Weakness after surgery. Coronary bypass surgery. Indications for coronary bypass surgery

Already for a long time The leading cause of mortality is occupied by cardiovascular diseases. Not proper nutrition sedentary lifestyle life, bad habits - all this negatively affects the health of the heart and blood vessels. Cases of strokes and heart attacks have become not uncommon among young people; elevated cholesterol levels, and therefore atherosclerotic vascular damage, are found in almost every second person. In this regard, cardiac surgeons have a lot of work.

Perhaps the most common is aortosurgery coronary bypass surgery. Its essence is to restore blood supply to the heart muscle, bypassing the affected vessels, and the saphenous vein of the thigh or artery are used for this purpose chest wall and shoulder. Such an operation can significantly improve the patient’s well-being and significantly prolong his life.

Any operation, especially on the heart, has certain difficulties, both in the technique of execution and in the prevention and treatment of complications, and coronary artery bypass grafting is no exception. The operation, although it has been carried out for a long time and on a large scale, is quite difficult and complications after it, unfortunately, are not such a rare occurrence.

The highest percentage of complications occurs in elderly patients with multiple concomitant pathologies. They can be divided into early ones, which arose during the perioperative period (immediately during or within a few days after surgery) and late ones, which appeared during the rehabilitation period. Postoperative complications can be divided into two categories: from the heart and blood vessels and from the surgical wound.

Complications of the heart and blood vessels

Myocardial infarction in the perioperative period - a serious complication, which often causes death. Women are more often affected. This is due to the fact that representatives of the fair sex come to the surgeon’s table with cardiac pathology approximately 10 years later than men, due to hormonal characteristics, and the age factor plays an important role here.

Stroke occurs due to microthrombosis of blood vessels during surgery.

Atrial fibrillation is a fairly common complication. This is a condition when the full contraction of the ventricles is replaced by their frequent fluttering movements, as a result of which hemodynamics are sharply disrupted, which increases the risk of thrombosis. To prevent this condition, patients are prescribed b-blockers, both in the preoperative and postoperative periods.

Pericarditis- inflammation serous membrane hearts. Occurs due to the addition of a secondary infection, more often in elderly, weakened patients.

Bleeding due to a blood clotting disorder. From 2-5% of patients who have undergone coronary artery bypass surgery undergo re-operation due to bleeding.

Read about the consequences of cardiac bypass surgery of a specific and nonspecific nature in the corresponding publication.

Complications from the postoperative suture

Mediastinitis and suture failure occur for the same reason as pericarditis, in approximately 1% of those operated on. More often, such complications occur in people suffering from diabetes.

Other complications are: suppuration surgical suture, incomplete fusion of the sternum, formation of a keloid scar .

Mention should also be made of neurological complications, such as encephalopathy, ophthalmological disorders, damage to the peripheral nervous system, etc.

Despite all these risks, the number of lives saved and grateful patients suffered disproportionately from complications.

Prevention

It must be remembered that coronary artery bypass surgery does not get rid of the main problem, does not cure atherosclerosis, but only gives a second chance to think about your lifestyle, draw the right conclusions and start a new life after bypass surgery.

Continuing to smoke, eat fast food and others harmful products you will very quickly damage the implants and waste the chance given to you. Read more about diet after heart bypass surgery.

After discharge from the hospital, the doctor will definitely give you a long list of recommendations, do not neglect them, follow all the doctor’s instructions and enjoy the gift of life!

After CABG surgery: complications and possible consequences

After bypass the condition of most patients improves in the first month, which allows them to return to normal life. But any operation, including coronary artery bypass surgery. can lead to certain complications, especially in a weakened body. The most serious complication can be considered the occurrence of heart attacks after surgery (in 5-7% of patients) and the associated likelihood of death; in some patients, bleeding may occur, which will require additional diagnostic surgery. The likelihood of complications and death is increased in elderly patients, patients with chronic lung diseases, diabetes, kidney failure and weak contraction of the heart muscle.

The nature of complications and their likelihood are different for men and women of different ages. Women are more likely to develop coronary heart disease late age than in men, due to a different hormonal background, accordingly, CABG surgery is statistically performed in patients 7-10 years older than in men. But at the same time, the risk of complications increases precisely due to advanced age. In cases where patients have bad habits (smoking), when lipid spectrum or have diabetes, the likelihood of developing coronary artery disease at a young age and the likelihood of undergoing heart bypass surgery increases. In these cases, concomitant diseases can also lead to postoperative complications.

Complications after CABG

The main goal of CABG surgery is to qualitatively change the patient’s life, improve his condition, and reduce the risks of complications. For this purpose, the postoperative period is divided into stages intensive care in the first days after CABG surgery (up to 5 days) and the subsequent rehabilitation stage (the first weeks after surgery, until the patient is discharged).

The state of shunts and the native coronary bed at various times after coronary artery bypass surgery

Section contains:

• Condition of mammary coronary shunts at various times after surgery
• Changes in autovenous shunts at various times after surgery
• The influence of shunt patency on the state of the native coronary bed

Condition of mammary coronary bypass grafts at various times after coronary artery bypass surgery

Thus, as the analysis of the studies shows, the use of stenting in the endovascular treatment of multivascular lesions can reduce the incidence of acute complications in the hospital period. In contrast to balloon angioplasty, multivessel stenting, according to published randomized trials, is not associated with more frequent development in-hospital complications compared with coronary artery bypass surgery.

However, in the long term after treatment, relapse of angina, according to the results of most studies, is more often observed after endovascular implantation of stents than after bypass surgery. In the largest BARI study, angina recurrence in the long-term period after angioplasty was 54%; the use of stents in the Dynamic Registry (continuation of the study) reduced the rate of angina recurrence to 21%. However, this indicator was still significantly different from the operated patients - 8% (p< 0.001).

