Show how to perform heart surgery. What types of heart surgeries are there?

Replacement heart valve
- Stages of the procedure and further rehabilitation
- Can there be complications after valve replacement?
- What is coronary artery bypass grafting?
- Why is surgery necessary?
Carrying out coronary artery bypass surgery
- Possible complications and care recommendations

Heart operations are performed only when necessary. The most common of these are heart valve replacement and coronary artery bypass grafting. The first is necessary if the patient is concerned about heart valve stenosis. It should be noted that heart operations pose a serious risk to the patient’s life; they are performed with maximum precision and care. Heart surgery sometimes leads to numerous problems and complications, to avoid this you can use alternative technique- valvuloplasty.

The procedure can replace replacement surgery and help normalize the activity of the heart muscles. During the process, a special balloon is inserted into the opening of the aortic valve, and at the end this balloon is inflated. It is worth considering: if a person is elderly, valvuloplasty does not have a long-term effect.

Heart Valve Replacement

To decide on such a procedure, it is necessary to establish a diagnosis.

The operation is carried out immediately or some time after the tests are completed.

In some situations, the results indicate that a person needs bypass surgery. Valve replacement - open procedure, which can be performed using minimally invasive surgery. It should be remembered that replacing a heart valve is a very complex procedure, despite this, it is performed very often.

Return to contents

Stages of the procedure and further rehabilitation

First you need to open your chest. Next, the doctor connects the patient to a special machine that provides artificial blood circulation. The device temporarily replaces the heart. Circulatory system The patient is connected to the device, after which the removal of the natural valve begins and its replacement is carried out. When this manipulation is completed, the device is turned off. In most cases, heart surgery goes well, but a scar forms on the organ.

After recovery from the anesthesia state, the breathing tube is removed from the lungs. If you need to remove excess liquid, such a tube should be left for a while. After 24 hours, you are allowed to drink water and liquids; you can walk only after two days. After such an operation, pain may be felt in the area chest, and on the fifth day the patient is completely discharged. If there is a risk of complications, the hospital stay must be extended by 6 days.

Return to contents

Can there be complications after valve replacement?

A person may encounter such problems different stages diseases. During the operation, there is a risk of heavy bleeding, in addition, difficulties with anesthesia may arise. Possible risk factors include internal bleeding, seizures, possible infections. A heart attack can also happen, but this is very rare. As for the greatest danger, it lies in the appearance of tamponade of the pericardial cavity. This phenomenon occurs when blood fills its cardiac sac. This causes serious disruptions in the functioning of the heart. Heart surgery can have an impact on general condition person. During the rehabilitation period, strict medical supervision. The need to visit a surgeon arises 3-4 weeks after the operation. It is important to maintain the general well-being of the patient. The optimal dose of physical activity should be prescribed, and it is important to adhere to the diet.

Return to contents

What is coronary artery bypass grafting?

Coronary artery bypass grafting is a type of surgery that restores blood flow in the arteries. The procedure is necessary to eliminate coronary disease hearts. The disease manifests itself when the lumen coronary vessels narrows, resulting in insufficient oxygen reaching the heart muscle. Coronary artery bypass surgery aims to prevent changes in the myocardium (heart muscle). After surgery, it should recover completely and contract better. It is necessary to restore the affected area of the muscle; for this, the following procedure is performed: everyday shunts are placed between the aorta and the coronary vessel that is affected. In this way, new coronary arteries are formed. They are designed to replace narrowed ones. After a shunt is placed, blood from the aorta flows through a healthy vessel, thanks to which the heart produces normal blood flow.

Return to contents

Why is surgery necessary?

This procedure will be required if the left coronary artery of the vessel that provides flow to the heart is affected. It is also needed if all coronary vessels are damaged. The procedure can be double, triple, single - it all depends on how many shunts the doctor needs. With coronary heart disease, a patient may need one shunt, in some cases two or three. Bypass surgery is a procedure that is often used for atherosclerosis of the heart vessels. This occurs when angioplasty cannot be performed. As a rule, the shunt can serve for a long time, its functional suitability is 12-14 years.

Return to contents

Carrying out coronary artery bypass grafting

The duration of the operation is 3-4 hours. The procedure requires maximum concentration and attention. The doctor needs to gain access to the heart, this requires cutting through the soft tissue, then opening the sternum and performing a stenotomy. During the operation, a procedure is performed that is necessary for temporary, it is called cardioplegia. The heart must be cooled with very cold water, then a special solution must be injected into the arteries. To attach the shunts, the aorta must be temporarily blocked. To do this, you need to clamp it and connect the heart-lung machine for 90 minutes. Plastic tubes should be placed in the right atrium. Next, the doctor carries out procedures that promote the flow of blood into the body.

What is conventional vascular bypass surgery? This method involves the implantation of special implants into the coronary vessels beyond the blockage, the end of the shunt is sutured to the aorta. To be able to use the internal mammary arteries, the procedure must take more time. This is due to the need to separate the arteries from the chest walls. At the end of the operation, the doctor carefully fastens the chest together using a special wire. With its help, the soft tissue incision is sutured, then drainage tubes are applied to remove residual blood.

Sometimes bleeding occurs after surgery and continues throughout the day. Installed drainage tubes should be removed 12-17 hours after the procedure. Upon completion of the operation, you must delete breathing tube. On the second day, the patient can get out of bed and move around. Heart rate recovery occurs in 25% of patients. As a rule, it lasts for five days. Regarding arrhythmia, this disease can be eliminated within 30 days after surgery, for this purpose they are used conservative methods therapy.

