I. What is coronary heart disease? What are the risk factors for the disease? What are the symptoms of coronary heart disease?
The heart is a 24-hour organ that must ensure adequate blood supply. The blood supply to the heart muscle comes from the left and right coronary arteries that originate from the root of the aorta.
Coronary artery disease is a heart disease caused by atherosclerosis of the coronary arteries, which blocks the lumen of the vessels and leads to ischemia and hypoxia of the heart muscle. Heart disease is caused by narrowing of the lumen of the coronary arteries that supply the heart itself due to the formation of atheromatous plaque in the walls of the coronary arteries. The clinical symptoms of coronary heart disease vary depending on the number of branches and the degree of coronary artery stenosis. The cause of this disease is not yet fully understood, and the factors are as follows.
1, age and gender ;
2, hyperlipidemia;
3, hypertension;
4, smoking;
5, diabetes mellitus;
6.Obesity;
7.Sedentary lifestyle;
8, there are also genetic, alcohol consumption, environmental factors, etc.
The symptoms of coronary heart disease are closely related to the degree and number of branches of atherosclerotic stenosis of coronary arteries, that is, depending on the degree of ischemia of the heart. It can produce angina pectoris, myocardial infarction, arrhythmia, heart failure, and even sudden death. Angina pectoris is a typical symptom of coronary heart disease. It is characterized by paroxysmal, crushing retrosternal pain, which may radiate to the back of the shoulder and the left upper extremity, and is prone to attack after exertion, after a full meal, when emotionally excited, or when cold, usually lasting 3-5 minutes. It is accompanied by pallor, cold sweat and difficulty in breathing.
Second, the treatment of coronary heart disease and coronary artery bypass grafting
Drugs can only control the symptoms and stabilize the plaques in the coronary arteries. Drugs are the foundation, but not the ultimate cure. Coronary artery bypass grafting (CABG), also known as “coronary artery bypass grafting”, is a procedure in which a vein or artery that does not affect physiological function is taken from the patient and connected at one end to the root of the aorta and at the other end to the distal end of the coronary artery lesion, just bypassing the diseased part of the coronary artery, like a “bridge” to reach the distal end. “CABG is not only a good solution to various problems, such as lesions at branches of coronary arteries, lesions at multiple branches, unprotected left main lesions, etc., but also the most thorough and complete way to reconstruct blood flow. According to the authoritative data, patients who are followed up after bypass surgery can return to normal work in 1-2 months, and the ten-year patency rate of the internal mammary artery bridge also reaches more than 90%, which is the best coronary artery replacement material at present.
Indications for this procedure are.
1.Stenosis of more than 50% in three vessels of the left main stem;
2.Proximal left main stem (proximal anterior descending branch and proximal gyrus branch) blockage of 75% or more;
3.Coronary artery stenosis combined with ventricular wall aneurysm formation;
4.Multiple stenoses of the anterior descending branch of the coronary artery or the right common coronary branch, which are not suitable for PCI.
5.People with failed PCI intervention.
III. Traditional extracorporeal circulation coronary artery bypass grafting
Traditional surgery is usually performed under general anesthesia, hypothermia, extracorporeal circulation, and cardiac arrest, and usually takes 3-4 hours. During the surgery, the saphenous vein on the calf or thigh is removed and anastomosed to the distal end of the narrowed coronary artery at one end and to the ascending aorta at the other end, or several lateral holes can be opened in one vein at the same time to anastomose to several coronary arteries side-by-side, which is called sequential bypass or serpentine bypass.
With saphenous vein bypass, the surgery is less invasive and simpler, but the long-term results are worse than arterial bypass, so it is suitable for older patients. The arterial bypass is more damaging, technically demanding, and more difficult to perform, but the long-term results are better than the saphenous vein, so it is suitable for younger patients. In general, the saphenous vein bypass can be used alone in elderly people over 80 years old, while arterial bypass can be considered for those under 55 years old, and an internal mammary artery plus the saphenous vein can be used in other ages. And with the development of new technology, for patients with poor cardiac function and unable to tolerate extracorporeal circulation techniques at advanced age, coronary artery bypass grafting is performed with the heart beating, and the surgery is significantly less damaging to the patient, with less blood transfusion and faster recovery.
IV. Minimally invasive coronary artery bypass grafting
Minimally invasive cardiac bypass grafting is different from traditional coronary artery bypass surgery under extracorporeal circulation. It is done without extracorporeal circulation device and the target vessel is fixed with the help of cardiac table stabilizer under the beating heart, which has the advantages of less trauma, no or less blood transfusion and faster recovery, reduces the incidence of postoperative brain complications and better solves the problem of senior heart surgery.