The paucity of information accumulated to date on the results of stenting of multivascular lesions determines the relevance of studying this problem. To date, two major studies have been published in the foreign literature comparative effectiveness stenting and coronary bypass surgery in patients with multivessel disease. The disadvantages of the work carried out include the lack comparative analysis dynamics of exercise tolerance after treatment, the need to take antianginal drugs at various times after the intervention. To date, there are no studies in the domestic literature on the comparative effectiveness of endovascular and surgical methods of treating multivascular lesions. In our opinion, in addition to studying the clinical results of endovascular and surgical interventions actual problem is to study the cost-effectiveness of treatment: analysis of the comparative cost of both methods and the length of the patient’s hospital stay.

The state of shunts and the native coronary bed at various times after coronary artery bypass surgery.

Condition of mammary coronary bypass grafts at various times after coronary artery bypass surgery

Today, the problem of optimal selection of autotransplants remains relevant in cardiovascular surgery. The limited viability of shunts can lead to the resumption of the clinical picture of coronary heart disease in operated patients. Secondary intervention, be it re-operation of coronary artery bypass grafting or endovascular angioplasty, is usually associated with increased risk compared with the primary revascularization procedure. Therefore, determining preoperative risk factors for damage to coronary artery bypass grafts remains an important practical task. In turn, the formation of artificial coronary anastomoses leads to significant changes in hemodynamics in the coronary bed. The influence of working shunts on the state of the native bed, the frequency of appearance of new atherosclerotic lesions has not been fully studied, and many specialists in the field of cardiac surgery are dealing with this problem.

Large studies have demonstrated significantly better viability of arterial autografts both in the immediate and long term after surgery compared to venous autografts. According to E. D. Loop et al. 3 years after surgery, the rate of occlusion of mammary shunts is about 0.6%; after 1 year and 10 years, 95% of shunts remain patent. The use of the internal mammary artery has been shown in some randomized trials to improve long-term prognosis operated patients compared with autovenous shunting. Such results may be due to both the high resistance of the internal mammary artery to the development of atherosclerotic changes, and the fact that this artery is primarily used for bypassing the anterior descending coronary artery, which itself largely determines the prognosis.

The resistance of the internal mammary artery to the development of atherosclerosis is due to both its anatomical and functional features. IAV - artery muscular type with a jagged membrane that prevents the growth of smooth muscle cells from the media into the intima. This structure largely determines the resistance to intimal thickening and the appearance of atherosclerotic lesions. In addition, the tissues of the internal mammary artery produce a large number of prostacyclin, which plays a certain role in its atrombogenicity. Histological and functional studies have shown that the intima and media are supplied with blood from the lumen of the artery, which preserves the normal trophism of the vessel wall when used as a shunt.

Changes in autovenous shunts at different times after coronary artery bypass surgery

The effectiveness of the internal mammary artery has been established both in patients with normal myocardial contractility and in patients with poor left ventricular function. When analyzing the life expectancy of patients after operations, E. D. Loop et al. demonstrated that patients who used only autologous veins for coronary reconstructions had a 1.6 times greater risk of dying over a 10-year period compared with the group of patients using a mammary artery.

Despite the proven effectiveness of the use of the internal mammary artery in coronary surgery, a significant number of opponents of this technique still remain. Some authors do not recommend using the artery in following cases: the vessel is less than 2 mm in diameter, the caliber of the shunt is less than the caliber of the recipient vessel. However, a number of studies have proven the good ability of the internal mammary artery to physiological adaptation in various hemodynamic conditions: in the long-term period, an increase in the diameter of mammary shunts and blood flow through them was observed with an increase in the need for blood supply in the area of ​​the shunted vessel.

Changes in autovenous shunts at different times after coronary artery bypass surgery

Venous autografts are less resistant to the development of pathological changes in arterial circulation compared to the internal mammary artery. According to various studies, the patency of autovenous shunts from v. saphena one year after surgery is 80%. Within 2-3 years after surgery, the frequency of occlusions of autovenous shunts stabilizes at 16-2.2% per year, however, then it increases again to 4% per year. By 10 years after surgery, only 45% of autovenous shunts remain patent, and more than half of them have hemodynamically significant stenoses.

Most studies examining the patency of venous shunts after surgery indicate that if the shunt is damaged in the first year after surgery, thrombotic occlusion occurs. And since in the first year after the operation it is affected greatest number autovenous shunts, then this mechanism can be considered the leading one among the reasons leading to the failure of coronary shunts of this type.

The reasons for the high incidence of thrombosis, according to R. T. Lee et al. , lie in the specific structure of the venous wall. Its lower elasticity compared to the arterial one does not allow it to adapt to conditions of high blood pressure and ensure the optimal speed of blood flow through the shunt, which creates a tendency to slow blood flow and increased thrombus formation. Many research works have been devoted to studying the causes of the high incidence of thrombosis in the first year after surgery. As evidenced by major research on this topic, the main reason for early failure of vein grafts is the inability in many cases to maintain optimal blood flow through the graft. This feature is due to insufficient adaptation mechanisms when placing a venous vessel in the arterial bed. As is known, the venous circulatory system functions under conditions low pressure and the main force providing blood flow through the veins is the work of skeletal muscles and the pumping function of the heart. The middle layer of the venous wall, representing the smooth muscle layer, is poorly developed compared to the arterial wall, which, under conditions of arterial blood supply, plays an important role in regulating blood pressure by changing vascular tone and, thereby, peripheral resistance. Placed in the arterial bed venous vessel experiences increased stress, which in conditions of high pressure and lack of regulatory mechanisms can lead to impaired tone, pathological expansion and, ultimately, slowing blood flow and thrombosis.

