Coronary bypass surgery without opening the chest. How and when coronary artery bypass surgery is performed Heart surgery without opening the chest

May God grant everyone to live long life so that his heart would never be touched by a surgeon’s scalpel. However, cardiac surgery cannot always be replaced by therapy.

In what cases is surgery necessary?

1. When conservative therapy does not give the desired result.
2. When, despite all the treatment, the patient’s condition continues to deteriorate.
3. When severe birth defects heart, severe arrhythmia, cardiomyopathy.

By urgency cardiac surgery There are emergency and planned.

1. Emergency calls are carried out when a person’s life is in serious danger. This happens when a myocardial infarction occurs, a blood clot suddenly breaks off, or aortic dissection begins. They do not tolerate delays in surgery when the heart is wounded. The consequences of delay are severe.
2. Planned ones are carried out in accordance with the developed plan for correcting the patient’s health. The date of the operation may be postponed depending on the circumstances. For example: with a cold, to avoid additional stress on the heart, or when the pressure suddenly drops.

Surgical interventions vary in technique. There are the following types of heart surgeries:

• with autopsy chest;
• without opening the chest.

Operations with opening of the chest

This surgical intervention is used in particularly severe cases when complete accessibility of the heart is required during surgery.

The chest is opened for the following pathologies:

• tetralogy of Fallot (the so-called congenital heart defect with four serious anatomical disorders);
• serious anomalies of intracardiac septa, valves, aorta and coronary arteries;
• heart tumors.

The patient arrives at the hospital one day before the operation. He undergoes an examination and gives written consent. You will definitely have to wash with antibacterial soap and shave your hair. Where is body hair shaved? The hair will be shaved at the site of the intended incision. If you have coronary artery bypass surgery, you will have to shave your legs and groin. If you have a heart valve replacement, you will need to shave the hair in your lower abdomen and groin area.

Surgery is performed under general anesthesia. To gain access to the heart, the surgeon opens the chest of the person being operated on. The patient is connected to an artificial lung ventilation device, the heart is stopped for a while and surgical manipulations are performed on the organ.

How long the operation lasts depends on the severity of the pathology. On average - several hours.

Open heart surgery has two advantages.

1. The surgeon has full access to the patient's heart.
2. Such surgery is possible without state-of-the-art medical equipment.

However, there are also significant drawbacks.

1. Surgical manipulations with the heart last several hours, which leads to fatigue of the operating team, and during the operation there is a higher probability of making an erroneous action.
2. Opening the chest is fraught with various injuries.
3. A noticeable scar remains after heart surgery.
4. Various complications cannot be excluded:

• myocardial infarction,
• thromboembolism,
• bleeding,
• infections;
• coma after surgery.

1. Long-term recovery with significant restrictions in the patient's activities is required.

In most cases, when surgery is performed by opening the chest, disability is given after heart surgery, as after a heart attack.

What operations and for what pathologies are performed on an open heart?

Pathologies of the coronary arteries

Coronary bypass surgery is performed in case of serious damage to the coronary arteries by atherosclerosis, leading to a severe form coronary disease hearts. The essence of bypass surgery is to create a bypass path for blood flow to the heart using a shunt, for which an artery or vein taken from the patient is used. For example: mammary coronary artery bypass grafting (MCBG) is performed using the internal mammary artery.

Heart valve defects

These days, valves made from the patient's biological material are used to replace damaged valves.

1. The Ross operation involves the use of the patient's own pulmonary artery with a valve apparatus to replace the pathologically altered aortic valve. An implant is installed instead of the pulmonary valve. Eliminates complications associated with rejection of a valve made of foreign material. It is done for both adults and children.
2. The Ozaki procedure involves using the patient's own tissue. Only in this case, the aortic valve is replaced with a valve made from the patient's pericardium. Complications with valve rejection are not observed for the same reason.

Heart surgery is used only in cases where other methods of treating cardiology have exhausted themselves and are no longer able to improve the patient’s condition. Used as a last resort, surgery can save a patient who is on the brink of death, but the risks of failure are usually very high. In recent decades, cardiac surgery has moved forward by leaps and bounds, but cardiac surgery still remains one of the most difficult treatment methods. Their implementation can only be entrusted to a professional surgeon, but even in this case the patient must be prepared for the subsequent problems and complications. Until the condition worsens and death occurs.