How are operations performed?

An operation is an intervention in human body with a violation of its integrity. Each disease requires an individual approach, which naturally affects the way in which the operation will be performed.

How heart surgery is done: preparation for surgery

Heart surgery (cardiac surgery) is one of the most difficult, dangerous and responsible types of surgical intervention.

Elective surgeries are usually performed in the morning. Therefore, in the evening (8-10 hours before) the patient is not allowed to eat or drink, and immediately before the operation a cleansing enema is given. This is necessary for the anesthesia to work as it should.

The place where operations are performed must be sterile. IN medical institutions For these purposes, special rooms are used - operating rooms, which regularly undergo sterilization treatment with quartz treatment and special antiseptics. Moreover, all medical staff The person who takes part in the operation washes before the procedure (you even have to rinse your mouth with an antiseptic solution), and also changes into special sterile clothes, and puts sterile gloves on your hands.

The patient is also put on shoe covers, a cap on his head, and the surgical field is treated with an antiseptic. If necessary, the patient's hair is shaved before surgery if it covers the surgical field. All these manipulations are necessary to avoid infection surgical wound bacteria or other dangerous active microorganisms.

Anesthesia or anesthesia

Anesthesia is a general anesthesia of the body with immersion in a medicated sleep. At surgical interventions General anesthesia is used on the heart, and in some cases, when performing endovideosurgical operations, spinal anesthesia is used, in which a puncture is made in spinal cord at lumbar level. Substances that cause pain relief can be administered in different ways - intravenously, through Airways(inhalation anesthesia), intramuscularly or combined.

Progress of open heart surgery

After the person goes into medicated sleep and stops feeling pain, the operation itself begins. The surgeon uses a scalpel to open the skin and soft tissue on the chest. Cardiac surgery may also require “opening” the chest. To do this, the ribs are sawed using special surgical instruments. Thus, doctors “get” to the organ being operated on and place special expanders on the wound, which provide better access to the heart. Junior medical personnel use suction to remove surgical field blood, and also cauterizes cut capillaries and vessels so that they do not bleed.

If necessary, the patient is connected to the device artificial heart, which will temporarily pump blood throughout the body while the organ being operated on is artificially suspended. Depending on what kind of heart surgery is performed (what damage is eliminated), appropriate manipulations are performed: this can be the replacement of blocked coronary arteries, the replacement of heart valves due to defects, bypass surgery of veins, or the replacement of an entire organ.

The surgeon and all staff are required to be extremely careful, as the patient’s life depends on it. It should also be added that constant monitoring is carried out during the operation. blood pressure and some other indicators that indicate the patient’s condition.

Endovideosurgery: stenting and angioplasty

Today, more and more often, heart surgery is performed not in an open way - with an incision in the chest, but with access through the femoral artery in the leg, under the control of an X-ray machine and a microscopic video camera. After preparing for operation, which is similar for all types of surgical interventions, and putting the patient into medicated sleep, access to the femoral artery is provided through an incision in the leg. A catheter and a probe with a video camera at the end are inserted into it, allowing access to the heart.

In cardiac surgery, this method is used to perform angioplasty with vascular stenting, which is necessary for blockage of the coronary vessels that supply blood to the heart itself. Special stands are installed in the narrowed vessels - cylindrical implants, which prevent the arteries from becoming clogged, which prevents the possibility of developing coronary disease.

After the main part of the operation is over, and the heart is on its own again functions, stitching of damaged nerves, vessels and tissues is performed. The wound is again treated with an antiseptic, the surgical field is closed, and soft tissue and skin are sutured with special threads. A medical bandage is applied to the external wound. After all these procedures are completed, the patient is removed from anesthesia.

Other types of operations

In addition to the abdominal operations described above, there are also operations performed in a less traumatic way:

Laparoscopy - performed using a laparoscope, which is inserted through 1-2 cm incisions in the skin. Most often used in gynecology, during gastric resection and other operations in abdominal cavity. You can read more about this
Laser surgery is performed using a special laser beam. Usually this method is used to perform operations on the eyes, when removing skin lesions, etc. You can read more about the method

If you have a few days or weeks to prepare for surgery, remember that this is the time when you need to take the best care of yourself. Try to: eat properly, get enough rest, walk more or do the exercises prescribed by your doctor, and don't smoke.

Proper nutrition

Try to eat healthy foods daily and regularly, even if you don't feel hungry. Your body needs to get enough vitamins and proteins. Proper nutrition can help you recover more easily and feel better after surgery.

Rest

Avoid getting tired at all costs before surgery. The better rested you are, the stronger your body will be. If friends or acquaintances call and want to visit you, answer that you would like to relax now. They will probably understand you and will not be offended.

Exercises

Go for a walk or do any other exercise your doctor recommends. This will help you relax and relieve muscle tension. It is very useful to walk on a flat surface. If you feel discomfort in your heart function, stop.

Smoking

Smoking harms your lungs and heart because:

promotes the occurrence of atherosclerosis,
increases blood pressure,
forces the heart to work more actively,
narrows coronary arteries and blood vessels,
increases the amount of mucus in the lungs.