In the case of thrombotic occlusion, the entire shunt is usually filled with thrombotic masses. This type of lesion represents an unpromising area for endovascular treatment. Firstly, the probability of recanalization of an extended occlusion is negligible, and secondly, even with successful recanalization, a large volume of thrombotic masses poses a threat to distal embolization when performing balloon angioplasty.

Factors influencing the condition of shunts after coronary artery bypass surgery.

Due to the current lack of effective therapeutic measures to eliminate occlusion of venous shunts in the first year after surgery, measures to avoid or reduce the risk of thrombosis of this type of shunt after coronary artery bypass grafting are of greatest importance. As the time after surgery increases, the so-called “arterialization” of the venous shunt and hyperplasia of its intima occurs. The shunt acquires the adaptation mechanisms necessary for proper blood flow, however, as long-term observations show, it becomes susceptible to atherosclerotic damage to no less extent than the native arterial bed. According to autopsy data, typical atherosclerotic changes of varying severity are observed after 3 years in 73% of autovenous shunts.

Factors influencing the condition of shunts after coronary artery bypass surgery.

Various studies devoted to the prevention of pathological changes in autovenous shunts after CABG indicate that the effect various factors the frequency of damage to shunts varies at different times after surgery. Most of the studies have been devoted to the study of clinical risk factors for closure of autovenous shunts. Studies conducted to determine clinical predictors of shunt occlusions in the near future postoperative period, did not identify clinical factors ( diabetes, smoking, hypertension), which negatively affect the frequency of occlusions in the early postoperative period. At the same time, in the long term after surgery, clinical factors that contribute to the progression of atherosclerosis in the native course also accelerate the development of pathological changes in autovenous shunts. A study conducted in the Department of Cardiovascular Surgery examined the relationship between blood cholesterol levels and the number of occlusions of vein grafts at different times after surgery. When analyzing shuntography data, no correlation was found between high content cholesterol and a higher incidence of graft failure in the first year after coronary artery bypass grafting. At the same time, in the long term, when a morphological restructuring of the venous bed occurred, a significantly higher incidence of shunt lesions was observed in patients with hypercholesterolemia. Prescribing lipid-lowering therapy with statins to patients in this study did not change the number of shunt occlusions in the immediate period, but led to a significant decrease in lesions in the long term.

During the first year after surgery, an extremely important role is played by factors that influence the speed of blood flow through the shunt (the condition of the distal bed, the quality of the anastomosis with the coronary artery, the diameter of the bypassed artery). These factors significantly influence the quality of outflow and, thus, determine the speed of blood flow through the shunt. In this regard, the work of Koyama J et al is interesting, where the degree of influence of a defect in the distal anastomosis on the speed of blood flow in mammary and venous shunts is assessed. It was revealed that the pathology of the distal anastomosis of the mammary shunt practically does not change the speed characteristics of blood flow compared to a shunt without an anastomotic defect. At the same time, a defect in the distal anastomosis of an autovenous shunt significantly slows down blood flow, which is explained by the unsatisfactory ability of the venous wall to change tone in the presence of increased resistance, which in this case is caused by the pathology of the anastomosis.

Most authors identify the diameter of the shunted vessel as the most important of all the local factors influencing the patency of shunts in the first year after surgery. A number of studies have shown a significant decrease in the percentage of shunt patency in the early and late postoperative periods with autovenous bypass of arteries less than 1.5 mm. Also important issue in indications for surgical treatment The degree of stenosis of the coronary arteries is considered. There is disagreement in the literature regarding the need for bypass surgery for “borderline” stenoses of 50-75%. A number of studies have noted low patency of shunts during interventions on such lesions (17% according to Wertheimer et al.). The concept of competitive blood flow is most often put forward as the reason for unsatisfactory results: the shunted bed distal to the anastomosis is supplied with blood from two sources and, with good filling in the native bed, conditions are created for a reduction in blood flow through the shunt with subsequent thrombosis. In other works on significant amount The material shows no differences in the patency of shunts to vessels with critical and non-critical stenoses. There are also reports in the literature about the dependence of the condition of shunts on the vascular area in which revascularization is performed. Thus, in the work of Crosby et al. indicate worse patency of shunts to the circumflex artery compared to other arteries.

Factors influencing the condition of shunts after coronary artery bypass surgery

Thus, there remains disagreement among researchers regarding the influence of various morphological characteristics on the condition of the shunts. From a practical point of view, it is interesting to study the influence of morphological factors on the condition of shunts both in the immediate and long-term period, when morphological restructuring of the shunts occurs and adaptation to hemodynamic conditions is completed.

The influence of shunt patency on the state of the native coronary bed.

Literary information regarding the impact of working shunts on the dynamics of atherosclerosis in the shunt bed is scarce and contradictory. Among researchers studying the condition of coronary artery bypass grafts, there is no consensus on how functioning shunts influence the course of atherosclerosis in the native coronary bed. There are reports in the literature about negative impact functioning shunts on the course of atherosclerosis in segments proximal to the anastomosis. Thus, in the work of Carrel T. et al. It has been shown that in stenotic segments of the coronary arteries, bypassing which the myocardium is supplied with blood, rapid progression of atherosclerotic changes occurs with the development of occlusion of their lumen. An explanation for this is found in the high competitive blood flow through coronary artery bypass grafts, which leads to a reduction in blood flow through stenotic arteries, thrombus formation in the area of ​​atherosclerotic plaques and complete closure of the lumen of blood vessels. In other works devoted to this problem, this point of view is not confirmed and there is no report of provoking the aggressive course of atherosclerosis in bypassed arteries. . The above-mentioned studies address the problem of progression of atherosclerosis in segments that have hemodynamically significant lesions before surgery. At the same time, the question of whether functioning shunts can provoke the development of new atherosclerotic plaques in unaffected segments remains open. In modern literature, there are no reports on studying the effect of functioning shunts on the appearance of new atherosclerotic lesions that were absent before coronary artery bypass surgery.