Operation methods

1. closed operations. This involves surgical intervention using special equipment. The heart itself is not directly affected during such operations; all manipulations are performed with large arteries in the pericardial zone. This method is used as a primary method and, as a rule, subsequently more serious methods of influencing the heart muscle are used.
2. Minimally invasive operations. In their process, the patient makes a small incision in the chest area, which allows surgeons to gain access to the pericardial region. Most often, this method is used when installing pacemakers and allows successful operations using robots. The so-called minimally invasive technique combines cardiac surgery with coronary angiography.
3. Open heart surgery. They involve an extensive opening of the chest of the person being operated on and connecting him to a heart-lung machine (ACB). During the operation, the patient's heart is stopped for some time. This is done so that specialists can quickly manipulate the heart muscle at rest. Using the heart-lung system, surgeons today are able to perform operations of any complexity. Open cardiac surgery procedures last several hours and are considered one of the most painstaking and complex.
4. Open beating heart surgery. They are used in cases where the patient’s health does not allow starting the process of artificial circulation using artificial blood circulation. With certain pathologies, a person’s lungs begin to swell during cardiac arrest and the likelihood of a stroke increases. To avoid this, specialists perform surgery on the beating heart, limiting blood flow only in the area of ​​the coronary artery. The risks of an unfavorable outcome for such procedures are much higher, but they save the lives of patients whose circulatory system is in a state of disrepair.

Indications

The reasons why cardiologists can make a clear decision to perform cardiac surgery are:

• ischemic disease and its consequences (heart attack);
• congenital or acquired heart disease;
• heart rhythm disturbance (chronic).

Surgery is most often used in cases with progressive coronary heart disease. The accumulation of cholesterol on the walls of the pericardial vessels leads to a decrease in blood permeability in this area. At a certain point, a detached cholesterol plaque can clog a narrow space, leading to myocardial infarction. In this case, surgery is the only way to save the patient’s life, but, unfortunately, the chances of its success are not so great.

After a heart attack, a patient may develop a cardiac aneurysm - a sac-like formation on the heart muscle. Over time, it begins to accumulate excess circulating blood, which leads to a lack of blood supply in certain organs and tissues. Blood clots formed in such a “bag” can enter the artery and lead to a stroke. This pathology can only be combated surgically: no drugs will be able to help the patient.

Types of operations

1. Coronary artery bypass surgery. It is used for coronary heart disease and involves connecting the aorta and coronary vessel with a special shunt(s). This promotes the formation of a healthy artery, which can subsequently supply the myocardium with oxygen, bypassing the affected area. Depending on the stage of the disease, specialists may use one or more shunts (maximum three). During the operation, the patient is connected to a heart-lung machine and his heart is stopped. After opening the chest, surgeons manipulate the shunts, temporarily blocking the aorta and cooling the area of ​​the heart. cold water. The procedure usually lasts three to four hours. Then the patient is disconnected from the AIK and given time for primary rehabilitation. Installed shunts, in the absence of rejection by the body, can last 12-14 years.
2. Vascular bypass. It involves implanting miniature implants into the coronary vessels beyond the blockage. During the operation, the end of the shunt is sutured to the aorta. In general, the process is very similar to coronary artery bypass surgery, but takes much longer due to the sophistication of the work. At the end of the operation, the chest of the person being operated on is temporarily secured with a special wire, and excess blood is removed using drainage.
3. Angioplastic stenting. It begins with inserting a compact catheter into a vein (usually the thickest vein in the patient's leg). The catheter reaches the heart area, and at a certain point, specialists inflate a microscopic balloon installed at one of its ends. The device under pressure fixes a frame in the affected vessel, which subsequently prevents its walls from narrowing to a critical level. Then the catheter is removed from the body in the same way, monitoring the process using a fluorograph.
4. Heart valve replacement. It can be performed either openly or using minimally invasive surgery. An incision is made in the patient's chest and he is temporarily connected to an artificial blood supply. Surgeons then remove the natural valve and replace it with an implant. Level modern medicine allows such operations to be performed without much risk to the patient’s life. However, after surgical intervention At the site of the incision, a person remains with a scar for life. In old age, it can make itself felt by pain and discomfort in the chest area.
5. Installation of prostheses and implants. Until recently, surgeons were only able to use artificial prostheses made of metal and plastic. Such implants can last more than ten years, but after the operation the patient becomes dependent on anticoagulants for life. He had to take blood thinners regularly to prevent blood clots from forming in the area of ​​the prosthesis. Today there is an alternative method of combating heart disease - installing biological implants. They cost an order of magnitude more than their artificial predecessors, but they last much longer (more than twenty years) and do not require the patient to take anticoagulants. In both cases, the patient must be prepared for a second operation, since prostheses often do not last as long as described in the instructions.
6. Heart transplantation. It is used only in the most extreme cases, if all other methods of surgical intervention have exhausted themselves. The patient’s “native” heart is completely removed and replaced with a donor organ or an artificial device. Unfortunately, such an operation can prolong a person’s life for a maximum of five years, after which death occurs. In addition, transplantation of this kind is very expensive and extremely difficult due to the lack of donor material.