Thus, before any operation it is better to abstain from smoking, at least for short term. It will become easier to breathe, and the heart will not be overloaded.
Of course, quitting smoking is not easy, especially when you are nervous and stressed before surgery. The tips below may be helpful to you.
Light a cigarette once a day. Ask your family and friends not to smoke in your presence. When the urge to smoke comes, do something else: go for a walk, come up with some work to keep your hands busy.

Learn to relax. Be alone: just sit quietly, listen to your breathing, read a book, listen to music. Reduce the dose of coffee, alcohol or other drinks that you tend to smoke while drinking.

Get up from the table quickly if you are used to lighting a cigarette immediately after eating. Distract yourself with something.

In the hospital

If you've been in a hospital before, you already know a thing or two about it. If you haven’t, then at first your health will be somewhat strange, because it’s not so easy to be sick. The tips below will help you get comfortable.

Disease history

You will be asked:

whether you have had other health problems or surgeries,
about recent symptoms
about allergies to food and medications,
about jaundice

Medicines

It's important to know the names of all the medications you use, how much you take, and when you take them, including cold medications, vitamins, and aspirin. Bring medications or a list of them to the hospital.

If you are taking anticoagulants (blood thinners), such as warfarin or aspirin, your doctor may tell you not to use them before surgery. He may also stop taking other medications or change them to others. Take only the medications prescribed by your doctor. If you use nitroglycerin, take it only when needed and tell your nurse or doctor.

Signature confirming your consent

Before any operation you will be asked to give written agreement for the treatment offered to you. If you are unable to sign yourself, a family member or someone you designate must do so.

Some hospitals require such written consent immediately upon admission for treatment. But most often, a signature on a special form confirms consent to invasive procedures, anesthesia and surgery. The form explains what products will be used, the possible risks and the expected results. If the explanations are not clear enough to you, ask for more detailed information.

The medical staff will explain how to behave correctly to avoid lung problems after surgery. You will be instructed on how to cough, taught deep breathing techniques, and shown how to use a pillow pressed to your chest to help you breathe and cough correctly; They will teach you some exercises that need to be performed in the recovery room, as well as proper breathing using not only the chest muscles, but also the diaphragm. If you are a smoker, it is very important to stop smoking as soon as possible before surgery. Every day and even an hour before anesthesia that you spend without a cigarette will reduce the likelihood of lung problems that sometimes arise after surgery.

The nurse will come to explain the various instruments, devices, and other equipment you will need after surgery. Feel free to say whatever you think is necessary, this will significantly improve your care.

Ask your nurse or staff member to explain:

what is the schedule for taking food and medications,
how to use the bedside alarm,
how the bed is designed,
at what hours are patients allowed to visit?

If your nurse knows the following details, it will be easier for her to care for you:

The anesthesiologist will visit you, talk about preoperative medications and general anesthesia, artificial circulation, possible problems about the heart's activity and about the medications you will be given in the operating room. Before the operation, you will receive so-called premedication in the form of tablets and injections.

If your surgery is scheduled for the next morning, you will not be allowed to drink or eat after midnight. If it is in the afternoon, you may be allowed to eat some liquid food early in the morning on the day of surgery.

In the evening or morning you will be offered to wash with antibacterial soap. They will use it to treat areas of the body where incisions are planned and shave the hair. If you are undergoing coronary artery bypass surgery, the hair from your legs is shaved - from the feet to the groin; if surgery is performed on heart valves, the lower abdomen is shaved, and, if necessary, groin area. Antibacterial soap reduces the number of bacteria normally found on the skin, thereby reducing the risk of infection. Before going to the operating room, you will be given medications prescribed by the anesthesiologist. These medications will help you relax and prevent nausea. Don't be alarmed if you feel drowsy and possibly have a dry mouth after taking them.

Finally you are in the operating room. Before the operation begins, doctors will connect special tubes (catheters) to you. This is necessary in order to constantly monitor your vital signs (heart rate and rhythm, blood pressure level and pressure inside the cavities of the heart) during and after the operation.

Catheters are threaded into arteries and veins after you fall asleep. Even though several of these tubes are connected in the neck area, you will be able to move your head. The following tubes, catheters and wires are commonly used:

An arterial catheter is usually inserted into the artery of the hand and serves for continuous monitoring of blood pressure and to obtain blood samples for laboratory testing.

The Swan-Hans catheter is most often inserted through a vein in the neck. When connected to the corresponding device, it receives information about the pressure in the cavities of the heart, cardiac output, and peripheral resistance; Based on these indicators, the required amount of fluid is determined and introduced into the body.

One or two catheters are inserted into the veins of the neck and arms. They are used to administer additional fluids and medications both during and after surgery.
All catheters are inserted by puncture; in rare cases, a small incision is required.

The anesthesiologist will insert a flexible plastic tube (endotracheal tube) through the mouth, behind the glottis, and into the trachea. A breathing apparatus is connected through this tube,
which will support your breathing during and after surgery.

A gastric tube is inserted through the nose into the stomach. The contents of the stomach are drained through it. The probe is removed after surgery along with the breathing tube.

The foley catheter is inserted into bladder. Through it, urine is drained into a plastic bag. This allows nurses to measure the amount of urine excreted by the kidneys, and the doctor to determine whether the heart is working well during and after surgery. A catheter inserted into the bladder sometimes causes the urge to urinate.

Three to five insulated wires to monitor the heart rate and rhythm will be attached using adhesive tapes to the chest. These
the wires lead to a special monitor that continuously shows your electrocardiogram.

