From this article you will learn: what is aortocoronary bypass, full information about what a person will have to face in such an intervention, and how to achieve the maximum positive result from such therapy.
- Contents of the article:
- What is the operation of
- Indications
- Possible contraindications
- Preparing for operation
- Hospitalization as undergoing operation
- Life after shunting
- Results of treatment
Aortocoronary shunting refers to the surgical operation of the affected heart vessels( coronary arteries) directed at the atherosclerosisrestoration of their patency and circulation by creating artificial vessels that bypass the sites of constriction, in the form of shunts between the aortaand a healthy portion of the coronary artery.
Such an intervention is performed by cardiac surgeons. It is difficult though, but thanks to modern equipment and advanced operational technology of specialists, it is successfully performed in all clinics of cardiosurgery.
The essence of the operation and its types
The essence and meaning of aortocoronary shunting is the creation of new, by-pass vascular ways to restore the blood supply to the myocardium( cardiac muscle).
Such a need arises in chronic forms of coronary heart disease, in which atherosclerotic plaques are deposited within the lumen of the coronary arteries. This causes either their constriction or complete blockage, which disrupts the blood supply to the myocardium and causes ischemia( oxygen starvation).If the blood circulation is not restored in time, it threatens a sharp decrease in the working capacity of patients due to pain in the heart under any load, as well as a high risk of heart attack( necrosis of the heart) and death of the patient.
With the help of aortocoronary bypass it is possible to completely solve the problem of disturbed blood circulation in the myocardium in ischemic disease, caused by narrowing of the heart arteries.
During the intervention, new vascular messages are created - shunts replacing insolvent own arteries. As such shunts are used either fragments( about 5-10 cm) from the arteries of the forearm, or superficial veins of the thigh, if they are not affected by varicose veins. One end of such a shunt prosthesis of its own tissues is sewed into the aorta, and the other into the coronary artery below the site of its narrowing. In this way, blood can go unhindered to the myocardium. The number of shunts applied during one operation is from one to three, which depends on how many arteries of the heart are affected by atherosclerosis.
Types of coronary artery bypass graft Stages of intervention
The success of any surgical intervention depends on compliance with all requirements and the correct execution of each consecutive period: preoperative, operational and postoperative. Given that the intervention of aortocoronary shunting involves manipulation directly to the heart, there are no trifles here at all. Even an ideally performed surgeon operation can be doomed to failure due to neglect of secondary training rules or postoperative period.
The general algorithm and the path that each patient should undergo in aortocoronary bypass surgery is presented in the table:
Period Activities carried out at stage 1. Preoperative period Determination of indications and contraindications Inspection Preparation for operation 2. Immediate intervention Hospitalization at the clinic Day of operation Stay in the operating room First hours after the intervention 3. Postoperative period EarlyIRS hospital discharge and rehabilitation Return to normal life When is shown shunting
Aortocoronary bypass surgery is not the only option for surgical treatment of ischemic disease. There is an alternative method - endovascular surgery. Although it is more easily tolerated by the sick, it is still less radical and in all cases it does not solve the problem.
The main indication for coronary artery bypass grafting is ischemic heart disease with severe and multiple narrowing of the heart arteries:
- stable angina pectoris 3-4 of the functional class, as well as its unstable form, which are not medically treated in people without severe comorbidities;
- failed attempts to endovascular treatment of ischemic disease;
- overlap of the left coronary artery by more than half( by 50%);
- multiple narrowing of the heart arteries( more than 70%);
- marked narrowing of the anterior interventricular artery at the point of its departure from the central artery, combined with any manifestations of coronary artery atherosclerosis.
Possible contraindications to
Among patients requiring coronary artery bypass grafting, there are those to whom it can not be performed:
- common multiple contractions of all coronary arteries affecting their terminal sections;
- marked decrease in myocardial contractility as a result of cicatricial degeneration after extensive heart attack;
- congestive heart failure;
- severe concomitant diseases of the lungs, liver, kidneys, extensive stroke, malignant tumors in people of any age.
Elderly age is not a contraindication to coronary artery bypass grafting if the general condition of the patient is satisfactory.
Preparing for operation
The patients with the established diagnosis and indications for coronary artery bypass grafting are selected by the clinic where the operation will be performed, as well as the operating cardiac surgeon, consulted beforehand with him, and decides the date of hospitalization to the hospital.
