off.

For stitching the sternum, special tight staples are applied. A thin catheter is left in the wound to drain blood and control bleeding. The whole operation takes about four hours. The aorta remains clamped for up to 60 minutes, cardiopulmonary bypass is maintained for up to 1.5 hours.

How is the postoperative period?

From the operating room, the patient is taken to the intensive care unit on a gurney under a dropper. He usually stays here for the first day. Breathing is carried out independently. In the early postoperative period, continue monitoring the pulse and pressure, control over the release of blood from the installed tube.

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

Exercise therapy (physiotherapy exercises) is recommended to start from the second day: make movements imitating walking with your feet - pull socks towards you and back so that the work of the calf muscles is felt. Such a small load allows you to increase the "pushing" of venous blood from the periphery and prevent thrombosis.

On examination, the doctor pays attention to breathing exercises. Deep breaths straighten lung tissue and protect it from congestion. Balloons are used for training.

A week later, the suture material is removed at the sampling sites. saphenous vein. Patients are advised 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 early days, the doctor recommends a small unloading due to light nutrition: broth, liquid cereals, sour-milk products. Taking into account the existing blood loss, dishes with fruits, beef, and liver are offered. This helps restore hemoglobin levels in a month.

The motor mode is gradually expanded taking into account the cessation of angina attacks. Do not force the pace and chase sporting achievements.

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

How likely are complications?

The study of the statistics of postoperative complications indicates a certain amount of risk for any type of surgical intervention. This should be clarified when deciding on consent to the operation.

The lethal outcome in planned coronary artery bypass grafting is now no more than 2.6%, in some clinics it is less. Experts point to the stabilization of this indicator in connection with the transition to trouble-free operations for the elderly.

It is impossible to predict in advance the duration and degree of improvement in the condition. Observation of patients shows that the indicators of coronary circulation after surgery in the first 5 years dramatically 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 10 to 15 years. Survival after surgery is within five years - 88%, ten - 75%, fifteen - 60%.

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

What complications are possible after the operation?

The most common complications of coronary artery bypass grafting are:

Less frequent include:

• myocardial infarction caused by a detached thrombus:
• incomplete fusion of the sternal suture;
• wound infection;
• thrombosis and phlebitis of deep veins of the leg;
• stroke;
• kidney failure;
• chronic pain in the area of ​​operation;
• the formation of keloid scars on the skin.

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

Physicians began over 50 years ago. Today, technologies have changed, equipment has improved, surgical instruments have become richer, the skill of specialists has increased, but complications after CABG on the heart occur periodically. This is not a reason to believe that the risks before manipulation are high. Operations carried out in Israel have reached maximum level security. However, not everything depends on the operating doctor. Sometimes failures are associated with the individual reactions of the patient's body, the general state of his health and other third-party factors.

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Bleeding after CABG

Bleeding after surgery can occur from a couple of hours to several days. The reason is often not a medical error, but an insufficient rate of blood clotting of the patient due to the use of drugs that stimulate the blood flow of increased blood pressure. To prevent postoperative complications coronary artery bypass grafting, it is important to follow the doctor's recommendations for preparing for the procedure and after it.

Thrombosis

Installed veins or arteries are removed by surgeons from the patient's body to create an alternative way of blood supply to the heart muscle. Material is usually taken from lower extremities and forearms. This creates temporary difficulties in restoring blood flow at the site of the withdrawn vessels. When coronary artery bypass surgery is performed, the consequences can manifest as deep vein thrombosis. Indicate negative changes pain and swelling of the legs after coronary artery bypass grafting, which occur a few days after the intervention. The attentive attitude of doctors will allow you to notice deviations at an early stage and eliminate them without harm to the patient's health. In many situations, the consequences are easy to prevent if the profile administration of drugs that favorably affect blood flow is carried out.

Heart rhythm disorders

CABG surgery is a complex procedure that requires high skill from the surgeon performing it. The essence of the method is simple. At one end, a shunt expropriated from another area is sutured into the aorta. The second end goes into the coronary vessel under the constriction. Despite the high qualification of surgeons, cardiac arrhythmia may occur immediately after surgery or during the post-rehabilitation period. If the complications of CABG are expressed in this way, the therapy of the condition includes antiarrhythmic drugs, in severe cases, electrical cardioversion.

heart attack

The most severe consequence of a negative nature is myocardial infarction, which is characteristic of the early period of recovery after surgery. A heart attack can occur in the first few hours or days. Severe chest pain after CABG, pressure, burning in the center of the sternum, which do not disappear after taking the drugs, should alert. atherosclerosis strikes large areas vessels. A complex approach in treatment and constant monitoring of the patient's condition after the bypass procedure is not always able to prevent complications. This is explained by the activation of the cells that cause the inflammatory process, causing an increase in the ability of the blood to clot.