After surgery is completed, wires are sometimes connected to the heart to temporarily stimulate the heart. These wires are fixed with threads on the skin and through
several days are deleted.

One or two tubes will be temporarily left in the chest. They are connected to a plastic container bag or other transparent container with filters. Blood from the chest or pericardium will drain here. Don't be surprised if doctors return this blood to your body again. When the operation is completed, the sternum ( sternum) is securely stitched with stainless steel wire.

What awaits you after heart surgery? What loads are permissible and when? How will the return to normal life take place? What should you pay attention to in the hospital and at home? When can you return to a full sex life, and when can you wash your car yourself? What and when can you eat and drink? What medications should I take?

All answers are in this article.

After heart surgery, you may feel like you've been given another chance—a new lease on life. You may think that you will be able to make the most of your “new life” and make the most of the results of the operation. If you have had coronary artery bypass surgery, it is important to consider lifestyle changes, such as losing 5 kilograms or starting regular exercise. This should be taken seriously and you should talk to your doctor about your risk factors. There are books about health and cardiovascular diseases, they should be guides to your new life. The days ahead will not always be easy. But you must move forward steadily towards recuperation and recovery.

In the hospital

In the inpatient department, your activity will increase every day. In addition to sitting on a chair, walking around the ward and in the hall will be added. Deep breathing to clear the lungs and exercises for the arms and legs should continue.

Your doctor may recommend wearing elastic stockings or bandages. They help blood return from the legs to the heart, thereby reducing swelling of the legs and feet. If for coronary artery bypass grafting was used femoral vein, slight swelling of the legs during the recovery period is quite normal. Raising your leg, especially when you are sitting, helps lymphatic and venous blood flow and reduces swelling. When lying down, you should take off your elastic stockings 2-3 times for 20-30 minutes.
If you get tired easily, taking frequent breaks from activity is part of recovery. Feel free to remind your family and friends to keep visits short.
Muscle pain and brief pain or itching in the wound area may occur. Laughter or blowing your nose can cause short-term but noticeable discomfort. Rest assured - your sternum is sewn very securely. Pressing a pillow to your chest can help reduce this discomfort; use it when you cough. Don't hesitate to ask for painkillers when you need them.

You may sweat at night, even though your temperature will be normal. These night sweats are normal for up to two weeks after surgery.
Possible pericarditis - inflammation of the pericardial sac. You may feel pain in your chest, shoulders, or neck. Typically, your doctor will prescribe you aspirin or indomethacin for treatment.

In some patients it is impaired heartbeat. If this happens, you will have to take medication for a while until the rhythm is restored.

Patients after open heart surgery often experience mood swings. You may be in a joyful mood immediately after surgery, but become sad and irritable during the recovery period. A sad mood and outbursts of irritability cause anxiety in patients and loved ones. If emotions become a problem for you, talk to your nurse or doctor about it. It has been established that mood swings are a normal reaction, even if they continue for several weeks after discharge. Sometimes patients complain of changes in mental activity - it is harder for them to concentrate, their memory weakens, and their attention is distracted. Don't worry - these are temporary changes and should disappear within a couple of weeks.

At home. What to expect?

You are usually discharged from the hospital on the 10-12th day after surgery. If you live more than an hour's drive from the hospital, take breaks every hour while traveling and get out of the car to stretch your legs. Prolonged sitting impairs blood circulation.

Although your recovery in the hospital was probably fairly rapid, your recovery at home will be slower. It usually takes 2-3 months to fully return to normal activity. The first few weeks at home can be challenging for your family too. Your loved ones are not used to the fact that you are “sick”; they have become impatient, and your mood may fluctuate. Everyone needs to try to make this period go as smoothly as possible. It will be much easier to cope with the situation if you and your family can openly, without reproaches or showdowns, talk about all your needs, and join forces to overcome critical moments.

Meetings with a doctor

It is necessary that you be observed by your regular attending physician (general practitioner or cardiologist). Perhaps the surgeon will also want to meet with you after discharge after one or two weeks. Your doctor will prescribe a diet and medications and determine the permissible loads. If you have any questions regarding the healing of post-surgical wounds, please contact your surgeon. Before you leave, find out where to go in any possible situations. See your doctor immediately after discharge.

Diet

Because you may initially experience a loss of appetite, and good food It has important While your wounds are healing, you may be discharged home on an ad libitum diet. After 1-2 months, you will most likely be advised to eat a diet low in fat, cholesterol, sugar or salt. If you are overweight, calories will be limited. For most heart diseases, a quality diet limits cholesterol, animal fats, and foods containing high content Sahara. It is advisable to eat foods high in carbohydrates (vegetables, fruits, sprouted grains), fiber and healthy vegetable oil.

Anemia

Anemia (anemia) is a common condition after any surgical procedure. It can be eliminated, at least partially, by eating foods rich in iron, such as spinach, raisins or lean red meat (the latter in moderation). Your doctor may recommend taking iron tablets. This medicine can sometimes irritate your stomach, so it's best to take it with food. Please note that this may discolor the stool. dark color and cause constipation. Eat more fresh vegetables and fruits and you will avoid constipation. But if constipation becomes persistent, ask your doctor to help with medications.