Rehabilitation after surgery

After heart surgery, the patient faces a long recovery process without the ability to leave the ward. For several days he is forbidden to get out of bed, and all this time he is forced to stay in the intensive care unit. An important role in this case is played by the diet that the attending physician prescribes to the patient individually. Initially, it may consist of eating only light cereals and broth, but a couple of days after the operation, the diet can be significantly expanded. So, after heart surgery, already on the third or fourth day, the diet of the patient, who by this time is usually transferred to a hospital, may include the following products:

• Porridge made from coarse cereals (pearl barley, barley, unpolished rice).
• Some dairy products (low-fat cottage cheese, cheese with a fat content of no more than 20%).
• Vegetables and fruits (both fresh and baked, steamed, in the form of salads).
• Meat (boiled or steamed chicken, rabbit, turkey).
• Fish (herring, salmon, capelin, Baltic herring, tuna, halibut, etc.).
• A variety of soups (preferably without frying and with a minimum amount of fat).

Often, a diet can be prescribed to a patient on a purely individual basis. In this case, with the permission of the doctor, he will have the opportunity to sometimes treat himself to beef and pork (exclusively in boiled form), as well as specially prepared cutlets. It is worth noting that any diet prescribed after heart surgery excludes all kinds of smoked meats from the diet. Also, under no circumstances should you consume meat products made from all types of liver, including sausages. If the patient does not suffer from diabetes, the diet may well include drinks such as hot chocolate and cocoa, not to mention tea. You should avoid drinking coffee.

Typically, the prescribed diet must be followed for a period of several weeks to several months. At this time, the patient after heart surgery, as a rule, is still in the hospital, and monitoring his diet is not difficult. However, upon returning home, many patients forget about such a concept as diet, which often leads to a deterioration in their well-being. Experts once again remind us that heart disease is incompatible with alcohol, tobacco and most foods. Diet in this case is not a whim of doctors, but a guarantee of successful rehabilitation after surgery. Neglecting it means putting your own life at risk.

Similar operations have been carried out for 70 years.

Atherosclerosis is a human condition in which a fatty layer forms on the walls of the heart arteries due to a large amount of cholesterol, calcium and the remains of dead cells. It promotes thickening and narrowing of arteries, which can ultimately cause heart attack, stroke and a number of other cardiovascular diseases. Coronary artery bypass surgery is an inevitable procedure after a severe heart attack. Its main goal is to create bypass paths (shunts) for the movement of blood through the arteries.

The principle of the operation and indications for its implementation

Bypassing is a process in which additional paths are created to bypass a deteriorated area using a system of shunts.

The main indications for performing such an operation for the treatment of coronary heart disease (blockage of the coronary arteries) are:

• damage to the left coronary artery, which supplies blood to the left side of the heart;
• damage to all coronary vessels.

During this operation, the surgeon installs a shunt (a bypass vessel, which can be a large vein under the skin on the thigh, the internal mammary or radial artery) between the aorta and the coronary artery in the lumen where the atherosclerotic plaque has formed. When a shunt is placed, blood flows from the aorta to the coronary artery through a healthy vessel. As a result, cardiac blood flow returns to normal.

The younger the patient, the more optimistic the prognosis after coronary artery bypass surgery. Before the start of surgery, patients are required to undergo a full range of examinations: a cardiogram, coronography and an ultrasound examination of the heart. Coronary artery bypass surgery is performed under general anesthesia and does not include food 8 hours before surgery.

This type of surgery is performed in several ways: using the traditional method, using new technologies and modern equipment. The classic method demonstrates the process in which the patient is connected to a heart-lung machine. The second method is using new technology, which does not require connection to a device. The newest method of minimally invasive bypass surgery without the use of thoracotomy (opening the chest) is used only when bypassing the anterior inferior artery left. CABG methods are selected based on the condition of the patient’s heart and blood vessels.

Carrying out the operation

After anesthesia, the patient is connected to equipment with a monitor. Anesthetic drugs are administered throughout the operation. After the patient is put into medicated sleep, an endotracheal tube is inserted into the trachea, which communicates with the anesthesia machine. This stage ends the work of the anesthesiologist and begins the work of the surgeon.

The surgeon makes a longitudinal incision into the sternum and, through visual assessment, decides where exactly to place the shunt (or shunts).

For the blood vessel, the large saphenous vein of the thigh, internal mammary or radial artery is selected. To prevent the formation of blood clots, the patient is given heparin. The surgeon stops the patient's heart, while the blood circulation is carried out throughout the entire surgical process using an artificial apparatus for 90 minutes. Cardiac arrest is performed by injecting a cooled potassium-containing solution into the heart.

The surgeon then sutures a shunt to the aorta and to the site of the coronary artery from the narrowed site. The heart starts up again, all devices are removed. Protamine is administered to neutralize heparin. The sternum is sutured. This completes the operating process. Bypass surgery time is about 4 hours. The patient is transferred to the intensive care unit, where he remains for 24 hours. On the fifth day after the operation, the operated patient is discharged.

Sometimes postoperative syndrome can occur, when heart rhythm disturbances occur in the first 3 hours. This is a temporary phenomenon that can be eliminated with the help of therapeutic procedures.

What complications can there be?