To summarize the above, it should be noted that the definition anatomical features coronary bed, affecting the prognosis of bypass performance, is of the same importance as the study of clinical risk factors for bypass occlusion. In our opinion, the study remains relevant today the following questions: determination of morphological characteristics of coronary artery lesions that affect the condition of shunts in the immediate and long-term periods after coronary bypass surgery; determining the effect of shunt patency on the severity of coronary atherosclerosis in the segments affected before surgery; study of the effect of shunt patency on the incidence of new atherosclerotic changes in the immediate and long-term periods. Analysis of these issues, in our opinion, would help predict the course of coronary artery disease in operated patients and differentiate the treatment of patients with different morphological characteristics.

This special kind surgery, which is aimed at creating a bypass for blood vessels to bypass the blocked area and restore normal blood flow to organs and tissues.

Timely shunting helps prevent cerebral infarction, which can be triggered by the death of neurons due to insufficient amounts entering the bloodstream. nutrients.

Shunting allows you to solve two main problems - combat overweight or restore blood circulation bypassing the area where the vessels were damaged for one reason or another.

This type The operations are performed under general anesthesia.

To restore the obstructed blood flow, a certain section of another vessel is selected for the new “vessel”-shunt - usually the thoracic arteries or thigh veins are used for such purposes.

Removing part of the vessel for the shunt does not in any way affect the blood circulation in the area where the material was taken.

Then a special incision is made on the vessel that will conduct blood instead of the damaged one; a shunt will be inserted here and sutured to the vessel. After the procedure, the patient must undergo several examinations to ensure that the shunt is fully functioning.

There are three main types of bypass surgery: restoration of blood flow to the heart, brain and stomach. Next, let's look at these types in a little more detail.

1. Bypass surgery of the blood vessels of the heart
   Heart bypass is otherwise called coronary bypass. What is coronary artery bypass surgery? This operation restores blood flow to the heart, bypassing the narrowing of the coronary artery. Coronary arteries contribute to the supply of oxygen to the heart muscle: if the performance of this type of vessel is impaired, then the process of oxygen supply is also disrupted. In coronary artery bypass surgery, the thoracic artery is most often chosen for the bypass. The number of shunts inserted depends on the number of vessels in which the narrowing has occurred.
2. Gastric bypass
   The goal of gastric bypass is completely different from heart bypass - helping with weight correction. The stomach is divided into two parts, one of which is connected to small intestine. Thus, part of the organ is not used in the digestion process, so a person has the opportunity to get rid of extra pounds.
3. Bypass surgery of the cerebral arteries
   This type of bypass serves to stabilize blood circulation in the brain. Just like a heart bypass, blood flow is redirected to bypass an artery that can no longer supply the required amount of blood to the brain.

What is cardiac and vascular bypass surgery: cardiac coronary artery bypass surgery after a heart attack and contraindications

What is cardiac and vascular bypass surgery? With help surgical intervention it is possible to create a new bloodstream, allowing blood circulation to be restored to the heart muscle in full.

With shunting you can:

• significantly reduce the number of angina attacks or get rid of it altogether;
• reduce the risk of developing various cardiovascular diseases and, as a result, increase life expectancy;
• prevent myocardial infarction.

What is cardiac bypass surgery after a heart attack? This is the restoration of blood flow in the area where blood vessels are damaged as a result of a heart attack. The cause of a heart attack is the blockage of an artery due to the formation of an atherosclerotic plaque.

The myocardium does not receive enough oxygen, so a dead spot appears on the heart muscle. If this process is diagnosed in time, the dead area will turn into a scar, serving as a connecting channel for new blood flow through the shunt, but there are quite frequent cases when necrosis of the heart muscle is not detected in time, and the person dies.

IN modern medicine There are three main groups of indications for bypass surgery of the heart and blood vessels:

• The first group is ischemic myocardium or angina pectoris, not responding to drug treatment. As a rule, this group includes patients who suffer acute ischemia as a result of stenting or angioplasty, which did not help get rid of the disease; patients with pulmonary edema as a result of ischemia; patients with a strongly positive stress test result on the eve of elective surgery.
• Group 2: presence of angina or refractory ischemia, in which bypass surgery will preserve the functioning of the left ventricle of the heart, as well as significantly reduce the risk of myocardial ischemia. This includes patients with arterial stenosis and coronary vessels heart (from 50% stenosis), as well as with lesions of the coronary vessels with possible development ischemia.
• The third group is the need for bypass surgery as an auxiliary operation before the main heart surgery. Usually, bypass surgery is required before surgery on the heart valves, due to complicated myocardial ischemia, in cases of coronary artery anomalies (with a significant risk of sudden death).

Despite the significant role of bypass surgery in restoring human blood flow, there are certain indications for this operation.

Bypass surgery cannot be performed if:

• all the patient’s coronary arteries are affected (diffuse damage);
• the left ventricle is affected due to scarring;
• congestive heart failure was detected;
• chronic nonspecific lung diseases;
• renal failure;
• oncological diseases.

Sometimes a young or old patient is considered a contraindication. However, if other than age there are no contraindications to bypass surgery, then surgical intervention will still be performed to save life.