Wound and muscle pain

Discomfort due to pain in the postoperative wound and muscles may persist for some time. Sometimes pain-relieving ointments help if you massage the muscles with them. The ointment should not be applied to healing wounds. If you feel clicking movements of the sternum, notify your surgeon. Itching in the area of a healing wound is caused by hair regrowth. If your doctor allows it, a moisturizing lotion will help in this situation.

Contact your doctor if you notice the following symptoms of infection:

temperature above 38°C (or less, but lasting more than a week),

wetting or discharge of fluid from postoperative wounds, persistent or new appearance of swelling, redness in the area of the postoperative wound.

Shower

If the wounds are healing, there are no open spots or getting wet, you can decide to shower 1-2 weeks after the operation. Use plain warm soapy water to clean the wounds. Avoid bubble baths that are very hot and very cold water. When you wash for the first time, it is advisable to sit on a chair while showering. Using a gentle touch (not wiping, but blotting), dry surgical wounds with a soft towel. For a couple of weeks, try to have someone nearby when you bathe or shower.

General guidelines for home practice

Gradually increase your activity every day, week and month. Listen to what your body is saying; rest if you are tired or have shortness of breath or feel chest pain. Discuss the instructions with your doctor and consider any comments or changes made.

If prescribed, continue to wear elastic stockings, but remove them at night.

Schedule rest periods throughout the day and get a good night's sleep.

If you are having trouble sleeping, it may be due to your inability to get comfortable in bed. Taking a painkiller pill at night will help you rest.

Continue training your arms.

Shower if the wounds are healing normally and there are no weeping or open areas on the wound. Avoid very cold and very hot water.

First week at home

Walk on level ground 2-3 times a day. Start at the same time and distance as you did during your last days in the hospital. Increase your distance and time, even if you have to stop a couple of times. short rest. You can do 150-300 meters.

Take these walks at the most convenient time of day (this also depends on the weather), but always before meals.

Choose a quiet, non-tiring activity: draw, read, play cards or do crossword puzzles. Active mental activity beneficial for you. Try walking up and down the stairs, but don't do it frequently.

Travel with someone for a short distance in a car.

Second week at home

Lift and carry light objects (less than 5 kg) for short distances. Distribute the weight evenly on both hands.

Gradually return to sexual activity.

Get busy light homemade work: wipe dust, set the table, wash dishes or help with cooking while sitting.

Increase your walking to 600-700 meters.

Third week at home

Do household chores and yard work, but avoid strain and long periods of bending or working with your arms raised.

Start walking longer distances - up to 800-900 meters.

Accompany others on short shopping trips by car.

Fourth week at home

Gradually increase your walks to 1 km per day.

Lift items up to 7 kg. Load both hands equally.

If your doctor allows, start driving for short distances yourself.

Do daily activities such as sweeping, briefly vacuuming, washing the car, cooking.

Fifth - eighth week at home

At the end of the sixth week, the sternum should have healed. Continue to continually increase your activity. Your doctor will order a stress test approximately six to eight weeks after surgery. This test will establish adaptation to stress and will serve as a basis for determining the extent of the increase in activity. If there are no contraindications and your doctor agrees, you can:

Continue to increase your walking distance and speed.

Lift things up to 10 kg. Load both hands equally.

Play tennis, swim. Tackle the lawn, weed, and shovel in the garden.

Move furniture (light objects), drive a car over longer distances.

Return to work (part-time) if it does not involve heavy physical labor.

At the end of the second month, you will probably be able to do everything you did before the operation.

If you were working before surgery but have not returned yet, now is the time to do so. Of course, it all depends on your physical condition and type of work. If the work is sedentary, you can return to it faster than heavy physical work. A second stress test may be performed three months after surgery.

Sex after surgery

Patients often wonder how the surgery will affect sexual relations and are reassured to learn that most people gradually return to their previous sexual activity. It is recommended to start small - hugs, kisses, touches. Transition to a full-fledged sex life only when you stop being afraid of physical discomfort.

Sexual intercourse is possible 2-3 weeks after surgery, when you are able to walk 300 meters at an average speed or climb one floor of stairs without chest pain, shortness of breath or weakness. The heart rate and energy expenditure during these activities are comparable to the energy expenditure during sexual intercourse. Certain positions (such as on your side) may be more comfortable at first (until the wounds and sternum are completely healed). It is important to rest well and be in a comfortable position. For sexual activity, it is recommended to avoid the following situations:

Being overly tired or excited;

Have sex after drinking more than 50-100 grams of strong alcoholic drink;

Overload with food during the last 2 hours before the act;

Stop if chest pain occurs. Some shortness of breath is normal during sexual intercourse.

Taking medications

Many patients require drug treatment after surgery. Take medications only as prescribed by your doctor and never stop taking them without consulting your doctor. If you forget to take a pill today, don't take two at once tomorrow. It is worth keeping a medication schedule and marking each dose on it. You should know the following about each of the prescribed medications: name of the drug, purpose of action, dose, when and how to take it, possible side effects.
Keep each medicine in its container and out of the reach of children. Do not share medications with other people because they may be harmful to them. It is recommended that you carry a list of your medications with you in your wallet at all times. This will come in handy if you go to a new doctor, get injured in an accident, or pass out outside your home.

Medicines to prevent blood clots (blood clots)

Antiplatelet agents

These bad cholesterol-lowering pills can reduce triglycerides and increase good cholesterol. Should be taken after dinner.

Eat fruits and vegetables more often. Try to always have them at hand (in the car, at your desk).