After heart bypass surgery, in some cases, a number of complications may occur, the most common of which are bleeding and irregular heartbeat. There are cases of blood clot detachment, which occurs due to untimely closure of the shunt lumen or in the process of its damage, which can cause myocardial infarction. Poor healing of the sternum, infectious complications, stroke, cases of temporary amnesia and chronic pain at the operation site cannot be excluded.

All side effects occur due to the unsatisfactory condition of the patient before surgery or insufficient time for preparation. Risks are unlikely when planned coronary artery bypass surgery is performed. The risk is much higher if you have diseases such as diabetes, emphysema, kidney pathologies. In order to eliminate all kinds of risks before starting an operation to install a coronary artery bypass, it is necessary to analyze all the risks, consult a doctor and be sure to undergo a full diagnosis and examination.

Patients often complain about severe pain in the place where the operation was performed. Doctors recommend not to endure pain and to use painkillers, but only after consulting a cardiologist.

For some patients, minimally invasive direct coronary artery bypass grafting may be appropriate. This applies to those patients who have several affected arteries.

Postoperative rehabilitation and prevention

Despite the fact that small veins are used to replace the removed vein, there is a risk of swelling, so patients after surgery are recommended to wear an elastic stocking for the first 1.5-2 months.

Since the sternum takes a very long time to heal, patients are not recommended to lift heavy objects or engage in active labor after coronary surgery. This should be followed for at least 6 weeks. In addition, you need to increase the load gradually.

Under no circumstances should we allow the problem that caused the surgery to return. To do this, doctors recommend adhering to proper nutrition: reducing the consumption of sugar, salt, and foods high in fat.

Foods rich in vitamins and minerals will bring much more benefit after such operations. You should include in your diet as much food as possible, which includes selenium, vitamins A, B, C and E. This will not only strengthen the heart muscles, maintain normal blood circulation, and normalize weight, but will also increase the effectiveness of the body’s protective properties.

After a person has undergone coronary heart bypass surgery, his daily lifestyle must be adjusted down to the smallest details. It is necessary to completely eliminate the use of alcoholic beverages and quit smoking. Recovery and rehabilitation measures are very popular after heart surgery, which include training patients in techniques that promote proper nutrition, individual programs of physical activities.

After such heart operations, patients are recommended to undergo restorative and health treatment in sanatoriums or dispensaries of this profile. Patients with atherosclerosis and other heart diseases should understand that the more such operations surgeons perform, the more often this leads to weakening of the heart, which is responsible for the vitality of the human body.

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Coronary artery bypass surgery: is it worth doing?

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

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

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

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

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

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

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

How are indications for surgery selected?

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

The success of other methods is unlikely if:

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

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

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

A patient may need more than one shunt to achieve results.

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

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

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

Group II includes patients who need very likely prevention of acute infarction (without surgery the prognosis is unfavorable), but are difficult to treat 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.

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.

The International Associations of Cardiology recommend Clinical signs and indications first, and then take into account anatomical changes. It is estimated that the risk of death from a possible heart attack in a patient significantly exceeds mortality during and after the operation.

When is surgery contraindicated?

Cardiac surgeons consider any contraindications relative, since additional vascularization of the myocardium cannot harm a patient with any disease. However, 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 saphenous vein of the leg perfectly replaces the coronary vessel

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. Standard tests include:

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

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

The patient must provide the surgeon with information about previous illnesses, a tendency to allergic reactions for food or medicine

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.

The state of complete sleep and pain relief is monitored using special indicators

Specialized centers use equipment for monitoring and control of:

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

The question of the need for intubation and transfer of the patient to artificial respiration is decided at the request of the operating 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;
• reduction of possible complications caused by the equipment;
• faster postoperative recovery.

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

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

Usually the operating team consists of at least two surgeons and nurses

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

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

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

How does the postoperative period proceed?

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

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

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

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

A week later, the suture material is removed 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.

A special bandage is placed on the chest to support the ribs and sternum to heal the sutures in the skin and strengthen the sternum

Discharge from the hospital is carried out after a week.

In the first days, the doctor recommends a slight fasting with light food: broth, liquid cereals, 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.

Small hematomas remain at the site of vein collection, which disappear after 10 days

How likely are complications?

A study of the statistics of postoperative complications indicates a certain risk for any type of surgical intervention. This should be clarified when deciding whether to consent to surgery.

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

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

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

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

What complications are possible after surgery?

The most common complications of coronary artery bypass grafting are:

Less common ones include:

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

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

Feedback from patients who have undergone surgery makes you think about personal choices and values ​​in life.

Galina Mikhailovna, 58 years old, music teacher: “I read the article and began to remember what prompted me to agree to the operation. I had just reached retirement when I had a heart attack. True, before this I had constant hypertension for 10 years. I was treated from time to time, there was no time to rest (like all music workers, I rock in two more places). Finding herself in a hospital bed with constant attacks and fear, she agreed without even thinking about the consequences. He was referred to the regional cardiology center for consultation. I waited 3 months for a coronary angiography. When they offered surgery, she immediately agreed. Before and after I did everything according to the doctor’s recommendations. The chest pain lasted for 3 days, then practically disappeared. Now I continue to do what I love, teach students, and work part-time in the orchestra.”

