Replacement of coronary arteries Modern innovation in the treatment of heart disease 2024

Coronary arteries

What is coronary arteries bypass surgery

Coronary arteries bypass surgery (coronary artery bypass grafting) is a procedure used to treat coronary artery disease (CAD) which means narrowing of the coronary arteries and blood vessels that supply oxygen and nutrients to the heart muscle.

Coronary artery disease occurs due to the accumulation of fatty substances inside the walls of the arteries. This accumulation causes the arteries to narrow from the inside, limiting the supply of oxygen-rich blood to the heart muscle.

One way to treat blocked or narrowed arteries is to bypass the blocked part of the coronary artery with a piece of healthy blood vessel from elsewhere in your body.

The blood vessels used to perform the operation may be a cut from a vein from the leg or an artery in the chest. An artery from the wrist can also be used.

To bypass the blocked coronary artery, your doctor makes a large incision in the chest and temporarily stops the heart. To open the chest, your doctor cuts the breastbone (sternum) in half lengthwise and separates it.

Once the heart is exposed, your doctor inserts tubes into the heart so that blood can be pumped through the body by a heart-lung shunt device and they are necessary to pump blood during cardiac arrest.

While the traditional open heart surgery procedure is still commonly performed and is often preferred in many situations, less invasive techniques have been developed to replace blocked coronary arteries.

And in which the heart does not have to be stopped, in the nineties. Other minimally invasive procedures can be used, such as surgery performed through very small incisions as well as robotic surgery.

Symptoms of coronary artery disease

They include the following:

  • Chest pain
  • Severe fatigue
  • Palpitations
  • Arrhythmia of the heart
  • Shortness of breath
  • Swelling of the hands and feet
  • Dyspepsia

Unfortunately, you may not have any symptoms in early coronary artery disease, however the disease will continue to progress until there is enough blockage of the artery to cause symptoms and problems. If blood flow to the heart muscle continues to decrease as a result of increased coronary artery occlusion, you may have a heart attack.

If the blood supply to a certain area of the affected myocardium cannot be restored, the tissues die.

Reasons for coronary artery bypass surgery

Coronary arteries bypass surgery is performed to restore blood flow around a blocked heart artery. Surgery can be performed as an emergency treatment for a heart attack, if other immediate treatments are unsuccessful.

Your doctor may recommend coronary artery bypass surgery if you have the following:

  • A blockage in the left main heart artery where this artery supplies the heart muscle with too much blood.
  • Severe stenosis of the main heart artery.
  • Severe chest pain caused by narrowing of several arteries of the heart. Stenosis reduces blood flow to the heart even during light exercise or at rest.
  • No more than one diseased heart artery and the lower left heart chamber work well.
  • A blocked heart artery that cannot be cured by coronary angioplasty. This less invasive treatment uses a balloon on the tip of a thin tube called a catheter to dilate the artery. A small coil called a stent is usually used to keep the artery open.
  • A catheter with or without a stent may not work, the artery may narrow again after stenting.

What procedures precede coronary artery bypass surgery

  • Review your health history your doctor will also conduct a full physical examination to make sure you are healthy before the procedure. You may need blood tests or other diagnostic tests.
  • You will be asked not to eat or drink for 8 hours before the operation, generally after midnight.
  • You may be asked to take a shower with a special soap or detergent the night before and the morning of surgery.
  • Tell your doctor if you are pregnant or think you may be.
  • Tell your doctor if you are allergic or have allergies to any medications, iodine, latex, adhesive tape, anesthetic drugs (topical and general).
  • Tell your doctor about all medications (prescription and over-the-counter), vitamins, herbs and supplements that you are taking.
  • Tell your doctor if you have a history of bleeding disorders or if you are taking any blood thinning medications, aspirin, or other medications that affect blood clotting. You may be asked to stop some of these medications before the operation.
  • Your doctor may do blood tests before the procedure to find out how long it takes for the blood to clot.
  • Tell your doctor if you have a pacemaker or other heart device inside your body.
  • If you smoke, stop smoking as soon as possible. This will improve your chances of successful recovery from surgery and benefit your overall health.

Depending on your medical condition, your doctor may ask you to do other things to prepare.

Stages of the coronary artery bypass operation

The first stage (before the procedure)

If coronary arteries bypass surgery is a scheduled procedure, you will usually be admitted to the hospital the morning of the surgery. You have several heart tests and blood tests in the days and hours before surgery.

 The second stage (during the procedure)

Coronary arteries bypass surgery is a major surgery performed in a hospital. Doctors trained in cardiac surgery, called cardiovascular surgeons, perform the surgery. Cardiologists and a medical team will help take care of you.