Eat lettuce, tomatoes, cucumbers and other vegetables with every meal.

Try adding one new vegetable or fruit each week.

For breakfast, eat porridge with bran (for example, oatmeal) or dry breakfast (muesli, cereal).

At least twice a week, eat sea fish for lunch.

Use vegetable oil, preferably olive.

Instead of ice cream, eat frozen kefir yogurt or juice.

For salads, use diet dressings and diet mayonnaise.

Instead of salt, use garlic, herbal or vegetable spices.

Watch your weight. If yours is high, try to reduce it, but no more than 500-700 grams per week.

More movement!

Monitor your cholesterol levels.

Only positive emotions!

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

The need for a postoperative bandage

Wound healing after abdominal surgery - Long procces associated with features thoracic spine.

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

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

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

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

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

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

Why is fixation needed after surgery?

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

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

cutting staples;
sternal discrepancies;
the emergence of a strong pain syndrome.

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

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

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

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

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

By the way, now you can get mine for free e-books and courses to help you improve your health and well-being.

pomoshnik

Get lessons from a course on the treatment of osteochondrosis for FREE!

Chest pain after CABG surgery

Coronary artery bypass grafting (CABG) is performed with an incision in the sternum. It is then secured with metal staples, since the massive bone of the sternum is constantly subjected to heavy loads. Regeneration of the skin above it occurs within several weeks. The sternum bone does not fuse, but is overgrown with soft tissue in 4-6 months. After CABG, it is necessary to wear corsets (medical bandages) to prevent cutting through the staples and divergence of the sternum.

There will be pain in the chest area for 4-6 months, and it will go into your arms. During this period, you need to take painkillers prescribed by your doctor, do a massage and gradually perform relaxation exercises. To rule out angina, a treadmill test or bicycle ergometry is performed. 2-3 months after CABG, the patency of new bypass tracts and the level of oxygen supply to the myocardium are assessed using a VEM stress test or using Treadmil.

If there is no pain and the ECG shows no changes, then the patient is fine. However, smoking, eating fatty pork and other fatty foods, especially fried foods, stopping taking medications is PROHIBITED. Otherwise, new plaques will begin to grow, and a new operation will be needed.

Contact your doctor immediately if:

when moving, clicks are heard in the sternum;
signs of infection appeared: constant severe pain and high fever;
fistulas have appeared in the suture area, and liquid exudate is released;
swelling does not go away or a new one has appeared;
The skin around the incision became red.

How long does it take for the sternum to heal after heart surgery?

Our institution occupies one of the leading positions in the implantation of seamless prostheses aortic valve PERCEVAL S in the Russian Federation.

1 vacancy is open - Doctor, with a valid certificate in the specialty "Anesthesiology-Resuscitation".

With any work experience, with Moscow registration, age up to 40 years.

1 vacancy is open - Nurse, with a valid certificate in the specialty (if possible), to work in a cardiac surgery operating room.

Work experience is not required, with Moscow registration, age up to 40 years.

Send your resume to e-mail to the address: or by phone

In the fall of 2012, commissioning work in the reconstructed operating block of the hospital was finally completed.

Equipped with the latest technology, the operating unit has rightfully become the most high-tech department in our country. During the reconstruction process, such well-known manufacturers of medical equipment as Draeger, BeeBrown, Mortara, Storz, and others introduced their achievements.

Two of the four operating rooms are equipped with OR-1 equipment, where it has become possible to perform a full range of open, endoscopic and hybrid operations on the thoracic and abdominal organs. It has also become possible to broadcast the progress of operations (from different fields of view) and receive instant interactive consultations from any specialists in the hospital, and from the World Wide Web.

And at the end of December, the Center’s operating rooms began operating at full capacity. cardiovascular surgery under the guidance of Professor I.A. Borisov.

Currently, another step has been taken towards combining into a single whole a complex of achievements of the global medical industry and science, focused on restoring the health of patients.

question about sternum

How long does it take to grow together and what does it feel like? This section is specially for beginners who have not figured out the structure of the forum - write here all the questions that you don’t know where to place - someone will definitely answer. Question from a newbie

You are viewing the mobile version of the “Kind Heart” forum.

If you do not use a mobile device, I highly recommend switching to full version forum:

Forum for parents of children and adults with congenital defect hearts"

question about sternum

How long does it take to grow together and what does it feel like?

How did your stitch (heal quickly?) not become inflamed?

For better fusion of the sternum in adults, a bandage should be worn.

Non-union of the sternum. Osteosynthesis of the sternum

Non-union of the sternum is far from a rare and very unpleasant phenomenon that arises as a consequence of previously performed open operations on the heart, lungs, mediastinal organs. The imperfection of methods and systems for fastening the dissected sternum leads to the fact that the patient experiences constant pain in the chest area, is limited in exercise and essentially becomes disabled, although he has been cured of problems with internal organs. Vladimir Aleksandrovich Kuzmichev, thoracic surgeon, Ph.D., told us about the causes of sternal nonunion, the features and methods of treating this consequence.

Corr.: Vladimir Aleksandrovich, what is sternal nonunion and why does it occur?