Sergei Nikolaevich, 60 years old, retired lieutenant colonel: “It is impossible to constantly be afraid and expect a heart attack, it is better to take a risk. After the operation, there were practically no attacks for 2 years. Once I increased the load at the dacha, I felt dizzy. It's gone after the rest. Maybe I can live at least 5 or 10 years without thinking about my heart. My peers are no longer able to physically work.”

My husband underwent coronary bypass surgery. A month has already passed, and the pain in the operation area does not go away. What to do?

3 years after the triple bypass operation, one bypass was thrombosed. What to do?

20 days after surgery, my sternum and left side from the incision hurt. This is fine?

How is coronary artery bypass surgery performed?

Coronary artery bypass grafting is the most effective method treatment of many heart diseases, including coronary heart disease.

With the help of this procedure, patients become capable again, the symptoms of the disease disappear.

Coronary artery bypass grafting is performed in a hospital setting, after surgical treatment a long rehabilitation period follows.

What is the operation

Patients who have problems with the coronary or coronary artery are wondering whether coronary bypass surgery is what it is, and whether the operation is dangerous. Coronary artery bypass grafting – surgical method treatment of coronary heart disease. It allows you to restore the blood supply to the heart muscle in full.

This is the most effective method treatment of ischemia, which reduces the risk of heart attack. Heart bypass surgery after a heart attack is a necessary measure and the only way to save a person’s life.

During surgery, a vessel taken from the thoracic artery or leg vein is introduced into the patient. The new vessel is placed above the area where the narrowing occurred or at its level. Blood flow is restored after treatment.

As a result of narrowing of the coronary artery, coronary heart disease develops. For this reason, the blood supply process is disrupted, and the heart muscle begins to experience a deficiency of oxygen and other nutrients. With insufficient therapy, the disease is complicated by myocardial infarction.

Bypass surgery allows you to completely solve the problem with blood supply. During the operation, an alternative blood flow is formed, which supplies the heart with all the necessary elements.

Coronary artery bypass grafting is indicated for the treatment of one or more blood vessels. Postoperative mortality statistics account for a small percentage of 1 to 3% of all cases.

Mortality is affected by the patient's age, the number of affected areas, and the characteristics of the shunt.

What is a shunt

During CABG, a graft - a shunt - is introduced into the artery, one end of it is sutured into the aorta, and the other slightly below the blocked area. Thus, the blood flow rushes along a new channel, bypassing the affected area.

A shunt is a vessel graft. The graft, in this case, is the thoracic or radial artery. In some cases, they resort to using the saphenous vein of the thigh as a bypass. The appearance of the shunt normalizes blood circulation, the symptoms of the disease disappear.

Before the operation, an additional examination of the vessel being removed is carried out in order to exclude a complication that may result from the removal of the vein.

Types of bypass surgery

Coronary artery bypass grafting is performed under general anesthesia; the operation is performed on an open heart.

Surgery for coronary artery bypass grafting proceeds according to one of the following methods:

1. An operation on a stopped heart, in which special equipment is used, which, during a period of temporary cardiac arrest, performs artificial circulation.
2. Coronary artery bypass surgery can also be done on a beating heart. This method eliminates the long-term postoperative recovery of the patient. The procedure itself does not take long, but to carry it out you should contact a specialist high level, since this type of operation is very complex.
3. Application of endoscopic methods. To perform the operation, the surgeon makes small incisions, due to which the wounds heal quickly and the patient recovers faster after treatment. The entire procedure lasts about two hours. This method is very popular in European clinics.

Coronary artery bypass grafting can cause complications. The outcome of each surgical procedure depends on the individual characteristics of the body and the severity of the disease.

Preparation for the procedure

For coronary bypass surgery to be successful, the patient needs preliminary preparation. Before the surgical procedure, a complete examination is required. The patient is prescribed:

In addition to information about the general condition of the patient, during the diagnosis the doctor determines the condition of the arteries, how narrowed the lumen in them is, and the specific location of the pathology. The specialist will explain to the patient what heart bypass surgery is and how to prepare for the operation.

Immediately before bypass surgery, the patient must observe the following measures:

• dinner on the eve of the operation should not be plentiful; eating at night is prohibited;
• men should shave the areas on their chest where surgery will be performed;
• the night before the operation you need to cleanse the intestines;
• After dinner they take their last medications.

If possible, medications should be stopped a week before the procedure.

Progress of the operation

Treatment is carried out in intensive care, where the patient is sent on a gurney. The operation is performed under general anesthesia. How the operation is done:

• the surgeon opens the chest;
• if necessary, the patient’s heart is stopped, surgery on a functioning heart is allowed;
• artificial circulation is supported using special equipment;
• the sternum is cut;
• the chest is fully opened;
• shunts are being introduced;
• the doctor closes the incision.