Provoked changes in the vascular network can lead to atherothrombosis. In medical statistics, there are cases when during CABG the myocardium does not receive the proper blood supply, which causes a heart attack. It is important to listen to the advice of doctors at the stage of preparation for the operation: eliminate bad habits, give the body a proper rest during stress, accustoming oneself to the regimen. A heart attack after CABG can be prevented by reducing the risk factors that cause it.

Stroke

Observations of the practice of conducting operations contribute to the formation of statistics. In 40%, low blood pressure after CABG, impaired blood supply to the brain lead to the development of a stroke on the first day after surgery. In 60% of cases of complications, a stroke occurs in the first week of the recovery period. It is signaled by numbness of the limbs, difficulty with movements and articulation. The preoperative state of the patient can also contribute to the development of a negative state if there is a history of atherosclerosis. coronary arteries and cerebral vessels.

Narrowing of shunts

When sending a patient for coronary artery bypass grafting, the doctor immediately identifies the risks. Common complications include shunt narrowing, atherosclerosis of established vessels, and thrombosis. A condition is observed in the first year after the procedure in 20% of patients, in the rest the vessels narrow after 7-10 years. This requires a second operation, the release of blood flow from atherosclerotic plaques that clog the vessels. A lot depends on the patient here. The more carefully the patient adheres to medical recommendations, the longer the operational result is preserved.

Factors influencing the occurrence of complications

If CABG surgery has taken place, the consequences of the intervention depend on the doctor and the patient. The above is not full list possible complications. Wound infection, suture failure, mediastinitis, sternum diastasis, and pericarditis should be noted. Some conditions cause serious danger to life. Arrhythmia after CABG, low or high pressure, pain symptoms. Statistics fixes the death rate after heart surgery within 3%. This is not a big indicator, given the complexity of medical manipulations. In medicine, there are factors that provoke the development of complications. Among them:

• Presence of a history of angina pectoris, myocardial infarction. Pathology indicates damage to the heart muscle and vascular network before surgery, which cannot contribute to quick rehabilitation and a trouble-free recovery period.
• Coronary artery bypass grafting gives a significant complication with stem lesions of the left coronary artery, dysfunction of the left ventricle. This factor is among the first noted by the doctor during examination and referral for surgery.
• Heart failure with a pronounced chronic character.
• Atherosclerosis of peripheral vessels, arteries.
• According to studies, the risk of complications is higher in women.
• Pulmonary diseases in a chronic form.
• Diabetes.
• Renal failure.

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Recovery after surgery

A few days in intensive care after surgery contribute to the initial recovery of the patient. Drawing pain in the sternum after CABG is explained by surgical incisions and suturing. To prevent rotting of the wound and infection, it is treated with antiseptics. For some time, the patient will experience discomfort, burning, but soon they pass. After a couple of weeks, with successful rehabilitation, you are allowed to take a shower.

Broken bones heal longer - up to 7 weeks. This period is recommended to wear elastic stockings, avoid physical exertion, so as not to provoke unwanted complications. Anemia is compensated by proper nutrition with the inclusion of products containing iron. It is important to learn how to breathe properly so as not to cause stagnation in the lungs. Cough after CABG is considered normal, doctors teach the patient to cough, returning the ability of the lungs to independent functioning.

Doctors are not alarmed by swelling of the legs after CABG, which should disappear within 2 weeks. If puffiness persists, additional studies, profile preparations and procedures are prescribed. In the future, a slight swelling is possible at the site of the removal of the veins, since the network of vessels still does not cope well with the outflow of blood. Duplex scanning, lymphography, ultrasound diagnostics, examination of the kidneys, the delivery of urine and blood tests.

Cardiac rehabilitation will reduce the risk of complications

It is impossible to independently make diagnoses about the prohibition or permission of CABG. The direction for the operation will be given by a professional doctor after the patient undergoes a thorough examination, identifying the risks of development negative reactions during the procedure and during the recovery period. The best option possible is to prevent coronary disease. If this is not possible, you should carefully consider the recommendations of doctors so that the results of shunting are not disturbed by the complications that have arisen.

Before the operation, you need to carefully prepare. The first conversation with the doctor should be confidential. It is necessary to warn about past diseases, chronic diseases. Care must be taken in choosing medical institution where the operation is performed. is famous for the level of emergency care and operations carried out as planned. High qualification of cardiac surgeons, modern equipment, well-established technique for managing severe patients are the factors of successful treatment.

Pay attention to the postoperative period. After undergoing CABG, it is worth taking the prescriptions prescribed by the doctor medications, attend rehabilitation therapy procedures, lead a healthy lifestyle. The first days may be dizziness after coronary artery bypass grafting, chest pain, slight swelling. Soon the negative symptoms will pass, the body will begin to recuperate. After surgery, many patients live a full life for a long time, exceeding several decades. Therefore, you should not be afraid of the consequences and complications, a professional doctor will do everything possible to reduce the risk of developing pathological reactions.