Coronary artery bypass grafting: surgery and how long they live after CABG on the heart

Coronary artery bypass surgery can be of several types.

• The first type is heart bypass with the creation of artificial circulation and cardioplegia.
• The second type is CABG on a heart that continues to work without artificial blood flow.
• The third type of CABG heart surgery is work with a beating heart and artificial blood flow.

CABG surgery can be performed with or without cardiopulmonary bypass. There is no need to worry, without maintaining blood circulation the heart will not stop artificially. The organ is fixed in such a way that work on the compressed coronary arteries is carried out without interference, since maximum precision and caution are required.

Coronary bypass surgery without maintaining artificial blood flow has its advantages:

• blood cells will not be damaged;
• the operation will take less time;
• rehabilitation is faster;
• there are no complications that could arise due to artificial blood flow.

CABG heart surgery allows you to live a full life for many years after surgery.

Life expectancy will depend on two main factors:

• from the material from which the shunt was taken. A number of studies show that a shunt from a thigh vein is not blocked in 65% of cases within 10 years after surgery, and a shunt from a forearm artery is not blocked in 90% of cases;
• from the responsibility of the patient himself: how carefully the recommendations for recovery after surgery are followed, whether the diet has changed, whether bad habits have been abandoned, etc.

Heart bypass surgery: how long does the operation last, preparation, main stages and possible complications

Before CABG surgery, special preparatory procedures must be performed.

First of all, before the operation, the last meal is taken in the evening: the food should be light, accompanied by still drinking water. In areas where incisions and shunt removal will be made, the hair should be carefully shaved. Before surgery, the intestines are cleansed. Required medications taken immediately after dinner.

On the eve of the operation (usually the day before), the operating surgeon explains the details of bypass surgery and examines the patient.

A breathing exercise specialist talks about special exercises which will have to be performed after surgery to speed up rehabilitation, so you need to learn them in advance. You are required to hand over your personal belongings to the nurse for temporary storage.

Stages of implementation

During the first stage of CABG surgery, the anesthesiologist injects a special drug into the patient's vein to make him fall asleep. A tube is inserted into the trachea to monitor respiratory processes during the operation. A tube inserted into the stomach prevents possible reflux of stomach contents into the lungs.

The next step is to open the patient's chest to provide the necessary access to the surgical site.

At the third stage, the patient's heart is stopped by connecting artificial blood circulation.

While connecting the artificial blood flow, a second surgeon removes the shunt from another vessel (or vein) of the patient.

The shunt is inserted in such a way that blood flow, bypassing the damaged area, allows the full supply of nutrients to the heart.

After the heart is restored, surgeons check the functionality of the shunt. The chest cavity is then sutured. The patient is taken to the intensive care unit.

How long does heart bypass surgery take? As a rule, the process takes from 3 to 6 hours, but other durations of the operation are possible. The duration depends on the number of shunts, individual characteristics patient, surgeon experience, etc.

You can ask the surgeon about the expected duration of the operation, but the exact duration of this process will be told to you only after completion.

Usually, possible complications appear after the patient is discharged home.

These cases are quite rare, but you should immediately contact your doctor if you notice the following signs:

• the postoperative scar has turned red and there is discharge coming out of it (the color of the discharge is not important, since in principle there should not be any discharge);
• heat;
• chills;
• severe fatigue and shortness of breath for no apparent reason;
• rapid weight gain;
• sudden change in heart rate.

The main thing is not to panic if you notice one or more symptoms in yourself. It is possible that behind these symptoms there is ordinary fatigue or viral disease. Only a doctor can make an accurate diagnosis.

Coronary artery bypass grafting: life, treatment and diet after coronary artery bypass grafting

Immediately after the completion of coronary artery bypass surgery, the patient is taken to the intensive care unit. For some time after surgery, anesthesia continues to act, so the patient’s limbs are fixed so that uncontrolled movement does not cause harm to the person.

Breathing is supported using a special device: as a rule, this device is turned off on the first day after surgery, since the patient can breathe on his own. Special catheters and electrodes are also connected to the body.

A completely common reaction to surgery is an increase in body temperature, which can persist for a week.

Profuse sweating in this case should not frighten the patient.

To speed up recovery if coronary artery bypass surgery has been performed, you need to learn how to perform special breathing exercises, which will allow you to restore lung function after surgery.

It is also necessary to stimulate coughing in order to stimulate the release of secretions into the lungs, and, accordingly, to restore them faster.

The first time after surgery you will have to wear a chest corset. You can sleep on your side and turn over only after your doctor's permission.

After surgery, pain may occur, but not severe.. This pain is caused by the site where the incision was made to insert the shunt as the site heals. By choosing a comfortable position, you can get rid of pain.

In case of severe pain, you should immediately consult a doctor. Full recovery after coronary artery bypass surgery occurs only after several months, so discomfort can persist for quite a long time.

Sutures from the wound are removed on the 8th or 9th day after surgery. The patient is discharged after 14-16 days of hospital stay.

There is no need to worry: the doctor knows exactly when it is time to discharge the patient to recover at home.

Life after

The motto of every person who has undergone coronary artery bypass surgery should be the phrase: “Moderation in everything.”

To recover from bypass surgery, you will need to take medications. The medications should only be those recommended by the doctor.

If you need to take medications to combat other diseases, be sure to inform your doctor about this: it is quite possible that some of the prescribed medications cannot be combined with medications the patient is already taking.

If you smoked before surgery, you will have to forget about this habit forever.: Smoking significantly increases the risk of repeat bypass surgery. To combat this addiction, stop smoking even before surgery: instead of smoking breaks, drink water or apply a nicotine patch (but after surgery you can no longer apply it).

