Coronary bypass - what is it? Coronary artery bypass grafts

Ischemic heart disease is a real scourge of the 21st century. Almost every second person suffers from this disease. Some can treat this disease medically, but some people need surgical intervention. One of the main operations that restore blood flow in the vessels of the heart is coronary bypass.

What it is?

This term began to appear in many medical sources for a long time. Currently, this operation is almost the only one of its kind. According to statistics, around a million such interventions are carried out annually around the world.

As it was said, most patients with coronary artery disease need coronary artery bypass grafting. Unfortunately, few people know what it is.

The operation of coronary artery bypass grafting involves the imposition of detours on the vessels of the heart.

The operation is extensive and quite heavy.

According to statistics, this operation is carried out only 12 percent of all who need it. Some have contraindications to its conduct, others do not always seek medical help.

As soon as the operation appeared, many eminent scientists showed considerable interest in it, however, two years after its creation, the operation was banned. It was reintroduced only a few years later, when this operation began to appear in the world's publications. Since then, its use has become almost daily, and many doctors do not represent another possibility of curing IHD, except for carrying out this operation.

Pathogenesis of ischemic heart disease

Coronary heart disease develops when coronary vessels begin to experience oxygen deficiency. This is due to the narrowing of their lumen. Causes leading to narrowing, a lot - ranging from congenital malformations and pathological narrowing from birth and ending with a decrease in lumen due to the proliferation of atherosclerotic plaques.

Normally, IHD symptoms do not manifest themselves until the lumen is narrowed by more than 70 percent. The clinic can appear only in case of significant physical exertion.

The main signs of the development of IHD is pain in the chest, accompanied by shortness of breath and a sense of fear. With a significant narrowing of the coronary vessel, the risk of developing a heart attack increases.

With ineffectiveness of conservative therapy (reception of vasodilator drugs), a shunting of the coronary arteries is performed.

Progress of the operation

The operation is performed on the open heart, i.e., it is necessary to open the thorax. The incision is usually made along the costal cartilage on the left.

The patient is connected to the cardiopulmonary bypass for the time of intervention .

The operation is performed under general anesthesia.

To create a shunt, usually use surface vessels (subcutaneous vein of the leg or internal thoracic artery). The obtained shunt, after its extraction, is placed above and below the level of the narrowing of the coronary artery and sutured inside the vessel. This facilitates the blood flow along the affected artery and allows to remove myocardial ischemia.

In some cases, a radial artery transplant is used, since the blood flow through the arteries is much better.

Currently, more are inclined to conduct operations without the use of artificial circulation, since the passage of blood through this apparatus contributes to the damage of red blood cells and hemolysis.

Indications for operation

Coronary artery bypass grafting is indicated in the following cases:

• Reducing the patency of blood on the left coronary artery by at least 50 percent. This vessel is the main one in myocardial nutrition. Most of the blood goes exactly on it, because of which the block at the level of this vessel is fraught with severe ischemia and myocardial infarction.
• Reducing the lumen of all coronary vessels to 70 percent.
• Presence of stenosis of the anterior interventricular artery (especially in the place of its bifurcation).

These indications are the main ones for coronary bypass surgery.

In addition, they can identify secondary, symptomatic indications. They are caused by frequent attacks of angina (pain, a feeling of compression in the chest) and usually stop medicamentally. However, the problem becomes more serious when drug therapy loses its effectiveness, and seizures become more frequent. It is in this case that the question of shunting should already be raised.

Contraindications

Thanks to the wide dissemination of information technology, it is not difficult to learn about coronary artery bypass grafting - what it is, what testimony it has. Everything is somewhat more complicated with contraindications.

Unlike indications for surgery, all contraindications are relative, since in each patient the question of the operation should be considered based on its specific data.

It was believed that the age of the patient, especially over 70 years of age, is a prohibiting factor for the intervention. Currently, many older patients are well tolerated for heart surgery (this is due to the absence of concomitant chronic diseases affecting hemodynamics). For those who have such diseases, doctors are more inclined to heart and vascular transplant (if there are no decompensated conditions).

Earlier, coronary artery bypass grafting was not performed with renal insufficiency or an active oncological process. Now you can find information about quite successful interventions in such patients with a favorable outcome and prolongation of life by more than 10 years.

Rehabilitation of patients

Since the operation is quite extensive and difficult, it is important to properly manage patients who underwent coronary bypass surgery. After the operation, complications such as pulmonary ventilation (due to the patient's long history of ventilation) and infectious complications quite often develop.

Prevention of respiratory disorders is carried out by inflating a ball or a special toy. To prevent the development of infectious complications is more difficult - not always careful and timely change of bandages helps to prevent the infectious process.

Be sure to monitor the patient's blood counts, because massive operations can often lead to significant blood loss. In this case, the patient simply needs a blood transfusion to make up for her deficiency.

All patients who underwent this operation - coronary artery bypass grafting - should for a long time undergo rehabilitation and avoid stresses. This is done to prevent the divergence of metal staples imposed on the sternum.

Opinions of patients regarding the operation

More and more patients are being intervened on the vessels of the heart. If you study different sites and forums devoted to this problem, it is clear that many people who underwent coronary artery bypass grafting have rather positive feedback. Significantly improved quality of life, and many patients can return to full-fledged activity (only after the rehabilitation period). The number of attacks of angina decreases, which significantly affects daily activity.

Many people ask themselves - how much does this operation cost?

It all depends on what the patient's state of health is at the time of determining the indications for the operation. If you are shown coronary bypass surgery, the price will be composed of such factors as the amount of intervention, the qualification of the operating surgeon, but almost all such operations are free of charge. The money for their holding is allocated by the state budget (in private clinics the cost of the operation varies from 7 to 10 thousand dollars, which is quite expensive).

Is it worth doing this operation?

Many patients with long-term angina suffer from coronary artery bypass grafting. What is this - know a few, because of what they necessarily need a detailed explanation of the doctor. Some are frightened and refuse surgery, since the procedure is rather complicated and difficult, and the risk of complications is extremely high. Others deliberately take risks, realizing that without intervention everything can turn out much worse.

Whether it is worth doing an operation is an individual choice. However, if the operation is indicated, then it is better to carry it out, because with a favorable outcome (lethality during the operation is less than 2 percent), the condition and quality of life improves significantly.