Sign up for treatment

In fact. Fear is the main problem of a person who is going to have coronary artery bypass surgery. To cope with it helps the desire, if not forever, then at least for a while to forget about the pain. By the way, it is pain in many ways that makes the patient decide on an operation.

Myth 2. After the operation, you will have to “carry” yourself like a crystal vase.

In fact. This is wrong. Usually, the very next day after the operation, the doctor warns: if you move a little, complications are possible, for example. The operated person immediately begins to learn to turn in bed, sit down ...

Shunts are placed so that the patient can walk without feeling pain. At first, of course, weakness interferes, and pain from the seam, but it is necessary to gradually increase physical activity. And then those movements that caused pain before the operation will be given easily.

Myth 3. Pain can return.

In fact. There is no need to wait for the pain to return, but it is better to imagine that it never happened at all. However, "feats" do not need to be performed. Everything should be in moderation. The patient should set realistic goals for himself: for example, today and tomorrow I will walk 50 meters, the next days - 75, then - 100 ...

Statistics show that not all patients succeed even after CABG. And this is not surprising: no matter how well the operation is done, it is only one of the stages in the treatment of coronary heart disease. Doctors have not yet learned how to cleanse the vessels of the heart from atherosclerotic plaques - the main cause of the disease. Therefore, even after successful operation in about half of patients, angina pectoris may persist, manifested by chest pain during exercise. But the number of seizures and pills taken after CABG will still be less. So the quality of life of the patient will still improve. And most importantly - it will be possible to delay the onset of myocardial infarction, which means - to prolong life.

Myth 4. After CABG, you can live as before

In fact. Alas, it is not. Even with a good outcome of the operation, one should try to strain the arms and the entire shoulder girdle as little as possible. This is due to a significant surgical trauma in the chest area. It is advisable to limit heavy lifting. You will also have to give up some gardening work.

Myth 5. Smoking does not affect the heart after surgery much.

In fact. Quitting smoking extends the life of shunts by several years. After all, the duration of the functioning of shunts in each patient is different. On average, it is 5-7 years. This period largely depends on how much a person was able to change his life after the operation, whether he follows the recommendations of doctors.

(diet with restriction of animal fats), normalization of body weight, adequate physical activity, taking all the necessary medications in total add a few more years of active and fulfilling life.

Myth 6. After the operation, it will be possible to live without drugs.

In fact. People who have had CABG should never stop taking their medications. Most of the drugs that are prescribed today after surgery are vital. In order to reduce the risk of shunt closure by blood clots, it is often necessary to take drugs that reduce blood clotting.

Drugs from the group of beta-blockers are needed in order to reduce the excessive work of the heart. They also slow down the heart rate. However, any changes in treatment must be agreed with the doctor. It is too risky to solve such questions on your own.

Coronary artery bypass surgery is a fairly common procedure these days. Surgical intervention is necessary for patients suffering from coronary heart disease with the ineffectiveness of drug treatment and the progression of pathology.

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

What is ischemic heart disease?

Ischemic heart disease is an acute or chronic decrease in functional activity myocardium. The reason for the development of pathology is the 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 due to the narrowing of the coronary arteries responsible for supplying the myocardium with oxygen. Vascular patency decreases against the background of atherosclerotic changes. Insufficiency of blood supply is accompanied by pain syndrome, which on initial stages 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 ("angina pectoris"). They usually radiate to the neck, left shoulder, or angle of the mandible. 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 represent the greatest danger, since they are often diagnosed already in the later stages.

The most dangerous complication of ischemic 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 an X-ray contrast 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 issue 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 trained in deep breathing and coughing techniques. He has the opportunity to get to know the surgical team and get detailed information about the nature and course of the intervention.

On the eve of the preparatory procedures including cleansing enema. An hour before the start, premedication is carried out; the patient is given drugs 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 is significantly increased. Surgical treatment can improve the quality of life of the patient and increase its duration.

The average duration of the operation is 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 a beating heart is also possible.

At surgical treatment without connecting the patient to a heart-lung machine, there are a number of advantages, including:

• shorter duration of intervention (up to 1 hour);
• reduction of recovery time after coronary bypass surgery;
• exclusion of possible damage to blood cells;
• the absence of other complications associated with connecting the patient to the EC 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 course and duration of the operation depends on the following factors:

• type of vascular damage;
• the severity of the pathology (the number of shunts created);
• the need for parallel aneurysm repair or heart valve reconstruction;
• 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 the branch of the coronary artery, bypassing the narrowed or obturated area.

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

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

Note:the use of an artery fragment allows you to create a more functional 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, that is, they are relatively “clean”. In addition, the collection of such a transplant subsequently does not lead to health problems. The remaining veins of the legs take on the load, and blood circulation in the limbs is not disturbed.

The ultimate goal of creating such a bypass is to improve the 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. In patients, physical endurance increases, working capacity is restored and the need for taking pharmacological preparations decreases.