The modern method of bypass surgery, practiced in European clinics, is carried out with minimal invasive intervention. The procedure is performed without opening the chest, but through the intercostal space. This type of operation is possible thanks to modern equipment. The minimally invasive method shortens the duration of the postoperative period and reduces the risk of postoperative complications.

Coronary artery bypass surgery will take from 3 to 6 hours, depending on the complexity of the disease and the number of shunts being installed. After the procedure, the patient is sent to the intensive care unit, where he is kept for 24 hours.

Postoperative and rehabilitation periods

After the operation, the patient will not immediately be able to return to a normal lifestyle. He will require a postoperative recovery period. Whether the disease will recur in the future depends on how the rehabilitation proceeded.

Postoperative recovery lasts about 10 days and involves several techniques:

• drug treatment;
• physical procedures;
• psychological mood.

Drug treatment is selected individually in each specific case. The doctor selects complex therapy including the following drugs:

For the first few days, the patient is given painkillers and antibacterial medications. medicines. The patient is put on bed rest. A stationary posture while lying on your back is contraindicated; this can cause fluid accumulation in the lungs, which in turn can cause pneumonia.

If you are in good condition, on the second day you are allowed to sit down on the bed and stand up for a short time. Breathing exercises and a special diet are required.

Physical procedures are recommended from the second day after bypass surgery. The patient gradually restores physical activity day by day. The important thing is walking. With its help, the patient's blood circulation is restored and the heart muscle is strengthened.

Particular attention should be paid to breathing exercises.

Psychological rehabilitation is no less important. Psychologists will help the patient cope with psychological trauma that develops as a result of postoperative pain and brain hypoxia. Patients are irritable, anxious, and have insomnia.

Two weeks after the operation, the patient will be discharged from the hospital, provided that the postoperative period was successful and there were no complications or exacerbation of concomitant diseases.

After discharge, the patient is registered with a specialist and visits the doctor every three months. Later, it will be enough to go to the doctor for a medical examination once a year.

Is heart surgery performed without opening the chest?

Today, cardiac surgery can be performed without opening the chest. With this approach, there is no need to saw through the sternum, and the entire operation is performed through a small-diameter hole in the sections of the chest.

Using this technique, it is possible to replace the aortic and reconstruct the mitral and tricuspid heart valves without damaging the sternum. Another advantage of operations without opening the chest is the absence of large cosmetic defects in the form of scars.

This method of performing heart surgery significantly reduces the duration of rehabilitation of patients in the postoperative period.

Patients often wonder how long they can live after heart bypass surgery? The prognosis for life after CABG is favorable if you follow all the recommendations of doctors, and the surgical intervention itself does not reduce the life expectancy of patients.

Heart bypass surgery - what it is and how it can help - are important questions for people who have. With such a disease, this operation may be the only hope for full activity.

Heart bypass surgery - what is this operation?

Just 45 years ago, no one had a question: heart bypass surgery - what is it and why is it performed? The first developments in this direction, undertaken by the Soviet cardiac surgeon V.I. Kolesov, were questioned and even persecuted. The scientist’s assumption that with the help of a shunt it was possible to create a bypass to replace vessels damaged by atherosclerosis seemed fantastic. Now coronary artery bypass surgery saves the lives of tens of thousands of people every year. The operations are popular and effective, so they are carried out in many countries around the world.

When understanding the question: heart bypass - why and what it is, you should take into account its purpose. The operation is used for diseases that affect the vessels of the heart and impair blood flow. The essence of the intervention is to create a new blood flow path that will replace the affected part of the vessel. For this purpose, shunts made from the patient's veins or arteries are used. Vein bypasses are easier to create, but they are less reliable and may close a month after surgery. It is better to use arterial shunts, but such an operation is technically more complicated and not always possible.

Coronary artery bypass grafting - indications

Cholesterol deposits on the walls of blood vessels lead to a decrease in the lumen of the vessel. As a result, blood flows to the organs in insufficient quantities. If the lumen of the heart muscle vessel is narrowed, this can also cause myocardial damage. To expand the lumen of blood vessels, drug therapy, coronary angioplasty, and stenting are used. If the situation is complex, cardiac surgeons may resort to surgery. Coronary artery bypass grafting is indicated in the following cases:

• severe angina, in which the patient is unable to care for himself;
• problems with several coronary vessels at the same time (more than three);
• narrowing of coronary vessels exceeds 75%;
• combination with heart.

Why is heart bypass surgery dangerous?

Along with the question: heart bypass, what is it, the question often arises about the safety of this method. When cardiac surgeons are asked whether heart bypass surgery is dangerous, they answer that it is no more dangerous than other operations. Although this type of surgical intervention is complex, modern advances in medicine and technology make it possible to perform it as safely as possible. In the postoperative period, the risk of complications increases in patients with the following concomitant diseases:

• excess weight;
• diabetes;
• high levels of bad cholesterol;
• high blood pressure;
• serious kidney disease.

