Aorto-coronary shunting and coronary shunting is surgical treatment of the effects of ischemic heart disease. Operational intervention is shown in cases where conservative (drug) therapy does not have the necessary effect.

IBS (myocardial ischemia) is a pathology that occupies a steadily leading position among all heart disease. From the consequences of the CHD, mainly thousands and thousands of people in any, even the most prosperous country die from the myocardial infarction.

Pathological changes in coronary arteries are direct consequence and one of clinical manifestations . As a result of insufficient supply of the heart muscle with blood, irreversible pathological processes in it increase, and also suffers the entire body as a whole.

Medicines that were used by cardiologists in the treatment of IWS dozens years have been developed in order to improve the impaired blood supply to the heart muscle. Therapeutic effect Such drugs are the expansion of the coronary arteries. But drugs can only help in certain cases.

Therefore, the development of radical treatment methods and the improvement of the operation itself is the task for the cardiac surgeons of the whole world. After all, the number of people who suffer from the effects of myocardial ischemia is steadily increasing every year.

Cardiac surgery - the most effective method with IHD

Until the second half of the 20th century, only drug funds were in the Arsenal of Cardiologists, which in many cases could not change the situation dramatically. The question in this case was only a postponement for a while.

Before surgery. Algorithm of action

• Hospitalization in a medical institution, after registration of the consent of the patient (in writing) to conduct, both surveys and the most surgical intervention.
• Filling forms (special form).
• Conducting various types of tests and diagnostic studies (electrocardiography and x-rays).
• Conversation with anesthesiologist.
• Consultation from a specialist in respiratory gymnastics.
• Recommendations of the doctor on therapeutic physical education.
• Conversation with a priest (at the request of the patient).

• enema;
• processing of the operation zone (shave);
• reception of prescribed drugs.

On the eve of the operation it is impossible to eat, only clean water is used, no later than midnight, if the operation is scheduled for the next day.

Operation day. Preparatory activities

• Delivery to Operational.
• Accommodation on the operating table.
• Next, the anesthesiologist conducts the necessary manipulations (introducing the necessary drugs, connecting to monitors and lines for intravenous drug administration).
• The effect of drugs and falling asleep.
• The doctor, making sure that the patient is deeply sleeping, gives a signal to intubation.
• The intubation (introduction into the respiratory pathways of the intubation tube) is made only after the introduction of anesthetics.
• Next applies a probe to the stomach to control the gastric secretion.
• Foley catheter is installed, designed to derive urine.
• A variety of medicines are also used that appointed a doctor.
• The operating field is treated with special antibacterial solutions.
• The patient's body is covered with sterile sheets, the surgical area is limited.

Operation result

After successful shunting, the following results are provided:

Saving in many cases of life.

Elimination of negative symptoms of IBS, which reduces the quality of the patient's life.

Return after a certain period of time to normal life.

Rehabilitation period

The time required for the restoration of each may be different, it depends on the individual factors of the patient's body and the features of the course of its disease, its type and degree, as well as the presence of concomitant diseases.

Improving well-being occurs gradually, although immediately after surgery, the patient can feel relief. Almost complete recovery occurs in a few weeks or months.

Essence of operation and reading

The decision on the need to take a doctor (consultation of specialists), taking into account:

• Data laboratory research.
• Functional surveys.
• Radiography and other instrumental research.

Essence of the operation

Creation in the process of surgical intervention of the optimal bypass path, as a result of which the blood supply to the heart muscle will be restored.

Anastomosis

Shunts are used, with which you can bypass the coronary arteries affected due to atherosclerosis. Such a way in cardiac surgery received a special name - anastomosis.

How is the operation?

1. Used natural biological material, Usually its own vein. The fragment of the veins is taken at the patient itself (usually from under the skin, in the hip zone).
2. One of her ends is sewn into the aorta.
3. The other end is sewn in the zone, which is slightly lower than the seat of the stenosis (area of \u200b\u200bnarrowing or blockage) in the coronary artery.

Features of the veins on the legs

Viennes of the lower extremities are usually less affected by atherosclerosis, they have a rather large length, large sizes and their easy to get a cardiac surgeon. Disturbance of blood circulation after the operation in the legs is usually not very violated, the recovery process is relatively quick.

Common Complaints after the operation relating to the lower extremities

At first after the operation, patients complain about pain in the leg. Especially pain is enhanced with an active load (walking over long distances, long standing position).

Attention! In the past few years, cardiac surgeons are increasingly using artery as shunt, and not veins. The artery fragment is taken from the zone of the inner surface of the chest, from the zone of the forearm. The use of both venous and arterial vessels has its pros and cons. Therefore, the choice of material for Shunts - the prerogative of the doctor who will take the optimal solution.

Coronary shunting and aorto-coronary shunting. Is there any difference?

The purpose of the operation is to create a new channel through which the blood supply will occur. The blood from the aorta will begin to be freely acting through the shunt cardiac surgery in the coronary artery. Hence the term "Aorto-Coronary Shunting".

When an internal pectoral artery is used as a shunt, then it is not required to enter it to the aorta, since the surgeon separates it from the ribs of the patient and its sternum, then it cuts out its lower part, which sews to coronary artery.

After a successful operation, the blood supply is distributed by the heart muscle already from the sternum and ribs. The term "coronary shunting" refers to this case, since here the artery (inner breast) does not depart from the aorta.

In the medical literature, both terms are freely used freely, the authors do not set the task to accurately adhere to strict wording. And the one, and the other technique can be called and so, and so, although this is not the Council for sure.