Coronary artery bypass grafting: postoperative period

After the end of the operation, the patient is placed in the intensive care unit, where he is monitored around the clock. Anesthesia drugs negatively affect the respiratory function, so the operated person is connected to a special device that supplies oxygen-enriched air through a special tube in the mouth. At fast recovery the need to use this device usually disappears within the first day.

Note:in order to avoid uncontrolled movements that can lead to the development of bleeding and detachment of droppers, the patient's hands are fixed until full consciousness is regained.

Catheters are placed in the vessels on the neck or thigh, through which drugs are injected and blood is taken for analysis. Tubes are removed from the chest cavity to suck the accumulated fluid.

Special electrodes are attached to the body of a patient who has undergone coronary artery bypass grafting in the postoperative period, 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 performed.

Note:while the action of drugs for general anesthesia continues, the patient may be in a state of euphoria. Disorientation is also characteristic.

As the patient's condition improves, they are transferred to a regular ward of a specialized department of a hospital. During the first days after shunting, an increase in overall body temperature is often noted, which is not a cause for concern. This is a normal reaction of the body to extensive tissue damage during surgery. Immediately after coronary artery bypass grafting, patients may complain of discomfort at the site of the incision, 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 invited to enter in a special diary data on the amount of fluid drunk and the volume of urine separated. To prevent the development of such complications as postoperative pneumonia, the patient is introduced to a set of breathing exercises. The supine position contributes to the stagnation of fluid in the lungs, so the patient is advised to turn on his side a few days after the operation.

To prevent the accumulation of secretions (improvement of expectoration), a careful local massage with tapping in the projection of the lungs is shown. The patient must be informed that coughing will not lead to suture separation.

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

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

The restoration of motor activity should be gradual. At first, the patient is allowed to take a sitting position, a little later - to walk around the ward or corridor for a short time. Shortly before discharge, it is allowed and even recommended to increase the walking time and climb the flight of stairs.

The first days the bandage is regularly changed, and the sutures are washed with an antiseptic solution. As the wound heals, the bandage is removed, as the air helps to dry out. If tissue regeneration proceeds normally, then the sutures and the stimulation electrode are removed on the 8th day. After 10 days after the operation, the incision area is allowed to be washed with ordinary warm water and soap. As regards general hygiene procedures, then you can take a shower only a week and a half after removing the stitches.

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

Important:until the complete healing of the sternum bone, lifting weights and making sudden movements is excluded!

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

After coronary bypass surgery, the patient stays in the hospital for another 2-2.5 weeks (provided there are no complications). The patient is discharged only after the attending physician is fully confident in the stabilization of his condition.

To prevent complications and reduce the risk of developing cardiovascular disease diet needs to be adjusted. The patient is advised to reduce their salt intake and minimize the amount of foods containing saturated fat. Persons suffering nicotine addiction you should quit smoking completely.

Exercise therapy complexes will help reduce the risk of relapse. Moderate physical activity (including regular hiking) contribute to the speedy rehabilitation of the patient after coronary bypass surgery.

Mortality statistics after coronary artery bypass grafting

According to data obtained in the course of long-term clinical observations, 15 years after a successful operation, 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 is about 18 years.

Note:at the time of 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 managed to celebrate their 90th anniversary!

Plisov Vladimir, medical commentator

1. Stable angina pectoris 3-4 functional classes, poorly amenable to drug therapy (multiple attacks of retrosternal pain during the day, not stopped by taking short and / or long-acting nitrates),
2. Acute coronary syndrome, which can stop at the stage of unstable angina or develop into acute myocardial infarction with or without ST elevation on the 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, identified during exercise tests - treadmill test, bicycle ergometry,
5. Severe painless ischemia detected during daily monitoring BP and ECG according to Holter,
6. The need for surgical intervention in patients with heart defects and concomitant myocardial ischemia.

Contraindications

Contraindications for bypass surgery include:

Preparing for the operation

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

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

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

How is the operation carried out?

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

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

In most cases, during the operation, the heart is connected to a heart-lung machine (ABC), which during this period of time carries out blood flow through the body instead of the heart. It is also possible to perform shunting on a beating heart, without connecting the AIC.

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 be a bypass and brings it to the affected coronary artery, suturing the other end to the aorta. Thus, blood flow to the coronary arteries will be carried out from the aorta, bypassing the area in which the plaque is located. There may be several shunts - from two to five, depending on the number of affected arteries.

After all the shunts have been sutured to the right places, metal wire staples are applied to the edges of the sternum bone and sutured soft tissues and an aseptic dressing is applied. Drainages are also removed, through which hemorrhagic (bloody) fluid flows from 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?

The CABG operation belongs to high-tech types of medical care, so its cost is quite high.

