The surgical management of a blocked coronary artery is called coronary artery bypass grafting. An extra blood vessel is removed from your body and sutured to the distal end of the narrowed coronary artery at one end and to the aorta at the other end, usually a vein, obtained from the lower extremity, or possibly an artery, obtained from the inside of the chest wall. After bypass surgery a good blood supply is re-established and blood is also passed from the aorta to the distal end of the blocked coronary artery through the bypassed bridge. Sometimes one or more bridges need to be created to improve myocardial ischemia overall. Removing the vein from the leg usually does not create any problems because the function of the vein can be replaced by other veins. The length of the vein needed for bridging depends on how far the blockage is from the aorta and how many bridges are needed. Sometimes the intrathoracic artery (called the internal mammary artery) is also used for bypass, and bypass with the internal mammary artery requires only a suture at its free end to the distal end of the blocked coronary artery. The long-term patency rate of arterial bridges is usually higher than that of venous bridges, but arterial bridges are somewhat more limited and more invasive in their extraction, and the surgeon will decide which material to use for bypass depending on the characteristics of the coronary artery lesion. Traditionally, coronary artery bypass grafting is performed under extracorporeal circulation, and 70% of its postoperative complications are also related to extracorporeal circulation, mainly systemic inflammatory reaction, immune deficiency and damage to the aortic wall. In recent years, minimally invasive coronary artery bypass grafting has been rapidly promoted worldwide, and China is no exception. Minimally invasive coronary artery bypass grafting refers to a group of cardiac surgical techniques that avoid extracorporeal circulation or conventional median sternotomy, reduce trauma, accelerate patient recovery after surgery, and reduce hospitalization time and cost. At present, the level of minimally invasive coronary artery bypass grafting technology in our hospital is among the leading ones in China, and we preside over the scientific and technological research projects in Hubei Province.
What are the indications for coronary artery disease surgery?
1.Surgical indications for angina pectoris.
(1) Stable angina is ineffective by medical treatment, and obviously affects labor and life ability or is confirmed by imaging to be a proximal lesion of the left main trunk or multiple vessels.
(2) Unstable angina is not treated by internal medicine.
(3) Variable angina with moderate to severe coronary artery obstructive lesions, drug treatment, ineffective.
(4) Post-infarction angina: if coronary angiography is performed at the same time as medical treatment, it is confirmed that there is significant stenosis or obstruction in the main trunk or major branches of the coronary arteries.
2.Surgical indications for coronary lesions.
(1) Stenosis and obstruction of the left main trunk >50%.
(2) Left anterior descending branch near high stenosis obstruction > 50%, not suitable for percutaneous transluminal coronary angioplasty (PTCA).
(3) Three or more branches with obvious symptoms.
3.Acute infarction: Emergency “bypass” within 6 hours after the infarction. If the infarction has exceeded 6 hours, the surgery should be performed after 1 month of medical treatment.
4.Complications after acute infarction.
(1) Left ventricular wall tumor.
(2) Perforation of the ventricular septum.
(3) papillary muscle rupture.
(4) left ventricular rupture.
(5) Post-infarction cardiogenic shock should be operated urgently if it cannot be controlled by medical treatment.
(5) If there is no symptom of occult coronary artery disease, but myocardial ischemia is found in electrocardiogram, coronary angiography should be performed, and if it is determined that there are obvious stenotic lesions in the main trunk or multiple major branches of coronary arteries, surgery should also be performed to prevent heart attack or sudden death.
Second, what should be done before coronary artery disease surgery?
The preparation is centered on the central issue of reducing myocardial oxygen consumption.
1.Psychological preparation: increase the awareness of surgery, which is not very risky compared with the risk of medical treatment. Active request or willingness to accept the treatment makes the surgery half successful.
2.Cardiopulmonary exercise: practice deep breathing, coughing, closing the air, etc., and preoperative oxygen intake.
3.The amount of whole body activity should be reduced and the amount of limb activity should be increased before surgery.
4.Clean your teeth once before surgery, brush your teeth 4 times a day, rinse your mouth in the morning and in the evening, and ensure “four cleanings and one emptying” (i.e., clean mouth, pharynx, nasal cavity, skin, and empty intestine) before entering the operating room. Take oral supplemental blood volume.
5.Pre-operative diet should be high vitamin, high fiber, low animal fat, low cholesterol, low calorie, high quality protein, easy to digest food, such as soy milk, shrimp, lean meat, fish, soy products, green vegetables, fruits, etc.
6.Keep the volume of urine at about 1500-2000ml per day, and keep the stool free of dryness, 1-2 times per day.
7.Keep sleeping 8-10 hours a day and drink 200-300ml of water before going to bed, at night and before getting up.
8.Maintain blood pressure below 135/85mmHg, heart rate 70 times/min or less, blood glucose below 8mol/l. Patients whose weight exceeds 20% of standard weight should consider losing weight.