Quite often, patients who have undergone bypass surgery feel that recovery is too slow. If this feeling does not go away, you should consult a doctor. However, as a rule, this does not carry with it serious reasons for excitement.

Special cardio-rheumatological sanatoriums provide assistance in recovery after bypass surgery. The course of treatment in such institutions varies from four to eight weeks. It is best to undergo sanatorium treatment with a frequency of trips once a year.

Diet. After coronary artery bypass grafting, the patient’s entire lifestyle will need to be adjusted, including nutrition. In your diet you will need to reduce the amount of salts, sugar and fats you consume.

If you abuse dangerous products, the risk of repeating the situation increases, but with shunts - the blood flow in them can be hampered by the cholesterol formed on the walls. You need to control your weight.

Tanya1307lena1803 10/22/2017 5:24:05 PM

Hello, my name is Elena, we have the same problem. My beloved mother is 58 years old, two months ago she had coronary bypass surgery, complications began, her heart enlarged, the blood was not pumped correctly and her lungs were clogged with blood. What should we do? I’m very afraid for her, but our doctors just shrug their shoulders.

In February of this year, I came across the article “Shunts do not last forever.” A correspondent for the Evening Moscow newspaper spoke with the head of the laboratory of X-ray endovascular methods of cardiology scientific center doctor medical sciences A.N. Samko. The discussion was about the effectiveness of coronary artery bypass grafting (CABG) operations. Dr. Samko painted a bleak picture: after a year, 20% of shunts close, and after 10 years, as a rule, all of them! In his opinion, repeat bypass surgery is risky and extremely difficult. This means that life is guaranteed to be extended by only 10 years.

My experience as a cardiac surgery patient with long experience, who underwent two coronary artery bypass operations, suggests that these periods can be increased, primarily due to regular physical activity.

I view my illness and operations as a challenge from fate that must be actively and courageously resisted. Unfortunately, physical activity after CABG is mentioned only in passing, by the way. Moreover, there is an opinion that some patients after heart surgery live safely and for a long time without making any effort. I have never met such people. What I want to talk about is not a miracle, not luck or a fortunate coincidence, but a combination of the high professionalism of the doctors of the Russian Scientific Center for Surgery and my perseverance in implementing my own program of restrictions and loads (RON).

My story is this. Born in 1935. In his youth he suffered from malaria for many years, during the war - typhus. Mother - a heart patient, died at 64 years old.

In October 1993, I suffered an extensive transmural posterolateral myocardial infarction of the left ventricle, and in March 1995 I underwent coronary artery bypass grafting - 4 shunts were sewn in. Thirteen years later, in April 2008, angioplasty of one shunt was performed. The other three were functioning normally. And after 14 years and 3 months, I suddenly started having angina attacks, which I had never had before. I went to the hospital, then to the Scientific Cardiology Center. I underwent further examination at the Russian Scientific Center for Surgery. The results showed that only two of the four shunts were functioning normally, and on September 15, 2009, Professor B.V. Shabalkin performed a repeat coronary artery bypass surgery on me.

As you can see, I have been able to significantly extend the average life expectancy with shunts, and I am convinced that I owe this to my RON program.

Doctors still consider my post-operative physical activity too high and advise me to rest more and take medication constantly. I can't agree with this. I want to make a reservation right away - there is a risk, but it is a justified risk. Understanding the seriousness of my situation, from the very beginning I introduced certain restrictions into my system: I excluded jogging, exercises with dumbbells, on the horizontal bar, hand push-ups and other strength exercises.

Typically, clinic doctors classify CABG surgery as an aggravating factor and believe that the person undergoing surgery has only one destiny: to live out his life quietly and calmly and constantly take medications. But bypass surgery ensures normal blood supply to the heart and the body as a whole! And how much work has been invested, effort and money spent to save the patient from death and give him the opportunity to live on!

I am convinced that even after such a difficult operation, life can be fulfilling. And I can’t come to terms with the categorical statements of some doctors that my workload is excessive. They are feasible for me. But I know that if atrial fibrillation appears, severe pain in the heart area, or the lower limit of blood pressure exceeds 110 mm Hg, you must immediately call an ambulance doctor. Unfortunately, no one is immune from this.

My RON program includes five points:

1. Physical training, constant and gradually increasing to a certain limit.

2. Dietary restrictions (mainly anti-cholesterol).

3. Gradually reduce your medications until you stop taking them completely (I only take them in emergencies).

4. Prevention of stressful conditions.

5. Constantly being busy with interesting things, leaving no free time.

Gaining experience, I gradually increased physical activity, included new exercises, but at the same time strictly controlled my condition: blood pressure, heart rate, orthostatic test, heart fitness test.

My daily physical activity consisted of measured walking (3-3.5 hours at a pace of 138-140 steps per minute) and gymnastics (2.5 hours, 145 exercises, 5000 movements). This load (metered walking and gymnastics) was performed in two doses - in the morning and in the afternoon.

Seasonal loads were added to the daily loads: skiing with stops every 2.5 km to measure heart rate (total 21 km in 2 hours 15 minutes at a speed of 9.5 km per hour) and swimming, one-time or fractional - 50- 200 m (800 m in 30 minutes).

In the 15 years since my first CABG operation, I have walked 80 thousand kilometers, covering a distance equal in length to two equators of the earth. And until June 2009, I didn’t know what angina attacks or shortness of breath were.