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

To obtain a quota, the patient must undergo examination methods confirming the need for surgical intervention (ECG, coronary angiography, ultrasound of the heart, 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 apply to any state (in Russia) or private (abroad) clinic that practices such operations. The approximate cost of shunting is from 45 thousand rubles. for the operation itself without the cost of consumables up to 200 thousand rubles. with the cost of materials. With joint prosthetics of heart valves with shunting, 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 side of 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. The risk factors for developing a heart attack are mainly in the time of operation of the heart-lung machine - the longer the heart does not perform its contractile function during surgery, the more risk myocardial damage. Postoperative heart attack develops in 2-5% of cases.

Complications from other organs and systems develop rarely and are determined by the age of the patient, as well as the presence of chronic diseases. Complications include acute heart failure, stroke, exacerbation of bronchial asthma, decompensation diabetes and others. 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 of the day after shunting. The sternum, being a bone, heals much later - 5-6 months after the operation.

In the early postoperative period rehabilitation measures are being taken with the patient. These include:

• diet food,
• Respiratory gymnastics - the patient is offered a kind of balloon, inflating which, the patient straightens the lungs, which prevents the development of venous congestion in them,
• Physical gymnastics, first lying in bed, then walking along the corridor - at present, patients are encouraged to activate as early as possible, if this is not contraindicated due to general severity conditions, for the prevention of stagnation of blood in the veins and thromboembolic complications.

In the late postoperative period (after discharge and thereafter) continues to perform exercises recommended by a physiotherapist (exercise 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 alcohol consumption,
2. Compliance with the basics of a healthy diet - the exclusion of fatty, fried, spicy, salty foods, more consumption of fresh vegetables and fruits, fermented milk products, lean meats and fish,
3. Adequate physical activity - walking, light morning exercises,
4. Achieving the target level of blood pressure, carried out with the help of antihypertensive drugs.

Registration of disability

After the bypass surgery of the heart vessels, temporary disability (according to sick leave) is issued for a period of up to four months. After that, patients are sent to the ITU (medical and social examination), during which it is decided to assign a particular disability group to the patient.

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

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

I group assigned to persons with severe chronic heart failure requiring the care of unauthorized persons.

Forecast

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

Based on the foregoing, it should be noted that CABG is an excellent alternative to long-term drug treatment IHD and angina pectoris, as it significantly 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 live after heart bypass surgery for more than 10 years.

Video: coronary artery bypass grafting - medical animation

operacia.info

Indications for coronary artery bypass surgery

The presence of stenosis of the trunk of the left coronary artery by 50% or more.
The defeat of the two main coronary arteries with the 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 not possible, due to the complex anatomy of the vessels (severe tortuosity)
Complication during percutaneous coronary angioplasty. Dissection (dissection) or acute occlusion (blockage) of the coronary artery is also an indication for urgent coronary artery bypass grafting.
High functional angina pectoris.
Myocardial infarction, if it is impossible to perform angioplasty.
Heart defects.

In patients with diabetes mellitus, extended occlusions (blockage) of the arteries, severe calcification, damage to the main trunk of the left coronary artery, the presence of severe narrowing 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 more than 50%.
Diffuse lesion coronary vessels when it is not possible to place a shunt.
Decreased contractility of the left ventricle (left ventricular ejection fraction less than 40% according to echocardiography).
Renal failure.
Liver failure.
Heart failure.
Chronic non-specific lung diseases

Preparing the patient for coronary artery bypass surgery

If coronary artery bypass grafting is performed in a planned manner, then at the outpatient stage, an examination is necessary before admission to the hospital to perform the operation. A clinical blood test, a general urinalysis, a biochemical blood test (transaminases, bilirubin, lipid spectrum, creatinine, electrolytes, glucose), a coagulogram, electrocardiography, echocardiography, chest x-ray, ultrasound examination of the vessels of the neck and lower extremities, fibrogastroduodenoscopy, ultrasound are performed abdominal organs, the results of coronary angiography (disk), examination for hepatitis B, C, HIV, syphilis, examination by a gynecologist for women, a urologist for men, oral cavity sanitation are needed.

After the examination, hospitalization is carried out in the cardiosurgical department, as a rule, 5-7 days before the operation. In the hospital, the patient gets acquainted with his attending physician - a cardiac surgeon, a cardiologist, an anesthesiologist is examined. Even before the operation, it is necessary to learn the technique of special deep breathing, 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, the anesthesiologist, who will clarify the details of the operation and anesthesia. In the evening, they will cleanse the intestines, hygienic treatment of the body, and at night they will give sedative (soothing) drugs so that sleep is deep and calm.

How is the operation performed

On the morning of the operation, you will give nurse to store their personal belongings (glasses, contact lenses, removable dentures, jewelry).

After all preparatory activities an hour before the operation, the patient is given sedative (sedative) drugs and tranquilizers (phenobarbital, phenozypam) for better tolerance of anesthesia and is taken to the operating room, where an intravenous system is connected, several injections are made into a vein, sensors of the system for constant monitoring of 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 the introduction of the patient into anesthesia produce access to the chest. This used to be achieved by sternotomy (cutting the sternum, this is a classic technique), but more recently it has been used more and more. endoscopic surgery with a small incision in the left intercostal space, in the projection of the heart. Next, the heart is connected to an IR apparatus, or an operation is performed on a beating heart. This is determined in advance by surgeons when discussing the course of the operation.