V.A.: Sternal nonunion is a disease that is a consequence of the development of cardiovascular surgery. The fact is that heart surgeries, especially coronary artery bypass grafting (CABG), are being done more and more. And Russia even lags behind many countries in terms of the number of their implementation. That's why total heart surgeries on the one hand, and, on the other hand, an increase in operations in older patients leads to an increase in the number of complications from the sternum, which are quite unpleasant. Indeed, in this case the patient is cured of heart disease, but at the same time he cannot be called a healthy person. Even if it is cured of the inflammatory process, it still does not become complete, since the integrity of the sternum is very important for ensuring the stability of the spine, normal breathing, and arm movement.

And the cause of nonunion of the sternum is precisely all those associated factors that affect the healing process. And among them is a violation of bone metabolism in old age. In addition, with coronary artery bypass grafting, the internal mammary artery, which is also the source of blood supply to the sternum itself, is used to polarize the myocardium. Therefore, in addition to the fact that the patient may have impaired healing properties, the blood supply may also be impaired, which complicates the process of normal healing of the sternum.

Corr.: So, we can say that nonunion of the sternum is more typical for older people?

V.A.: It can happen to everyone, but it still happens with greater frequency and probability in elderly, obese patients, people suffering from diabetes mellitus, osteoporosis, as well as in the presence of lung diseases, since in this case the severity of the cough is greater and, as a result, the chest stretches more in the postoperative period. The greater the load, the more likely that the seam with which we tied it together will not hold up.

Corr.: Do I understand correctly that non-union of the sternum is still a complication after surgery, and not a consequence of poor-quality fastening of the edges of the sternum or a poorly performed operation?

V.A.: Yes, this is exactly a complication after the operation. Because they sew everyone the same way.

Corr.: Are there any statistics on these operations? How often are they held in Russia?

V.A.: You know, it’s very difficult to say here, because no one gives real statistics. Moreover, very often, when you ask cardiac surgeons how often this happens, they say that it is extremely rare. But in reality there are many of these patients. According to publications from European countries, where the level of medicine is no worse than in Russia, the number of these complications can reach 1-2% of operations. This is quite a lot if you imagine how many operations are performed, and this is, in general, tens of thousands.

Corr.: Vladimir Alexandrovich, what is the situation with this problem abroad?

V.A.: Large funds are attracted abroad and, accordingly, it is possible to use methods with a lower probability of developing complications. Traditionally, the sternum is simply sutured with wire. A more expensive method, but currently available in Russia, is the use of special nitinol retainers, which, however, you need to know how to use and be able to select the correct sizes. These fixatives certainly improve healing capabilities. It is interesting that these nitinol fixatives are manufactured by a Russian company, while in Europe they are known under the Italian brand. An Italian company completely bought the right to sell these clamps, and there they are sold as Italian ones, and much more expensive than ours.

Corr.: Are these clamps installed for life?

V.A.: Yes, they, like the wire, remain for life and are removed only if any complications arise.

Corr.: Vladimir Aleksandrovich, what methods and systems do you use to reduce and secure the sternum?

V.A.: In my opinion, the most effective method of performing osteosynthesis of a dissected sternum is the use of the Swiss TFSM design (a set of surgical instruments and plates from Synthes). Its main advantage is that fixation is carried out with special screws not only on the sternum, but also on the ribs. The fact is that after a sternotomy, especially if internal mammary vessels were used, a year after the operation, when the question of restoring the sternum arises, the sternum tissue itself can be very poorly expressed due to osteoporosis. Also, sometimes when performing a sternotomy, especially if there was a narrow original sternum, the surgeon may make a mistake and make the incision line so that it actually runs along the ribs, and not along the middle of the sternum. This often happens on a narrow chest. Then there are very few areas left that can be fixed, so in this case, osteosynthesis using the Swiss system is the only way to restore something.

Another advantage of this system is that it has a connector in the middle so the staple can be removed if there is a need to re-cut the sternum. This is potentially possible. In general, the Synthes TFSM system is intended for sternal osteosynthesis, but not necessarily for reoperations. It can also be used when primary operations on the heart, when the surgeon assumes that there will be problems with healing, under accompanying circumstances.

Practice shows that, if necessary, it is better to perform both operations at once: for example, perform heart surgery and reduce the sternum with plates. At the same time, it is not necessary to install Swiss plates, as they are expensive. More often simpler plates are used, but it is still much more reliable than wire. For example, the nitinol fixative method we mentioned. There are clinics that have completely abandoned wires and use only nitinol fixatives.

Corr.: I see. Tell me, what is the cost of the Swiss Synthes TFSM system?

V.A.: In general, all osteosynthesis systems are very expensive. They can cost about dollars. But, of course, it is not used for all cases, but primarily for recovery.

Corr.: Tell me, is this operation included in compulsory medical insurance?

V.A.: The operation itself is part of a high-tech medical care, but the fact is that the cost of the plate itself is not covered by any types state aid, so the solution here is either to look for an opportunity to purchase a plate through a budget, or to buy a plate yourself.

Corr.: How complicated is this operation?

V.A.: This operation requires a certain understanding of the details, and it is also complicated because we are operating on an already operated person, that is, it takes more time to separate the scars, isolate the sternum from the heart and achieve a situation where we can bring and match the sternum. The actual application of the plate to the sternum is not very difficult, but it does require experience and understanding, because the plates must be bent correctly and the screws that secure the plates must be correctly adjusted.

Corr.: How long does rehabilitation take after such a complex operation?

V.A.: Recovery is quite fast, since the fixation is very reliable. The very next day the patient gets up and walks. The only thing is, of course, we recommend limiting physical activity for a month, and after a month, dosed exercises agreed with your doctor.