I did this not out of a desire to demonstrate my exclusivity, but because of the conviction that blood vessels, natural and artificial (shunts), fail (clog) not from physical activity, especially tense, but due to progressive atherosclerosis. Physical activity inhibits the development of atherosclerosis and improves lipid metabolism, increasing the content of high-density cholesterol (good) in the blood and reducing the content of low-density cholesterol (bad) - thereby reducing the risk of blood clots. This is very important for me, since my total cholesterol levels fluctuate at the upper limit. The only thing that helps is that the ratio of high and low density cholesterol, the content of triglycerides and the cholesterol coefficient of atherogenicity never exceed the established standards.

Physical exercises, gradually increasing and giving an aerobic effect, strengthen muscles, help maintain joint mobility, increase minute blood output, reduce body weight, have a beneficial effect on intestinal function, improve sleep, increase tone and mood. In addition, they help in the prevention and treatment of other associated with age diseases - prostatitis, hemorrhoids. A reliable indicator that the load is not excessive is nasal breathing, so I breathe only through my nose.

Everyone is sufficiently informed about measured walking. But I would still like to cite the opinion of a famous surgeon, who himself was not involved in sports, but was fond of hunting, to confirm its usefulness and effectiveness. And hunting means walking for many hours. We will talk about Academician A.V. Vishnevsky. Since his student years, fascinated by anatomy and having perfectly mastered the art of dissecting, he loved to tell his acquaintances all sorts of interesting details. For example, there are 25 joints in each human limb. With each step, 50 articulated sections are thus set in motion. The 48 joints of the sternum and ribs and the 46 bony surfaces of the spinal column do not remain at rest. Their movements are barely noticeable, but they are repeated with every step, with every inhalation and exhalation. Considering that there are 230 joints in the human body, how much lubricant do they need and where does this lubricant come from? Having asked this question, Vishnevsky answered it himself. It turns out that the lubricant is supplied by a pearly-white cartilaginous plate that protects the bones from friction. There is not a single blood vessel in it, and yet the cartilage receives nutrition from the blood. In its three layers there is an army of “builder” cells. Upper layer, worn out due to friction of the joints, are replaced by the lower ones. This is similar to what happens in the skin: with each movement, the clothing erases dead cells from the surface layer, and they are replaced by underlying ones. But the cartilage-forming agent does not die ingloriously, like a cell skin. Death transforms him. It becomes soft and slippery, turning into a lubricant. This way, a uniform layer of “ointment” is formed on the rubbing surface. The more intense the load, the more “builders” die and the faster the lubricant is formed. Isn't this a walking hymn!

After the first CABG operation, my weight remained between 58-60 kg (with a height of 165 cm), I took medications only in emergency cases: with increased blood pressure, temperature, heart rate, headaches, and arrhythmia. The main difficulty for me was my easily excitable nervous system, which I practically could not cope with, and this affected the results of the examinations. Sharp rise blood pressure and heart rate due to anxiety misled doctors about my actual physical capabilities.

After analyzing statistical data from long-term physical training, I determined the optimal heart rate for my operated heart, guaranteeing the safety and aerobic effect of physical exercise. My optimal heart rate is not unambiguous, like Cooper’s; it has a wider aerobic range of values, depending on the type of physical activity. For gymnastic exercises - 94 beats/min; for measured walking - 108 beats/min; for swimming and skiing - 126 beats/min. I rarely reached the upper limits of my heart rate. The main criterion was that the restoration of the pulse to its original value was, as a rule, rapid. I want to warn you: the optimal pulse recommended by Cooper for a 70-year-old man - 136 beats / min - after myocardial infarction and CABG surgery is unacceptable and dangerous! Long-term results physical training every year they confirmed that I was on the right path, and the conclusions made after the first CABG operation were correct.

Their essence is as follows:

The main thing for the operator is a deeply conscious understanding of the significance of the CABG operation, which saves the patient by restoring normal blood supply to the heart muscle and gives him a chance for the future, but does not eliminate the cause of the disease - vascular atherosclerosis;

The operated heart (CABG) has great potential, which manifests itself with a properly selected lifestyle and physical training, which should be done constantly;

The heart, like any machine, needs to be trained, especially after a myocardial infarction, when more than 25% of the heart muscle has turned into scar, and the need for normal blood supply remains the same.

Only thanks to my lifestyle and physical training system I managed to maintain a good physical fitness and undergo repeat CABG surgery. Therefore, in any conditions, even in the hospital, I always tried not to stop physical training, albeit in a reduced volume (gymnastics - 10-15 minutes, walking around the ward and corridors). While in the hospital, and then in the Cardiology Research Center and the Russian Research Center for Surgery, I walked a total of 490 km before the repeat CABG operation.

Two of my four shunts, installed in March 1985, survived for 14.5 years with the help of physical training. This is a lot compared to the data in the article “Shunts are not forever” (10 years) and the statistics of the Russian Scientific Center for Surgery (7-10 years). So the effectiveness of controlled physical activity for myocardial infarction and coronary artery bypass surgery seems to me to be proven. Age is not a barrier. The need and volume of physical activity should be determined by the general condition of the operated patient and the presence of other diseases that limit his physical activity. The approach must be strictly individual. I was very lucky in that I always had an intelligent, sensitive and attentive doctor next to me - my wife. She not only observed me, but also helped me overcome both medical illiteracy and fear of a possible negative reaction of the cardiovascular system to constantly increasing physical activity.

Experts say that repeat operations pose a particular challenge for surgeons around the world. After my second operation, my rehabilitation did not proceed as smoothly as the first time. Two months later, some signs of angina appeared with this type of exercise, such as measured walking. And although they were easily removed by taking one tablet of nitroglycerin, this really puzzled me. Did I understand? that it is impossible to draw hasty conclusions - too little time has passed since the operation. And rehabilitation began in the sanatorium already on the 16th day (after the first operation, I began more or less active actions 2.5 months later). In addition, it was impossible not to take into account that I had become 15 years older! All this is true, but if a person, thanks to his system, achieves certain positive results, he is inspired and confident. And when fate throws him back overnight, making him vulnerable and helpless, this is a tragedy associated with very strong emotions.