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

The next step is to install drainage into the pericardial region (the outer shell of the heart) to exclude complications in the form of hemopericardium (accumulation of blood in the pericardial cavity). After that, 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.

Thus, a bypass is formed around the affected area of ​​the coronary artery and normal blood flow to the heart muscle is restored. The main coronary arteries and their large branches are subject to shunting. The volume 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 brackets 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 by small incisions in the intercostal space, then stitches are applied.

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

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

Starting from 3-4 days, it is recommended to perform breathing exercises, respiratory therapy (inhalation), oxygen therapy. The patient's activity mode is gradually expanding. With dosed physical activity, it is necessary to keep a self-control 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 indicators of the work of the heart. 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 bypass) 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 calf or ankle usually resolves in six to seven weeks.

Rehabilitation after coronary artery bypass grafting takes an average of 6-8 weeks.

Rehabilitation after surgery

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

Clinical (medical) - postoperative medication.

Physical - aimed at combating hypodynamia (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.

In the vast majority of studies, it has been proven that surgical methods for the treatment of coronary artery disease are in many ways superior to medical ones. Patients after coronary artery bypass grafting for 5 years after surgery showed a more favorable course of the disease and a significant decrease in the number of myocardial infarctions, as well as repeated hospitalizations. But, despite the successful operation, it is necessary to pay special attention to lifestyle modification, to streamline the intake 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 lethal cases is minimal, and the percentage of the absence of myocardial infarction and signs of coronary artery disease is very high, after the operation anginal attacks disappear, shortness of breath, rhythm disturbances decrease.

A very important point after surgical treatment is the modification of lifestyle, the elimination of risk factors for the development of coronary artery disease (smoking, overweight and obesity, high blood pressure and cholesterol levels, physical inactivity). Measures to be taken after surgical treatment: smoking cessation, strict adherence to a hypocholesterol diet, mandatory daily physical activity, reduction of stressful situations, regular medication.

It is very important to understand that a successful operation and the absence of symptoms of coronary artery disease do not cancel the regular intake 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-blockers - help the heart work in a more "economical" mode, ACE inhibitors stabilize blood pressure, stabilize the inner layer of the arteries, and prevent heart remodeling.

The list of necessary drugs can be supplemented based on the clinical situation: it may be necessary to take diuretics, with prosthetic anticoagulant valves.

However, despite the progress made, one cannot ignore the negative consequences of the standard coronary artery bypass grafting under cardiopulmonary bypass, such as Negative influence IR on the function of the kidneys, liver, central nervous system. With emergency coronary artery bypass grafting, as well as with concomitant conditions in the form of emphysema, kidney disease, diabetes mellitus or diseases of the peripheral arteries of the legs, the risk of complications is higher than with a planned operation. Approximately a quarter of patients develop an arrhythmia 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, dysfunction external respiration, hypercoagulability (increased risk of thrombosis).

Shunt stenosis is not excluded in the late postoperative period. The average duration of auto-arterial shunts is on average more than 15 years, and that of auto-venous shunts is 5-6 years.

Recurrence of angina pectoris 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 provides general information about coronary artery disease, or so-called coronary artery disease (CHD). Surgical method myocardial treatment is called coronary bypass surgery. This operation is the most effective method treatment of coronary artery disease and allows patients to return to a normal active life. This booklet is written for patients, however, family members and friends will also find it helpful.

1. Advances in the treatment of coronary artery disease.
2. Heart and its vessels
   • How do they work
3. • How coronary arteries fail
   • Diagnosis of coronary artery disease
   • How is IHD treated?
   • Coronary artery bypass grafting (CS)
4. Surgical treatments
   • Traditional KSH
   • How to improve cardiopulmonary bypass
   • CABG without cardiopulmonary bypass
   • Minimally Invasive Cardiac Surgery
   • Benefits of operations without cardiopulmonary bypass
   • Benefits of Minimally Invasive Cardiac Surgery
5. Operation KSH
   • Before surgery
   • Day of operation: preoperative period
   • During the operation
   • Day after surgery: postoperative period
   • Postoperative period: 1-4 days
   • After operation

Advances in the treatment of coronary artery disease (CHD).

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 in the world suffer from it.
For decades, physicians and cardiologists have tried to improve the heart's blood supply with drugs that dilate the coronary arteries. Coronary artery bypass grafting (CS) is a common surgical treatment for the disease. This method has long been proven to be safe and effective. Over the decades, a lot of experience has been accumulated and significant success has been achieved in the implementation of these operations. KSh is today a widespread and fairly simple operation.
Continuous improvement of surgical technique and the use of the latest advances in medicine allows surgeons to perform operations with less trauma to the patient. All this helps to reduce the length of the patient's stay 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 oxygenated blood and nutrients through the body to the cells. To accomplish this task, the heart cells themselves (cardiomyocytes) also require oxygen and nutrient-rich blood. This blood is delivered to the heart muscle through vasculature 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 the colic arteries. The left coronary artery also divides into two main branches: the anterior descending and circumflex arteries.