Depending on the quality of the operation performed and general condition health, the following complications may occasionally occur: swelling and redness at the suture site, bleeding, heart attacks. Very rare, but possible complications relate:

• - inflammatory process on the serous membrane of the heart;
• disturbances in heart rhythm;
• acute heart failure;
• phlebitis - inflammation of the vein walls;
• stroke;
• pleurisy - inflammation of the pleura of the lung;
• reduction of the lumen in the shunt.

Heart bypass surgery - how long do you live after surgery?

Patients who have undergone heart surgery are always interested in how long they live after heart bypass surgery. Cardiac surgeons put the average figure at 15 years, but clarify that in the future everything depends on the patient and his state of health. With high-quality placement of the shunt and compliance with all recommendations, the patient can live another 20-25 years. After this, coronary artery bypass surgery may be required again.

How is heart bypass performed?

Before the operation, the patient is euthanized, a tube is placed in the trachea to control breathing, and a probe is placed in the stomach to avoid reflux of gastric contents into the lungs.

1. The chest is opened.
2. During surgery on a non-working heart, artificial circulation is connected, and when the heart is working, the bypass area is fixed.
3. A vessel is removed that will serve as a shunt.
4. One edge of the vessel is connected to the aorta, the other to the coronary artery below the affected area.
5. Check the quality of the shunt.
6. The heart-lung machine is turned off.
7. The chest is sutured.

Coronary bypass surgery on a non-functioning heart

Coronary artery bypass grafting is a complex and lengthy operation. Most of these operations are performed on a non-functioning heart using a heart-lung machine. This method is considered safer and more acceptable than open heart surgery, but it does increase the risk of complications. Using the device may cause problems such as negative reactions body:

• pulmonary edema;
• hematological problems;
• embolism of the kidneys and cerebral vessels;
• lack of oxygen for organ function.

Coronary artery bypass grafting on a beating heart

Coronary artery bypass surgery without artificial circulation allows you to avoid complications caused by the use of a medical device. Surgery on a beating heart requires deep knowledge and skill from the surgeon. Coronary artery bypass surgery is performed under physiological conditions for the heart, which reduces the risk of postoperative complications and speeds up the patient’s recovery and discharge from the hospital.

Coronary bypass surgery without opening the chest

Endoscopic bypass surgery of the heart vessels is performed without compromising the integrity of the chest. These operations are more modern and safe and are common in European clinics. After such an operation occurs fast healing wounds and restoration of the body. The essence of the method is to perform surgery through small incisions in the chest area. To carry out such an operation, special medical equipment is required that allows precise manipulations inside the human body.

Rehabilitation after cardiac bypass surgery

When talking about heart bypass surgery and what it is, doctors immediately touch upon the moment of rehabilitation, on which the patient’s recovery rate depends.

Coronary artery bypass grafting - postoperative period

After heart surgery, the patient is carefully monitored for 2-3 months. For the first 10 days, the patient can remain in the intensive care unit, which depends on the speed of recovery, well-being and the presence or absence of complications. During the period when anesthesia is in effect, the patient's limbs are fixed to avoid sudden dangerous movements. For the first hours after surgery, the patient can breathe using a device that is turned off at the end of the first day.

In the hospital, the sutures are treated daily and their condition is monitored. Slight pain, redness and a feeling of skin tension at the suture site are normal during this period. If coronary artery bypass grafting of the heart vessels is successful, then on the 7-8th day the patient’s sutures are removed. Only after this can the patient be allowed to shower. To facilitate the healing of the sternum bones, the patient is recommended to wear a corset for six months; during this period, one can sleep only on the back.

Life after coronary artery bypass surgery

Coronary artery bypass grafting is considered successful if the patient returns to his normal lifestyle after two months.

Diet after heart bypass surgery

In the postoperative period, patients who have undergone coronary artery bypass grafting should carefully monitor their diet. This factor determines how many more years of life they can live. The diet should be designed in such a way as to prevent the appearance of excess weight and the deposition of harmful cholesterol on the walls of blood vessels.

1. Reduce the amount of sugar by replacing it with stevia.
2. Dairy products must be low-fat.
3. Among cheeses, preference should be given to dietary cheeses and tofu.
4. Meats allowed include soy meat, white chicken meat, turkey, and lean veal.
5. You can do anything from cereals except semolina and rice.
6. Additionally, consume fish oil.
7. As for fish, you can eat low-fat and sometimes medium-fat fish.
8. It is advisable to avoid all fats except vegetable fats. olive oil cold pressed.
9. It is recommended to reduce the amount of salt.
10. It is beneficial to eat fresh vegetables and fruits.