Pulling myself together, I began to work out new program life and physical training and quickly became convinced that my work was not in vain, since the basic approaches remained the same, but the volume and intensity of the loads would have to be increased more slowly, taking into account my new condition and under conditions of strict control over it. Starting with slow walks and 5-10-minute gymnastic warm-ups (head massage, rotational movements of the pelvis and head, inflating the ball 5-10 times), 5 months after the operation I increased physical activity to 50% of the previous: gymnastics for 1 hour 30 minutes (72 exercises, 2300 movements) and dosed walking for 1 hour 30 minutes at a pace of 105-125 steps per minute. I perform them only once in the first half of the day, and not twice, as before. In 5 months after repeated bypass surgery, I walked 867 km. At the same time, I conduct auto-training sessions twice a day, which help me relax, relieve tension and restore performance. My gym equipment so far includes a chair, two gymnastic sticks, a ribbed roller, a roller massager and an inflatable ball. I stopped at these loads until the causes of angina manifestations were fully clarified.

Of course, the CABG operation itself, not to mention a repeat operation, its unpredictable consequences, possible postoperative complications create great difficulties for the operated person, especially in organizing physical training. He needs help, and not just medication. He needs a minimum of information about his disease in order to competently build his future life and avoid undesirable consequences. I almost never came across necessary information. Even in M. DeBakey’s book with the intriguing title “A New Life of the Heart,” the chapter “Healthy Lifestyle” talks mainly about eliminating risk factors and improving lifestyle (diet, weight loss, limiting salt intake, quitting smoking). Although the author pays tribute to physical exercise, he warns that excessive stress and sudden overload can end tragically. But nothing is said about what excessive loads are, how they are characterized and how to live with a “new heart”.

Articles by N.M. helped me develop a competent approach to organizing physical training. Amosova and D.M. Aronov, as well as K. Cooper and R. Gibbs, although all of them were devoted to the prevention of heart attack using jogging and did not affect CABG operations.

The main thing that I managed to do was to save mental activity and creative activity, maintain a spirit of cheerfulness and optimism, and all this, in turn, helped to gain the meaning of life, faith in oneself, in one’s ability to improve and self-discipline, in the ability to take responsibility for one’s life into one’s own hands. I believe that there is no other way and I will continue to continue my observations and experiments, which help me overcome emerging health difficulties.

Arkady Blokhin

Today, few people think about how long they live after bypass surgery of the heart vessels and other important points until the disease begins to progress.

Radical solution

Coronary heart disease today is one of the most common pathologies of the circulatory system. Unfortunately, the number of patients increases every year. As a result of coronary artery disease, damage occurs due to insufficient blood supply to the heart muscle. Many leading cardiologists and therapists in the world tried to combat this phenomenon with the help of pills. But nevertheless, coronary artery bypass grafting (CABG) still remains, albeit radical, but the most effective way to combat the disease, which has proven its safety.

Rehabilitation after CABG: the first days

After surgery, the patient is placed in an intensive care unit or intensive care unit. Typically, the effect of some anesthetics continues for some time after the patient has woken up from anesthesia. Therefore, he is connected to a special apparatus that helps with the breathing function.

In order to avoid uncontrolled movements that could damage the sutures on the postoperative wound, pull out catheters or drains, or disconnect the IV, the patient is fixed using special devices. Electrodes are also connected to it, which record the state of health and allow medical personnel to control the frequency and rhythm of contractions of the heart muscle.

Video

Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for self-treatment. Be sure to consult your doctor!

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

IHD is a whole group of diseases, which is currently one of the main causes of death in developed countries. Every year, about 2.5 million people die from its complications, of which about thirty percent are people of working age. But for last years Significant progress has been made in its treatment. In addition to the wide drug therapy(disaggregants, statins, sortans, b-blockers, etc.) are now actively introduced in the Russian Federation surgical methods. A real breakthrough previously was coronary artery bypass grafting. CABG is still not only one of the most radical operations, but also one of the most proven, proven in clinical practice.

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

Second - availability concomitant diseases before surgery, complicating the course of rehabilitation. It may be diabetes mellitus and others endocrine diseases, hypertension, previous strokes and other neurological diseases.

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

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

Physical rehabilitation: first week

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

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

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

Physical rehabilitation: second to third week

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

Physical rehabilitation: from 21 days

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

Halotherapy is added to physiotherapy, drug electrophoresis(with panangin, papaverine) on the cervical-collar area, electrostatic massage on the surgical area. The duration of the course is just over a month.

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

How to heal open wounds after CABG surgery?

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

After discharge

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

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

— Returning to work is possible in a month and a half. If severe physical labor– the period is negotiated individually with the doctor, if sedentary work – it can be earlier.

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

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

Diet

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

- lean red meat, turkey liver, chicken, rabbit

- any types of fish and seafood

- wholemeal bread, whole grain bread

- low-fat dairy products

- cold pressed olive oil

- boiled vegetables

- fruits in any form

– lightly carbonated mineral water

General forecast

After CABG for a patient need to tune in long-term use individual drugs– statins, antiplatelet agents, anticoagulants, b-blockers and others. The patient’s rehabilitation does not end with just the cardiac surgery and cardiology department. It is advisable to go to a cardio-rheumatological sanatorium annually (the average stay is a month). Also, based on the latest world research data, it follows that average duration patients after CABG is 17-18 years old.

Rehabilitation after CABG: video exercises