Coronary artery disease (CHD)

How do coronary arteries fail?

The coronary arteries can be blocked by fatty, cholesterol buildup called atherosclerotic plaques. The presence of plaques in the artery makes it uneven and reduces the elasticity of the vessel.
There are both single and multiple growths, of different consistency and location. Such a variety of cholesterol deposits causes a different effect on functional state hearts.
Any narrowing or blockage in the coronary arteries reduces the blood supply to the heart. Heart cells use oxygen to work 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 coronary artery disease may experience pain behind the sternum (angina pectoris). Pain in the heart area is a warning signal that tells the patient that something is wrong.
The patient may experience intermittent chest discomfort. Pain may radiate to the neck, leg or arm (usually on the left side), may occur during exercise, after eating, with temperature changes, with stressful situations and even at rest.

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

Diagnosis of diseases of the coronary arteries.

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

How is IBS treated?

According to the statistics of the Ministry of Health of the Russian Federation, published in 2000, it was found that mortality from coronary heart disease was 26% of all cases. In 1999, for the first time, data were obtained on repeated acute heart attacks. During the year, 22,340 cases were registered (20.1 per 100,000 adults). Every year there is a growing number of patients with coronary artery disease who need treatment to increase blood flow to the heart muscle. This treatment may include medical therapy, angioplasty, or surgical intervention.
Drugs dilate (widen) the coronary arteries, thus 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. You can also place a small device called a stent in an artery after angioplasty. This coronary stent gives confidence that the artery will remain open.
Coronary artery bypass grafting (CS) is surgical procedure aimed at restoring blood supply to the myocardium. Its essence will be presented below.

Coronary artery bypass grafting (CS)

CABG is a surgical intervention that restores blood flow to the heart below the site of vasoconstriction. With this surgical manipulation, another path for blood flow is created around the site of the narrowing to that part of the heart that was not supplied with blood.
Shunts to bypass blood are created from fragments of other arteries and veins of the patient. The most commonly used for this is the internal mammary artery (ITA), which is located on the inside of the sternum, or the great saphenous vein, which is located on the leg. 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.

Surgical treatments

Traditional KSh.

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 support of blood circulation in the patient is carried out with the help of cardiopulmonary bypass (EC). Instead of a heart, a heart-lung machine (heart-lung machine) works, which provides blood circulation throughout the body. The patient's blood enters the heart-lung machine, where gas exchange takes place, the blood is saturated with oxygen, as in the lungs, and then delivered to the patient through the tubes. In addition, the blood is filtered, cooled or warmed to maintain the required temperature of the patient. However, cardiopulmonary bypass can also bad influence on the organs and tissues of the patient.

How to improve artificial circulation.

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

• Centrifugal blood pump, for less traumatic blood flow control
• A system for cardiopulmonary bypass with a biocompatible coating to reduce the reaction of blood interaction with an extensive foreign surface.

CABG without cardiopulmonary bypass.

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 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 operation may include the following: a smaller surgical incision, incisions at different locations, and/or avoidance of cardiopulmonary bypass. Traditional heart surgeries are performed through a 12-14″ incision, while the newer minimally invasive approach involves the following: a thoracotomy (a small 3-5″ incision between the ribs), several small incisions (so-called "key holes"), or sternomia.
The advantages of minimally invasive surgery are, on the one hand, smaller incisions, on the other hand, the avoidance of extracorporeal circulation and the possibility for the surgeon to perform operations on a beating heart.

Benefits of performing CABG through a smaller incision:

• The best opportunity for the patient to clear his throat and breathe deeper after surgery.
• Less blood loss
• The patient experiences less pain and discomfort after surgery
• Reduced chance of infection
• Faster return to normal activity

Advantages of CABG operations without cardiopulmonary bypass:

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

Benefits of CABG

Patients often feel much better after undergoing coronary artery surgery, as they are no longer bothered by the symptoms of coronary artery disease. Patients experience a gradual improvement in well-being after surgery, as most significant changes in their condition occur after a few weeks or months.

Benefits of mini-invasive CABG surgery

The surgeon may choose to perform CABG with a minimally invasive approach 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 improvement of quality of life can be achieved with the use of CABG with minimally invasive access.
In addition to this, mini-invasive CABG leads to the following.

• Shortening the time of stay in the hospital: the patient is discharged from the hospital 5-10 days earlier than during the traditional operation US
• Faster recovery: the patient returns to normal activities faster than with traditional surgery (6-8 weeks for patient recovery)
• Less blood loss: during the operation, all the patient's blood passes through the extracorporeal circuit, so that it does not clot in the tubes, the patient is injected with anti-clotting drugs. Blood cells can be damaged during CPB, which also leads to impaired blood clotting after surgery.
• Reducing the number of infectious complications: the use of a smaller incision leads to less tissue trauma and reduces the risk of postoperative complications.

