Coronary artery bypass grafting is also known as coronary artery bypass surgery. As the name implies, the patient’s own blood vessel (such as the internal thoracic artery, the saphenous vein of the lower extremity, etc.) or a vascular substitute is taken to connect the distal end of the narrowed coronary artery to the aorta, allowing blood to spare the narrowed part and reach the ischemic area, improving the blood supply to the myocardium, thereby relieving angina symptoms, improving heart function, improving the patient’s quality of life and prolonging life expectancy.
This procedure is to establish a smooth path between the aortic root filled with arterial blood and the ischemic myocardium, so it is imaginatively referred to as a “bridge” over the heart, commonly known as “bypass surgery”.
1.Basic introduction
Coronary artery bypass grafting (CABG) is the most effective method for treating coronary artery disease, which has been recognized internationally for more than 30 years.
Generally speaking, when the coronary artery lumen stenosis is less than 50%, it has little effect on blood flow and can have satisfactory results with drug treatment. When the stenosis reaches 75%, the flow of blood is significantly affected and angina symptoms arise. In this case, interventional stenting or surgical bypass surgery is required. Currently, interventional stenting has become the main treatment for coronary artery disease, and is usually performed for single coronary artery stenosis or limited stenosis of multiple coronary arteries. Only for diffuse stenosis of multiple coronary arteries, bypass surgery is required.
2. Scope of application
It should be emphasized that patients with coronary angina, when the effect of drug treatment is not good, should receive stent surgery or bypass surgery in time, so that not only can eliminate the heart Coronary artery bypass surgery procedure angina, so that the patient can live and work normally, but also can prevent myocardial infarction and sudden death. For ventricular wall tumor formed after myocardial infarction, which seriously affects the heart function and produces serious heart rate arrhythmia or thromboembolism, in this case, surgery must be performed to remove and perform coronary artery bypass surgery at the same time, the effect will be better.
3.Suitable group
Left main stem lesion: According to the domestic and international guidelines, surgery is the first choice for left main stem lesion. This is because once blockage or restenosis of the left main trunk occurs, it may lead to heart life after coronary artery bypass surgery. To narrow the risk, bypass is the best choice.
Three branch lesions: There are more lesioned vessels, and if interventional treatment is chosen, many stents have to be placed, which will greatly increase the chances of restenosis and thrombosis. Moreover, the financial burden on the patient is higher.
Patients with cardiac insufficiency: These patients need complete hemodynamic reconstruction to promote the recovery of ischemic myocardium, which is difficult to do with interventions.
Patients with diabetes mellitus: Normal stents have a high restenosis rate in diabetic patients, while pharmacological stents have been introduced for a short time, and there is no clear evidence that intervention will have better efficacy than bypass.
Patients with post-coronary myocardial infarction complications: ventricular rupture, septal perforation, and mitral valve closure insufficiency must be treated with surgical bypass surgery as an option.
Patients allergic to anti-platelet drugs: Hong Tao, deputy director of the Department of Cardiology at Peking University First Hospital, said that since stents require patients to take anti-platelet drugs, patients allergic to this drug should also consider bypass surgery. “However, if the patient has respiratory disease, it may be dangerous to receive general anesthesia and is not suitable to receive conventional extracorporeal circulation bypass, and interventional treatment should be chosen instead.”
4. treatment pros and cons Pros and cons of coronary artery bypass grafting versus stent intervention
Coronary artery bypass grafting CT diagram cardiac catheterization stent intervention is a very fashionable method of treating coronary heart disease. There are three main ways to treat coronary heart disease: medication, surgery and stent intervention, each with its own strengths and weaknesses.
Medication does not change the narrowing of the blood vessels, but it is still the basis of coronary heart disease treatment and an important tool. In the case of severe narrowing of the heart vessels, coronary artery bypass surgery should be considered. And now when there is a severe stenosis (70% or more) or occlusion in the coronary vessels, stent intervention can be considered.
The advantages and disadvantages between bypass surgery and stent intervention. Coronary artery bypass surgery is a “big battle” and can solve severe coronary artery lesions, but it requires general anesthesia, tracheal intubation, extracorporeal circulation, a long operation time and a long hospital stay. Stenting, on the other hand, requires only local anesthesia and can be performed by puncturing the femoral artery in the thigh. Of course, not all patients with coronary artery disease are suitable for stent intervention. It is more difficult to do intervention for curved vessels, complete occlusion, bifurcation and left main stem stenosis. Stent intervention also has its own disadvantages. It has a high early success rate, a low chance of complications, and is simple and easy to perform with outstanding results, but the disadvantage is that there is almost a 30% restenosis rate at the six-month cycle;
5. Precautions
(1) Wound care diligently: It is normal to have slight redness, pain and swelling at the wound when discharged from coronary artery bypass grafting, sometimes even lasting for several months. After going home, you should check the wound frequently, and if you find any signs of infection, you should go to the hospital in time. The wound should be rinsed with water or antibacterial soap daily and the wound should be covered with a sterile dressing. The ankle may be swollen for several weeks after surgery. You can wear elastic stockings or elevate the affected limb at rest to reduce the swelling.
(2) Scientific arrangement of diet: After surgery, you should ensure the intake of appropriate amount of fruits and vegetables every day, eat more foods with high protein content (such as fish, eggs, etc.) and foods containing unsaturated fatty acids (such as corn oil, olive oil, sunflower oil, etc.), and eat less foods with high saturated fatty acid content (such as animal oil, cream, etc.).
(3) Small amounts of alcohol and strict prohibition of smoking: It is best not to drink alcohol after surgery, and to drink up to 50 ml of red wine per day. Smoking is an important risk factor for heart disease, so smoking should be strictly prohibited.
(4) Get plenty of rest: During the 4-6 week post-operative recovery period, it is important to get 8-10 hours of sleep per day. All activities should be scheduled after sufficient sleep, and the amount of activities should not feel strenuous.
(5) Appropriate participation in activities: After discharge from the hospital, you can first walk for 10 minutes in the morning and 10 minutes in the evening, and gradually increase the speed and extend the distance after a few days. During the process of increasing the amount of exercise, it is normal to have a slight headache, fatigue, sweating and general aches and pains. If angina attacks while exercising (such as walking), nitroglycerin should be taken under the tongue immediately. If it is still not relieved, or accompanied by shortness of breath, sweating, pain for more than 15 minutes, you should go to the hospital as soon as possible. It is advisable to choose to exercise in the morning or evening when the weather is cool in summer, or in the gymnasium in winter. Going upstairs is a moderate or heavy physical activity. Patients who live upstairs at home can go upstairs slowly by themselves. Later, it can be changed to do some light housework, such as cleaning, cooking, washing dishes, etc. It is important to avoid lifting heavy objects, such as moving furniture, scrubbing floors, etc. Avoid pulling the chest for 4-6 weeks after surgery, including holding children, pushing heavy objects, driving, etc.
(6) Pay attention to changes in memory and vision: Temporary loss of memory and concentration may occur after surgery. However, this is uncommon and can usually return to normal within a few weeks. There is usually a slight change in vision after surgery, but all of them can be restored to preoperative vision after 6 months.
(7) Pay attention to the negative psychological impact: Surgery is not only physically traumatic, but also has a large negative impact on the mental psychology, and many patients will experience depression. If symptoms such as sleep disturbance, weakness, drowsiness, apathy and despair and suicidal tendency appear, these are manifestations of depression and should be promptly seen by the psychological consultation department of a regular hospital.