9, actively cooperate with the completion of preoperative training of medical staff is an important part of ensuring the safety of surgery.
C. What should I pay attention to after coronary artery disease surgery?
After coronary artery bypass surgery, there is a gradual recovery process for both the heart function and the whole body, and the recovery time will be different depending on the patient’s preoperative coronary artery disease degree, heart function condition and physical condition. During this period, there are some precautions to be observed, which will help you recover as soon as possible, so that the operation can obtain satisfactory results.
1. Diet
During the recovery period after coronary artery bypass surgery, it is usually necessary to increase the intake of calories, proteins and vitamins to facilitate the recovery as soon as possible after the surgery. However, after this period, dietary treatment, i.e., control of hyperlipidemia, is a long-term task for patients with coronary artery disease. This is because coronary artery bypass surgery only treats the myocardial ischemia caused by blocked coronary arteries, but not the cause of coronary heart disease. Therefore, in terms of diet, attention to control hyperlipidemia is one of the important measures to prevent and slow down coronary artery or post-operative blockage again.
2.Exercise
Initially, you can walk around the room and the house, holding on to something while walking. Then, when you feel no difficulty, you can start walking, which is a good and effective exercise method. This method can improve blood circulation and increase the strength of muscles and bones, and start walking at a speed and pace that feels comfortable. Later, gradually accelerate the pace. To increase the heart rate and respiratory rate, can be three times a day, each time five minutes, starting from a comfortable walk, and then gradually increase the time and distance of the walk, to be able to tolerate themselves, more walks a day, than a long walk is more beneficial, adhere to the daily walk, and the daily walk distance gradually increase, as long as they can tolerate, can slowly go up the stairs, up a small hill, in the movement and exercise In the process, if chest pain occurs, it should be stopped immediately, shortness of breath, asthma and fatigue should also be stopped immediately, if these symptoms disappear, you can continue the activity at a slower pace, and then increase day by day. Fatigue is inevitable until you fully regain your strength, and you may feel your heart beating very strongly when you are active, but as long as the heartbeat rules are not particularly fast, this is normal and should not be a concern. In a few cases, some people feel a sudden loss of control of their heart or a rapid heartbeat, and may feel mild dizziness, weakness, and irregular pulse. Here are the training recommendations.
First week (week 1): Two five-minute walks per day.
Second week (week 2): two ten-minute walks per day.
The third week (the third week): two times a day, each time twenty minutes of walking.
The fourth week (fourth week): should be increased to one kilometer walk per day.
In winter or hot summer, you may not be able to walk outdoors, if so, you can rent or buy an indoor bike or exercise machine, exercise twice a day, 30 minutes each time, you can replace your exercise outdoors, you can slow walk on your jogging machine (fitness machine).
3.Work
Work recovery depends on your post-operative energy and physical recovery status. Avoid making major decisions, such as: investment, financial, work, family and other major decisions, as much as possible (at least within one month after surgery). It is normal to feel exhausted and have a feeling of crying out after surgery, which has consumed a lot of energy during the surgical hospitalization. All these factors must be taken into consideration as each person’s situation is different, their physical ability is different, as well as the time and intensity of the work they are doing.
4.Homework
Initially, you should engage in some light housework, such as removing dust, managing flowers and plants, helping to prepare meals, but those activities that require a lot of physical strength, such as vacuuming floors, carrying children, moving furniture or participating in sports, should be postponed to a later time.
5.Post-operative review
When you leave the hospital, you should make an appointment with your doctor when to review. If you have any discomfort or problems while you are resting at home, please do not hesitate to contact your local hospital or the hospital where you had your surgery as soon as possible. Usually, a full review should be done once in 3 – 6 months after surgery. If the local hospital is familiar with your situation it can also be done locally, or you can go to the hospital where the surgery was completed.
6.Wound protection and treatment
Within a few weeks after surgery, the wound will usually have different degrees of pain and sometimes local redness, usually after a period of time, the above performance will disappear, sometimes more than a few weeks. However, if there is more severe pain, redness and swelling, as well as discharge from the wound, it is important that you seek medical attention as soon as possible. Patients with coronary artery bypass grafting usually have an incision in the leg. It is helpful to elevate your lower extremities when you are resting and when you are sitting to reduce discomfort or swelling in your legs. If you feel discomfort in the wound on your chest or leg (lower extremity), give a local heat pack for 15 to 20 minutes, and also take some oral pain medications if needed under the guidance of your doctor, they will gradually reduce your pain, but if the pain problem of the wound persists, it is better for you to go to the hospital at this time.
Some factors can cause general discomfort or pain, including changes in body temperature, infection, prolonged stay in one position, etc. If there is wound pain, you can try shrugging your shoulders forward to relieve the pain. The correct posture to maintain after surgery is to hold your chest up as high as possible when your body is in an upright or sitting position, with your shoulders slightly back. If you do not maintain the correct posture during this recovery phase, you will feel a tightening sensation on your chest when you stand up straight. The small gauze on the surface of the wound is temporary and should be removed three days after the stitches are removed. A week or so after the stitches are removed, you may wash the area of your wound with clean water and soap as long as the wound is healing well. Do not swim or do throwing sports until the wound has healed.
