Open heart coronary surgery
Everything you need to know about coronary open heart surgery (CABGs)!
Every year, a large number of patients undergo open heart surgery for coronary artery bypass surgery to treat coronary artery blockage and its complications. Although this procedure is life-saving, it still has its own tips and risks that people with coronary artery disease should be familiar with.
The system of veins, or the black veins of the legs, is a dual system. In this way, both the deep veins and superficial veins known as “saphenous veins” can direct the blood in the legs to the heart through the saphenous veins. For this reason, the superficial veins of the leg can be removed easily and no problems will be caused in the venous blood flow of the leg. This vein, which has a length of 50 to 60 cm, is easily removed, and first the valves of the pigeon’s nest and its branches are separated and divided into several parts according to the length of the transplanted veins.
During coronary artery bypass surgery, one side of these black veins is sewn to the main artery of the body, i.e. the aorta, and the other side is sewn to the coronary arteries of the heart after the stenosis, and in this way, the blocked and narrow coronary area is bypassed. Blood flow is re-established in the post-coronary stenosis area. Usually, 2 to 4 of these grafts are used in each bypass operation.
Venous grafts have a thinner wall than the coronary arteries of the heart and the rest of the arteries, and their diameter is greater than the diameter of the coronary arteries, that’s why the tolerance of these grafts against arterial pressure is low and there is a possibility of their blockage over time. Venous grafts usually last about 5 to 10 years, after which up to 50% of these types of grafts will narrow and become blocked again. After 10 to 15 years, only 15% of these links are open, but considering that the re-blocking of these links happens gradually and over the years, the heart muscles can tolerate the re-blocking better and therefore suffer less. Chest pain.
Venous grafts can be easily treated with stents and angioplasty in case of obstruction and re-stenosis, and require less open heart surgery. Although all the venous connections are blocked and the risk of re-operation of the heart is not high, re-operation can be done. Open heart re-operation is associated with more risks than the first operation and is associated with a lack of veins due to their use in the first operation.
Due to the limitations of the use of black veins for coronary artery grafting, the use of arteries for cardiac artery grafting has received much attention. The justification for this interest in using arteries is that the walls of arteries are thicker and they can withstand intravascular pressure more than veins. Also, the diameter of the used arteries is almost similar to heart vessels and they create better and more regular blood flow. LIMA artery
In the past years, arteries such as the “radial artery of the hand” and “visceral arteries of the abdomen” have been used for this purpose, but the best results have been seen with the use of the “Internal Mammary Artery”. This artery inside the chest wall on the right and left side of the chest is separated from the “subclavian or subclavian” artery and moves downward and supplies blood to the space between the ribs. This artery has a lifespan of more than 20 years and can provide safe and secure blood supply to the heart for a long time.
Due to the importance of the internal chest artery LIMA, most surgeons prefer to transplant this vein to the most important coronary artery of the heart which is the left descending artery of the heart or “LAD” and use leg vein grafts for other veins.
Artificial veins are tubes made of “Teflon” or “Nylon” that are produced in different dimensions and diameters and can be used to connect all kinds of veins inside the body. In the past years, the use of these artificial veins in the heart has not had good results, and the speed of blockage and blood clot formation in them has been higher than that of venous and arterial grafts. Therefore, today this type of transplant is not used for heart bypass surgery and their use is limited to people whose natural vessels, whether veins or arteries, cannot be used for heart surgery
Methods of performing open heart surgery
After preparing vascular grafts for heart surgery and sewing them to heart vessels, several methods can be used. The use of these methods depends on the clinical conditions of the patient, the number of blocked vessels and the strength of heart function.
In all these methods, it is necessary for the patient to have complete anesthesia, and anesthesia methods cannot be used to perform heart surgery. Anesthesia during heart surgery is performed by cardiac anesthesiologists who have completed the necessary courses regarding diseases and anesthesia methods for cardiac patients. Therefore, it is necessary to examine and visit patients before open heart surgery by a cardiac anesthesiologist in terms of the presence of other diseases and examination of the patient’s medical background. Identifying anesthesia risk factors can help reduce the risk of open heart surgery and shorten the patient’s hospitalization period.
Classic heart surgery using a heart pump
This method is the most common method of coronary artery bypass surgery. In this method, the patient’s chest is opened from the middle and the sternum bone is cut using special tools so that the patient’s heart is accessible to the surgeon.
In the next step, the heart must be turned off! Considering that the contraction and beating of the heart causes the movement of cavities and vessels on the heart, and this can limit the access to the heart vessels, especially the vessels of the lower and back region of the heart, and the sewing and suturing of the transplanted vessels. It is necessary to face the problem. Therefore, by injecting drugs that have significant amounts of “potassium”, the patient’s heart will temporarily shut down and will not beat. For this reason, it is necessary to replace blood circulation in the body in other ways during the procedure so that enough blood reaches the brain and other body parts. For this purpose, a device called “cardiopulmonary pump” is used.
This device has strong motors that are constantly rotating and by means of large tubes blood is taken from the veins of the body and enters a series of special plates called “oxygenators”. An oxygenator is a device that injects fresh oxygen into dirty venous blood so that it enters the arteries of the body from the other side of the cardiopulmonary pump and delivers enough oxygen to the body. In this way, during open heart surgery, when the heart is shut down, other organs of the body will receive enough blood and oxygen.
Using this pump during heart surgery has positive and negative points.
The positive points of using a pump are that it allows the surgeon to complete the surgery faster and in a shorter period of time. It is also possible to make more vascular grafts in different areas of the heart, especially the vessels of the lower and back of the heart. For this reason, today this method, i.e. the use of a heart and lung pump or so-called “On-Pump”, is considered a routine and standard method during surgery.