V.A.: I think it is not entirely correct to interfere in this process, because in principle, an operation with dissection of the sternum is a very common intervention, this is the main access for cardiac surgeons. It's all worked out. We do not specifically touch upon the issues of healing of the sternum after sternotomy; our work begins when the patient has a divergence of the sternum. Our patients are those people who have undergone cardiac surgery and their sternum has not fused. When people have waited some time to recover, but the sternum has not fused and they begin to look for a way out, they end up with thoracic surgeons.

Corr.: How soon can a person discover this problem?

V.A.: As a rule, this becomes noticeable within a month. It's easy to diagnose. But, unfortunately, cardiac surgeons around the world often do not deal with this problem themselves. This is due to the fact that this is considered a somewhat “dirtier” job in medical terms, because cardiac surgery is an extremely clean job, the appearance of such patients in the cardiac surgery department threatens its closure. In addition, almost all cardiac surgery departments operate on the basis high-tech quotas, and this operation is not included in these quotas. Therefore, even from an organizational and administrative point of view, it is difficult to provide assistance to these patients.

Vladimir Alexandrovich, thank you very much for your story! We wish you success in your work!

What can a patient expect after coronary artery bypass surgery?

Typically, patients remain on a ventilator for some time after CABG. After restoration of independent breathing, it is necessary to combat congestion in the lungs; a rubber toy is well suited for this, which the patient inflates once a day, thereby ventilating and straightening the lungs.

The next problem is the problem of large wounds of the sternum and legs; their treatment and dressings are necessary. After 7-14 days, the skin wounds heal and the patient is allowed to take a shower.

Now it must be said that during the operation the sternum is dissected, which is then fastened with metal sutures, since it is a very massive bone and bears a large load on it. The skin over the sternum heals in a few weeks, but the bone itself takes at least 4-6 months. For her more fast healing, it is necessary to provide her with peace, for this they use special medical bandages. Of course, you can do it without a corset, but in my memory there are several patients whose sutures have cut through and the sternum has separated, and of course it was not possible without a repeat operation, even if not such a major one. Therefore, it is better to purchase and use a chest bandage.

Due to blood loss during surgery, all patients develop anemia, it does not require special treatment, eat boiled beef, liver, and as a rule, in a month the hemoglobin level will return to normal.

The next stage of rehabilitation is an increase motor mode. Despite the pain of the wounds and weakness, coronary artery bypass grafting was not performed in order to make you bedridden patient, but on the contrary, so that you can perform all the loads that are performed healthy people. And now that angina pectoris is no longer a concern, discuss with your doctor how you need to increase the pace. Usually they start by walking along the corridor up to 1000 meters per day. and gradually build up, over time you will be able to walk as much as you want. Just don’t need to do everything here on character and don’t need fanaticism - everything should be gradual.

It’s not a bad idea to go to a sanatorium after being discharged from the hospital for final recovery.

2-3 months after surgery, it is recommended to conduct a VEM or Treadmill stress test in order to assess how passable the new bypass paths are and how well the myocardium is supplied with oxygen. If there is no pain or changes in the ECG during the test, then everything is fine.

But keep in mind, this does not mean that you can now start smoking again, overeat on fatty pork and stop taking all medications. No one is immune from the growth of new plaques, and in this case the chances that you will be accepted for repeat surgery not great. IN best case scenario New narrowings can be stented. But your task is to prevent this from happening!

CARDIOVASCULAR DISEASES

Reminder for patients undergoing open heart surgery

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

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

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

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

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

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

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

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

If they become 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.

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

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

name of medicine

medication doses

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

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

when side effects medications, such as stomach pain, vomiting, diarrhea, rash, etc., should be reported to your doctor.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Try to rest at noon.

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

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

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

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

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

After heart surgery

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

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

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

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

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

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

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

How are indications for surgery selected?

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

The success of other methods is unlikely if:

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

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

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

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

Group I includes patients resistant to drug therapy or having a significant ischemic area of the myocardium:

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

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

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

TO III group include patients for whom coronary artery bypass grafting is performed as a concomitant operation with a more significant intervention:

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

International Heart Associations recommend putting clinical signs and indications first and then considering anatomical changes. It is estimated that the risk fatal outcome from a probable heart attack in a patient significantly exceeds the mortality rate during and after surgery.

When is surgery contraindicated?

Cardiac surgeons consider any contraindications relative, since additional vascularization of the myocardium cannot harm a patient with any disease. However, one should take into account the probable risk of death, which increases sharply, and inform the patient about it.

Classic general contraindications For any operations, the following are considered to be available to the patient:

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

The risk of mortality increases sharply with:

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

What is the additional bypass vessel made of?

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

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

The radial artery and saphenous vein can be removed:

openly through skin incisions;
using endoscopic technology.

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

What is the preparation for the operation?

Upcoming CABG requires a thorough examination of the patient. TO standard analyzes relate:

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

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

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

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

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

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

Pain relief method

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

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

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

IN specialized centers equipment is used for monitoring and control of:

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

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

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

How is the operation performed?

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

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

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

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

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

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

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

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

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

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

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

How does the postoperative period proceed?

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

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

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

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

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

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

Discharge from the hospital is carried out after a week.

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

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

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

How likely are complications?

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

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

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

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

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

What complications are possible after surgery?

Most frequent complications coronary artery bypass grafting are considered:

Less common ones include:

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

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