Before going to the operating room, the doctor inserts an intravenous substance into your forearm or hand and gives you a medicine called a sedative to help you relax.

When you’re in the operating room, that’s what happens:

Anesthesia: you receive a combination of drugs through a vein. These drugs put you in a pain-free, sleep-like state. This is called general anesthesia.

Breathing apparatus: the doctor inserts a breathing tube into your mouth. This tube is connected to a breathing machine called a ventilator. The machine breathes for you during surgery and immediately after it.

Heart-lung machine: during surgery, the heart-lung machine keeps blood and oxygen flowing through your body. This is called a pump coronary bypass.

Coronary artery bypass surgery usually takes about 3 to 6 hours. How long the surgery takes depends on the number of blocked arteries.

The surgeon makes a long cut in the middle of the chest along the breastbone. The surgeon spreads the rib cage to show the heart. After opening the chest, the heart is temporarily stopped with medication. The heart-lung machine is operated.

The surgeon removes part of the healthy blood vessels, most often from the inside of the chest wall or from the lower leg. This piece of healthy tissue is called a graft. The surgeon attaches the ends of the graft below the blocked heart artery.

This creates a new path for blood flow around the blockage. More than one bait can be used periodically.

Coronary arteries

Some of the variations of coronary artery bypass surgery include:

Out of pump or beating heart surgery. Sometimes the cardiopulmonary device is not used during coronary artery bypass surgery. Instead, surgery is performed on the beating heart. Special devices stabilize the specific area of the heart being operated on. This type of surgery can be difficult because the rest of the heart is still moving. It is not an option for everyone.

Minimally invasive surgery: the cardiac surgeon performs surgery through small incisions in the chest. Robotics and video shooting help the surgeon to work in smaller areas. Minimally invasive heart surgery may be called Port Access Surgery.

After the surgery is completed, the medical team will restore your heartbeat in the operating room and turn off the heart-lung machine. The surgeon uses wires to close the breastbone. The wire remains in your body after the bone heals.

The third stage (after the operation)

After coronary arteries bypass surgery, the medical team makes sure that you are as comfortable as possible. You may feel pain and confusion when you wake up.

Hospital stay: expect to spend 1 to 2 days in the intensive care unit of the hospital. The duration of your stay in the hospital depends entirely on how you recover and whether you have complications. Some people who have undergone coronary artery bypass surgery return home within a week.

Heartbeat and breath check: the medical team monitors you closely after surgery to check for complications. The devices record your breathing and heart rhythm. Have frequent temperature checks.

Medications: Medications are given to you intravenously to reduce pain and prevent complications such as blood clots. If you are not already taking aspirin daily, your doctor may recommend that you do so. You may need to take aspirin every day for life.

Cardiac rehabilitation: often called cardiac rehabilitation program, this program helps to improve heart health after heart surgery.

You will be encouraged to start moving and walking while in the hospital. When you return home, you continue the cardiac rehabilitation program at a medical center so that you can safely continue the Home program.

Post-recovery from coronary artery bypass surgery

  • After recovering from coronary arteries bypass surgery, most people feel better. Some people remain symptom-free for many years. But other arteries may become blocked in the future. If this happens, you may need surgery or another procedure.
  • The long-term results depend on how well you control your blood pressure, cholesterol levels, and chronic conditions such as diabetes. It is important to take your medications as directed.
  • You can manage and even improve your heart health by making lifestyle changes. Try these recommended steps:
  • Avoid smoking: Smoking is a major risk factor for heart disease, especially atherosclerosis. Quitting smoking is the best way to reduce the risk of heart disease and its complications.
  • Eat healthy foods: choose lots of fruits, vegetables and whole grains. Limit sugar, salt and saturated fats.
  • Maintain weight: being overweight increases the risk of heart disease. Ask your doctor about the right healthy weight for you.
  • Exercise: regular exercise helps control diabetes, high cholesterol, and high blood pressure – all of which are risk factors for heart disease. Aim for 30 to 60 minutes of physical activity on most days of the week. After coronary artery bypass surgery, the doctor will tell you when it is safe to start exercising again.
  • Avoid stress: find ways to help reduce emotional stress. Practicing mindfulness and connecting with others in support groups can be helpful. If you suffer from anxiety or depression, talk to your provider about help strategies.
  • Get enough sleep: lack of sleep can increase the risk of heart disease and other chronic conditions. Adults should aim to get 7 to 9 hours of sleep a day.

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