Operation US

Patient care is different character. 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 a patient. Therefore, the patient himself, without hesitating any questions, should ask the nurse or the doctor to help him understand difficult questions operations and discuss with them the issues that concern him most.

Before surgery

The patient is admitted to the hospital. After receiving the written consent of the patient to conduct research and operations, which are filled in a special form, various tests, electrocardiography and X-ray examination are performed.
Before the operation, an anesthesiologist, a specialist in respiratory gymnastics and physiotherapy exercises talks with the patient. At the request of the patient, a clergyman can visit him.
Before the operation, the doctor gives recommendations on sanitary and hygienic measures (taking a shower, setting an enema, shaving the surgical site) and taking the necessary medicines.
On the eve of the operation, the patient's dinner should consist only of clear liquids, and after midnight the patient is not allowed to take food and liquids.
The patient and his family members receive information and educational materials on heart surgery.

Day of operation: preoperative period

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

During the operation

The surgeon prepares the selected site on the chest for CABG. If necessary, a segment is taken from the saphenous vein of 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 the coronary artery (usually the left anterior descending artery) below the blockage. When the conduit preparation is complete, the patient's circulatory support (cardiopulmonary bypass) is gradually started, in cases where conventional CABG is performed. If the surgeon performs manipulations on a beating heart, he will use a special stabilizing system. Such a system allows you to stabilize the necessary area of ​​​​the heart.
After all coronary arteries have been bypassed, cardiopulmonary bypass, if used, is gradually discontinued. Install drains in the chest to facilitate the evacuation of fluid from the area of ​​operation. Careful hemostasis of the postoperative wound is carried out, after which it is sutured. The patient is disconnected from the monitors located in the operating room and connected to portable monitors, then transported to the intensive care unit (ICU).
The duration of the patient's stay in the intensive care unit depends on the volume of surgery and on his 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 studies, which can be repeated in case of additional need. 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 uses special stockings that support blood circulation in the legs, wrap him in a warm blanket to maintain body temperature. The patient remains in the supine position and continues to receive fluid therapy, pain relief, antibiotics, and sedatives. The nurse provides constant care for the patient, helps him turn over in bed and perform routine manipulations, and also communicates with the patient's family.

Day after surgery: postoperative period-1 day

The patient can remain in the intensive care unit, or they can be transferred to a special room with telemetry, where their condition will be monitored using special equipment. After restoration of fluid balance, the Foley catheter is removed from the bladder.
Remote monitoring of cardiac activity is used, drug anesthesia and antibiotic therapy continue. The doctor prescribes dietary nutrition and instructs the patient about physical activity (the patient should begin to sit down on the bed of the bed and reach for a chair, gradually increasing the number of attempts).
It is recommended to continue wearing support stockings. nursing staff performs rubbing on the patient.

Postoperative period - 2 days

On the second day after the operation, oxygen support stops, and breathing exercises continue. The drainage tube is removed from the chest. The patient's condition improves, but monitoring of parameters using telemetry equipment continues. The patient's weight is recorded and the administration of solutions and medications continues. If necessary, the patient continues anesthesia, and also fulfill all the doctor's prescriptions. The patient continues to receive dietary nutrition and his activity level gradually increases. He is allowed to gently get up and, with the help of an assistant, move to the bathroom. It is recommended that you continue to wear support stockings, and even start doing light exercise for your 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 to the patient about necessary activities preparing the patient for discharge.

Postoperative period – 3 days

The monitoring of the patient's condition is stopped. Weight registration continues. If necessary, continue anesthesia. Perform all doctor's prescriptions, 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, already 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, medication, home exercise, full recovery of vitality and preparation for discharge.

Postoperative period - 4 days

The patient continues to perform breathing exercises several times a day. The patient's weight is again checked. Diet food continues to be carried out (restriction of fatty, salty), however, the food becomes more varied and the portions become larger. It is allowed to use the bathroom and move around without assistance. The patient's physical condition is assessed and final instructions are given before discharge. If the patient has any problems or questions, then he must resolve them before discharge.
Nurse or Social worker help you solve all problems related to discharge. Usually, you are discharged from the hospital around noon.

After operation

It follows from the above that CABG surgery is the main step to return the patient to normal life. CABG surgery is aimed at treating coronary artery disease and relieving the patient of pain. However, it cannot completely rid the patient of atherosclerosis.
The most important task 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 you know, many factors directly affect the formation of atherosclerotic plaques. And the cause of atherosclerotic changes in the coronary arteries is a combination of several risk factors at once. Gender, age, heredity are predisposing factors that cannot be changed, however, other factors can be changed, controlled and even prevented:

• High blood pressure
Drugs for spasms of cerebral vessels Aortic valve insufficiency