In cardiological practice, some patients undergo coronary artery bypass grafting. This is a surgical treatment that is often used for various diseases heart (thrombosis, myocardial infarction). This radical measure is carried out only in severe cases in the absence of effect from conservative therapy.

Carrying out surgery

Bypass surgery is a procedure performed in the surgical department, during which blood flow in the vessels of the heart is restored. Shunts are used for this purpose. With their help, it is possible to bypass the narrowed section of the vessel. As a shunt, one’s own is most often used. blood vessels person ( saphenous vein or internal mammary artery). In most cases, such an operation is organized in the presence of coronary heart disease.

This disease is caused by impaired blood flow in the coronary arteries that supply the heart itself. Due to lack of oxygen, ischemia develops. This most often manifests itself as an attack of angina. In more severe cases, acute myocardial infarction develops.

Contraindications for surgery

CABG has its own indications and contraindications. Highlight 3 absolute readings, in which this manipulation is carried out:

• narrowing of the lumen of the left coronary artery by more than 50%;
• total stenosis of the coronary arteries by more than 70%;
• pronounced narrowing of the interventricular artery in the proximal area in combination with two stenoses of other arteries of the heart.

There are a number of pathological conditions for which bypass surgery is recommended. This group includes severe angina that is not amenable to drug therapy, proximal blockage of a coronary artery by a thrombus, angina of functional class 3 and 4, acute coronary syndrome(unstable form of angina), acute ischemia after angioplasty or stenting, myocardial infarction, pronounced positive stress test before any surgery, ischemic form of pulmonary edema.

Indications include narrowing of the trunk of the left coronary artery by 50% or more, three-vessel disease. Often, bypass surgery is an additional measure when performing operations on heart valves, for ventricular septal defects and aneurysms. Bypass surgery cannot be performed when total defeat all coronary vessels, with a decrease in blood output of the left ventricle to 30% or less and congestive heart failure. Such an operation is contraindicated in case of renal failure, severe lung diseases and oncological pathology. Bypass surgery in old age is dangerous.

Types and techniques of implementation

There are 4 main types of CABG:

• by type of artificial circulation;
• without one;
• bypass surgery on a heart that beats under conditions of artificial circulation;
• bypass surgery due to severe angina pectoris that limits human activity.

During the operation, natural and artificial grafts are used. Bypass surgery is a microsurgical operation because the doctor works with small arteries with a diameter of 1-2 mm. The procedure requires the use of special binocular loupes. An operating microscope can be used instead.

General anesthesia is required. If the heart is beating, an epidural may be needed. You will definitely need to make an incision in the sternum and open the chest. This procedure lasts from 2 to 6 hours, depending on the degree of obstruction of the coronary arteries. At the same time, transplants are collected.

After this, cannulation is performed and shunts are applied. Don't forget about safety measures. Embolism prevention is mandatory. When bypassing, distal and then proximal anastomoses are performed first. After the main stage of work, artificial circulation is turned off. Next, decannulation is organized.

The incision in the sternum area is sutured. All fluid is sucked out from the pericardial sac. Coronary artery bypass surgery requires the work of a whole team of specialists (doctor, assistant, anesthesiologist, nurses). Bypass surgery without artificial circulation has its advantages. These include less trauma to blood cells, shorter duration of surgery, lower risk of complications, and faster rehabilitation of the sick person.

Recovery period

For some time, people who underwent bypass surgery are in the intensive care unit. Many of them are connected to a ventilator. This period can last up to 10 days. All rehabilitation measures are divided into primary and secondary. Primary rehabilitation is organized within the walls of the hospital.

After a person begins to breathe independently, breathing exercises are required. It is necessary to prevent congestion in the lungs. Caring for postoperative wounds is of no small importance. They require processing and dressing. Wounds heal within 1-2 weeks. The bones in the sternum area fuse within 4-6 months.

They are fastened with special metal seams. After surgery, it is recommended to wear a bandage. In the first 2 weeks, it is forbidden to wash, as postoperative wounds may become infected. The rehabilitation period involves following a diet. It is necessary, since bypass surgery is characterized by quite large blood loss. If anemia develops, you should enrich your diet with foods that contain a lot of iron (meat, liver and other offal).

An important aspect in the postoperative period is the prevention of thrombosis and pulmonary embolism.

All those undergoing surgery must wear compression hosiery(elastic stockings). At the next stage of rehabilitation it is necessary to increase motor activity. Patients are recommended to visit a sanatorium or relax at sea. After a few months, stress tests are performed to evaluate the functioning of the heart and the state of blood flow in it.

A bicycle ergometry or treadmill test is organized. If you do not follow the doctor’s recommendations in the postoperative period, a relapse is possible (the appearance of new atherosclerotic plaques and blockage of the arteries). For such patients, a second operation may be contraindicated. In the absence of symptoms of angina, a person should gradually increase physical activity. Initially, it is recommended to walk a distance of up to 1000 m, then increase it. After coronary artery bypass surgery on a beating heart, the risk of complications is lower.