Cardiac surgery without the use of a pump
Along with the positive points of using the pump, this device makes patients need more blood transfusions after open heart surgery, because some of the patient’s blood is lost in the pump. Also, a type of inflammatory process occurs in the patient, which causes swelling of the patient’s body and the patient’s longer stay in the open heart ICU.
For this reason, some surgeons prefer to operate on patients who have a simpler surgery and the number of blocked vessels is less, with the heart beating continuously and without the use of a heart pump, or the so-called “Off-Pump” method. Of course, this is not possible in many patients with large and complex operations or patients who need another surgery at the same time, such as heart valve repair or replacement.
Of course, it should be noted that the long-term results of these two methods are similar in terms of patient mortality.
Minimally invasive bypass surgery
It is a special type of heart surgery that is performed by thoracoscopic method. The most important stress and concern of patients from open heart surgery is the splitting of the chest and fusion of the sternum bone, which usually lasts two to three months. In this method, the chest is not opened and instead, similar to abdominal laparoscopic surgery, several small holes are created in the chest and through them the surgical instruments are directed to the heart and the surgery is performed in a closed manner.
Procedures for open heart surgery
On average, open heart surgery may take 4 to 6 hours.
– First, the patient is put under anesthesia by an anesthesiologist. Anesthesia makes the patient sleep during the entire operation and does not feel any pain.
– The surgeon makes an 8-10 inch incision in the chest.
-The surgeon cuts all or part of the chest bones to access the heart.
Once the heart is visible, the patient may be connected to a heart-lung bypass machine. The machine diverts blood away from the heart so that the surgeon can perform the operation. Some newer methods do not use this device.
– The surgeon uses a healthy vein or arteries to create a new path around the blocked artery.
– The surgeon closes the chest with wires, and places these wires inside the body.
– The main incision is sutured.
Sometimes, sternal plating is done for people at risk, including the elderly or people who have had multiple surgeries. This is when the breast is reattached with small titanium plates after surgery.
Complications of open heart surgery
Some of the common complications of open heart surgery usually improve in the first hours and days of hospitalization, and the patient is carefully examined for the complications of open heart surgery by the hospital staff and through laboratory tests.
1- Bleeding after open heart surgery
It may occur at the site of a surgical incision or the area of the heart where surgery is performed.
2- Abnormal heart rhythm
In rare cases, a temporary external or permanent internal pacemaker may be needed to correct this problem.
3- Ischemic heart damage
Damage to heart tissue caused by lack of blood flow to the heart
Complications of open heart surgery
The risk of death increases in surgery in which the heart is stopped in any procedure.
5- Blood clotting
Blood clots may form in and around the heart or travel through the bloodstream.
It is often caused by clots that have formed in the blood after surgery.
7- Blood loss
In some cases, a blood transfusion may be necessary.
8- cardiac tamponade (pericardial tamponade)
A life-threatening disease in which the pericardium, the sac around the heart, fills with blood. This state makes the full functioning of the heart difficult or impossible.
Care after open heart surgery
After the open heart surgery, the patient will feel better and it is possible that he will not have any heart problems for 10 to 15 years. But in the long term, other vessels may become blocked and need to be operated again.
Although bypass surgery improves blood supply to the heart, it does not treat underlying coronary artery disease. The effective results of the treatment will last when you observe and control your diabetes. A healthy lifestyle is very effective in sustaining treatment results, including the following:
Following a healthy diet, such as the DASH diet (a food plan recommended to patients by the National Heart, Blood and Lung Association).
Having a balanced weight.
Doing sports exercises regularly.
In addition to lifestyle changes, in most cases a cardiac rehabilitation program is recommended by the doctor for the patient. Cardiac rehabilitation is a treatment program that includes special exercises and training. This program is specially designed for each person based on his conditions, to improve his heart function.things such as: regular use of drugs to prevent blood clots and blood pressure, cholesterol A cardiac rehabilitation program is used after heart attacks or other heart surgeries to help improve the patient’s condition. Cardiac rehabilitation often begins while you are still in the hospital. This program will continue under the doctor’s supervision until you can easily follow it after returning home.
But unfortunately, in general, some of the weight of about 30% of patients returns as a result of lack of exercise and improper diet.
6. Can I eat again like before?
Yes, after the first few months you can eat normal foods (but your portions will be smaller) and your obesity-related medical problems will improve, as will your energy and overall health.
7. Will everyone notice my bariatric surgery?
Most weight loss occurs in the first 6 to 12 months after surgery, so people may notice a change in your appearance, but it’s your choice whether or not to share your decision about bariatric surgery.
Telling your friends, acquaintances, colleagues and others is your decision, but we recommend that you definitely have some supporters in this way; Because bariatric surgery and weight loss are difficult. Having a supportive friend or family member on your weight loss journey can be helpful.
8. Will I have sagging skin after losing weight?
Most patients do not experience skin sagging after bariatric surgery. But some people may want to do cosmetic procedures to treat sagging skin! Several factors that can affect sagging skin; Age, genetics and hydration. Additionally, it is recommended that you begin exercising approximately 6 weeks after surgery to prevent skin sagging and build lean muscle.
Types of treatment methods for sagging skin after severe weight loss:
Cosmetic surgeries such as abdominoplasty and panniculectomy
Use of collagen creams
9. Can I get pregnant after bariatric surgery?
Yes, you can still get pregnant after bariatric surgery, and some patients actually find it easier to get pregnant after losing the weight they gain from bariatric surgery. We recommend that you wait at least 18 to 24 months after surgery before trying to get pregnant. It is important to tell your OB/GYN that you have had bariatric surgery and to stay in touch with your surgeon to ensure a safe pregnancy.