7. Visiting and hospitality
Within the first few weeks of your return home, you should try to avoid making noise and contact with people who have injuries, colds, sore throats and other signs of infection. If you are discharged from the hospital with a cold that can aggravate your localized wound pain, you should try to avoid people coming to your bedroom, visiting or attending various other types of gatherings until you have fully recovered, unless your doctor allows you to do so.
8.Sock care
During the initial recovery period, white elastic stockings can improve the blood supply to your lower extremities and reduce the collection of fluids and body fluids in your lower extremities.
9. Healing of the sternum
For the first three months, do not lift more than 10 to 15 pounds. Due to the wound recovery, it takes about six weeks, (each individual varies slightly) the healing of the sternum takes about three months, during this recovery process, although your sternum will not be cracked by light activities, it is still necessary to protect them. These actions create a tension on your healing sternum. According to your previous concept and feeling, you can lift heavier objects, but your wound may not be able to tolerate it. A reasonable exercise should not only not hurt your sternum, but also keep your upper limb muscles under certain tension, and at the same time avoid stiffness of the shoulder, which will help you recover as soon as possible, you can repeat the posture shown in the figure twice a day for one month after discharge. If you feel localized pain, increased movement of the sternum. Or there is a local discharge from the wound, or the local redness and swelling of the wound increases, you should seek medical attention from the relevant doctor as soon as possible.
10.Drinking alcohol
Drinking alcohol for a heart patient, whether it has a good effect or a bad effect, can not be absolutely said, moderate drinking is feasible, but for patients with diabetes, high triglycerides or poor heart function to completely avoid drinking alcohol, because drinking alcohol will aggravate the existing disease, if there is no such problem, you can still enjoy a small glass of wine before meals or bed, but you better limit your drinking to two times a day, a glass of Alcohol is a good source of energy in this respect, and there is still the possibility of weight gain for drinkers. In addition, alcohol still has a harmful effect on the major organs of the body, and since alcohol increases the side effects of sleeping pills, do not mix sleeping pills, sedatives and alcohol if you are on medication.
Medication: The doctor will bring you some post-operative medication when you leave the hospital:
1.You should know the name and appearance of each drug you take.
2.Take your medication on time as instructed by your doctor.
3.Do not stop taking your medication without your doctor’s permission.
Do not give your medication to your family and friends, as it is good for you and may be harmful to others.
5. Please tell your doctor about any side effects you experience while taking the drug. Some drugs have mild side effects that will go away over time, but some may persist and should not be ignored. We think it is very important to know exactly what each medication does for you.
V. How to prevent coronary heart disease?
We suggest you pay attention to some health care knowledge and the following advice.
1.Actively prevent and treat hyperlipidemia
Use dietary treatment and improve lifestyle. Fat intake should not exceed 10% of total calories. Saturated fat <30% and cholesterol intake <300mg/day. Should eat more protein-rich foods with less cholesterol, such as lean meat, poultry, fish (except scallops), shrimp, beans, soy products, vegetables and fruits; less foods containing saturated fatty acids and high cholesterol, such as fatty meat, dairy products, scallops, animal offal, etc. If the plasma low-density lipoprotein (VLDL) is high, the intake of sugar should be appropriately restricted, and the total calories should be controlled. Reduce body weight, avoid overweight, avoid excessive alcohol consumption, increase physical activity and eliminate excessive mental tension, etc. If the dietary treatment and improvement of lifestyle are not effective after six months to two years, drug treatment should be considered.
2, control of hypertension: our diet to reduce salt, calcium, appropriate increase in animal protein, is one of the important measures to prevent hypertension.
3, quit smoking: smoking can increase the morbidity and mortality of coronary heart disease. Should be resolutely quit.
4, control of diabetes: control of diabetes, especially active control of type E diabetes is an important measure to prevent coronary heart disease.
5, exercise for weight loss. Standard weight (kg) = height (cm) – 105. more than 20% of the standard weight should lose weight.
6, a small amount of alcohol: too much alcohol is a predisposition to coronary heart disease, drinking alcohol can increase weight and systolic blood pressure, reduce left ventricular function and cause arrhythmias. Moderate drinking can improve plasma high-density lipoprotein (HDL), but more harm than good. A small amount of alcohol may play a protective role through the coagulation system.
7, a large intake of vitamin C: Vitc can inhibit the oxidation of low-density lipoprotein (LDL) and has a preventive effect.
8, maintain a positive and optimistic mood is a must to reduce coronary heart disease.
9, more than 3 times a week, each time more than 30 minutes of physical activity (way to determine) is an important part of the prevention of coronary heart disease.