Compulsory examinations of
Each patient, who is undergoing aortocoronary bypass surgery, must be thoroughly examined. This is necessary in order to assess the general condition of the patient and the features of the disease, determine the degree of risk, prepare beforehand to overcome possible difficulties before the intervention.
The scope of compulsory diagnostics is given in the table:
Diagnostic methods List and features of the research Blood tests General clinical study, biochemistry, lipid spectrum, troponins, electrolytes, coagulation ECG At rest, exercise tests, Holter monitoring( daily ECG record) Ultrasound of the heart Standard ECO study and duplex scanning Coronarography Graphical registration of coronary arteries and their narrowing on an X-ray monitorre 
Diagnostic methods that must be completed before operation Hospitalization, how to proceed
It is best to go to the hospital 3-5 days before surgery. During this time:
- A further examination, additional diagnostics and consultations of different specialists are conducted, if there is a need in them.
- Patients communicate with the attending physician, with other patients who are already recovering. This greatly reduces the excitement and experience, adjusts the person to a positive shunting result.
- Provides maximum physical rest, training in proper breathing in the early postoperative period.
On the day of operation
Surgical intervention begins in the morning. Early hair shaves the hair on the chest in order to prepare the operated area. The patient is examined by an anesthesiologist( a doctor who will perform anesthesia), measures all vital signs. There is nothing in the morning, the last meal the night before in the form of a light dinner. If everything goes according to plan, the patient on a reclining gurney is transported to the operating room.
How the operation is performed
The average duration of aortocoronary bypass surgery is 3-6 hours( the more shunts will be applied and the more coronary arteries are affected, the longer the operation).A deep combined anesthesia is needed on apparatus breathing. Depending on the complexity of the shunting, the question is solved - is it necessary to stop the patient's heart, providing blood circulation with an artificial device. If the shunt is only one, and the operating surgeon is sure that there will be no problems with superposition of the vascular sutures, the manipulations are performed on the working heart. Otherwise, they resort to the apparatus of artificial circulation.
A short video with an illustration of the process( in English):
Step by step:
- access to the heart - a cut across the entire thorax in the middle of the sternum with a longitudinal intersection of the bone;
- evaluation of the heart, aorta and coronary arteries;
- sampling of fragments of vessels that will serve as shunts - areas of the large saphenous vein of the thigh or arteries of the forearm( often radial);
- cardiac arrest( if necessary) and attachment of the cardiopulmonary bypass device;
- application of vascular sutures between the aorta, coronary arteries and shunt ends;
- start the heart and restore its normal activity;
- layer-by-layer stitching of the formed wound on the chest.
Places of incisions for coronary artery bypass grafting 
Life after bypass
Patients who underwent aortocoronary bypass surgery remain in resuscitation during the first few days after the operation. Transfer to the general department is carried out after complete restoration of consciousness, breathing, circulation. In the early postoperative period it is important to adhere to such rules:
- Do not overstrain, gradually and smoothly perform all the movements allowed by the doctor( sit, get out of bed, walk).
- Control breathing( breathe moderately deep and smoothly) in order to prevent pneumonia, accelerate the healing of the sternum and restore the motor activity of the chest;
- If you want to cough, do not hold back and do not be afraid to do it. A rare moderate cough improves the condition of the lungs.
Every day, dressings are performed and wound healing is monitored. Sutures are removed for 9-14 days. Despite the healing of the skin, the bone scar at this time is still very weak. To ensure faster scarring, special post-operative bandages for the thorax help.
Rehabilitation
Restoration of motor activity should be gradual: starting from 3-4 days independently sits down, get out of bed, walk within the chamber, and then along the corridor. Usually, by the time of discharge, patients are allowed to walk about 1 km per day.
After discharge 2-3 weeks is better spent in a specialized sanatorium. The average duration of rehabilitation is 1.5-3 months. In the event of this time, under condition of complete absence of complaints, an ECG with a loading test is performed. If the changes characteristic of ischemic disease are not detected, the patient returns to work and daily life.
Results of treatment
The probability of early complications( heart attack, stroke, thrombosis, impaired healing or wound suppuration, lethal outcome, etc.) is 4-6%.To predict the likelihood of late complications and the life expectancy of the patient is difficult, but the average term of normal functioning of the shunts is 10 years.
About 60-70% of people after coronary artery bypass grafting, complete disappearance of symptoms, 20-30% of the impairment is significantly reduced. Provided that all recommendations of the specialists are repeated, atherosclerosis of the coronary arteries and shunts can be avoided in 85% of cases.