The advantages of the artery during the operation of aorto-coronary shunting

Such a shunt is currently considered more durable and more adapted to long-term and trouble-free operation in extreme conditions, namely in the case increased pressure blood. In the aorta pressure has the highest possible indicators. However, each specific case requires its decision, therefore it is always better to say that the artery is always better.

Reference. Medical literature gives the following information:

Shunt from Vienna. It is capable of working for at least ten years since the operation (at least 65% of cases). In 80-90% service life (the risk guarantee) is about a year.

Shunt from the artery. 12 months after the operation almost 100% of cases - there are no failures in the work (a fragment taken from the chest). 10 years - about 90% of cases.

Shunt from the zone of the forearm. Impeccable work of 12 months in 92-93.5% of cases, 5 years - about 82-84% of cases.

Operation Aorto-coronary shunting (AKSH). Do you need a heart stop?

During operation, cardiac surgeons open the chest, this is an inevitable effect. Need whether the heart stop is solved in each case.

How is the choice?

Consides:

• The results of coronary art.
• Expert assessment of the degree of damage to coronary arteries.
• Individual patient features.

Attention! If the diagnosis of "multifocal lesion of the coronary arteries of the heart muscle", including combined myocardial pathology, for example, post-infarction aneurysm left ventricle, as well as congenital or acquired vice, which requires radical treatment, then coronary shunting is necessarily carried out on a stopped heart with the provision of artificial blood circulation.

Application of artificial blood circulation

The first options that were made in the beginning of the introduction of this method were poured on a stopped heart. At the same time, almost complete disclosure of the chest is necessary. The duration of the entire operation depends on the amount of anastomoses created (from 3-4-EX to 6 and even more hours).

Essence:

The operation is carried out using a special apparatus of artificial blood circulation.

Blood from the heart muscle is given to a special apparatus.

In the apparatus, blood is filled with oxygen.

Then enriched blood enters the organs and systems of the body, bypassing the heart muscle.

Blood in the apparatus is filtering, cooling, or, on the contrary, warming, depending on the need, due to which the required patient's body temperature is supported.

Result:

Cardiac surgery is engaged in the artificial blood circulation by creating anastamose, which is located between the vein and the coronary artery. Anastaskin is located below the location of the coronary artery. After recovering cardiac activity, another end of the vein is sewn to the aorta.

disadvantages

During the operation possible functional disorders Some organs and systems (from 5 to 15% of the number of all operated):

• Brain.
• Lungs.
• Kidney.
• Liver and others.

Fortunately, in the overwhelming in most cases, such processes are reversible. The listed complications do not have a negative impact on the patient's health after the operation.

The risk group includes the elderly people who suffer from severe diseases (liver, lungs, kidneys, brain vessels).

Postoperative recovery

The rehabilitation process in this case takes a longer time, as the opening zone is significant and a certain period is required for its recovery. Therefore, rehabilitation can stretch for several months.

Operation on a working heart

A less traumatic option that is widely applied at present. This technique has become possible thanks to the achievements of modern medicine and the use of endoscopic technology.

Essence:

The incision is carried out in the intercostal zone.

A special expander is introduced.

The expander opens the access cardiac surgeon and, in addition, contributes to a decrease in myocardial contractility.

Advantages of operational intervention on the working heart

• Preservation of bone integrity.
• Low probability of infection.
• Minor blood loss.
• Less pain.
• The possibility of deep self-breathing during the operation.
• Short period of operation (about an hour or two).
• Not a long and not difficult rehabilitation period (in the hospital, several days).

The main two advantages:

1. There are no age limitations (successful operations of the older age group - after 80 years).
2. Does not play the role of serious concomitant diseases.

Reference. Such an operation is well tolerated by patients, but requires the highest cardiac surgery skill. For example, the highest indicators (mortality of 0.5% on coronary shunting) has only a few leading global clinics.

At the stopped heart, the operation is carried out at least longer, but much easier for the doctor. Interesting and the next fact confirmed from the point of view of medicine.

Operation on a working heart is less traumatic for the patient in terms of exposure to intellectual abilities in the future.

The figures are given - at the time of extracting from the hospital, patients note the decrease in the intellect (at least 53% operated on with the use of artificial blood circulation).

After about six months, a reduced intelligence in one way or another is about 25% of patients. Such problems do not arise at all from those who have suffered an operation on the functioning heart.

Do you need a re-operation for coronary shunting?

In some cases (this is about 1-2%), a re-operation is required after a certain time.

Rehabilitation period after aorto-coronary shunting. What to pay attention to?

Do not think that after surgery, problems disappeared forever.

Despite visible well-being and even in the absence of complaints, it is necessary:

• Strictly observe a certain diet aimed at anti-studosclerotic activities.
• Be sure to refuse tobacco smoking and other bad habits.
• Stabilize labor and recreation work.
• Take prescribed supporting medication therapy.
• Regularly visit the cardiologist at the place of residence, which will observe the patient in the dynamics.
• Come on the prescribed examination by a doctor, fulfill all the prescriptions of the specialists.

Shunting is a panacea, eliminating from ischemic heart disease once and for all. The operation allows in the overwhelming majority of cases to save life, but it does not eliminate the main reason caused by pathology.

Life after surgery

Finding in the resuscitation separation is a few days, under constant supervision. The decision on the transfer to the ordinary chamber accepts a doctor. Elementary postoperative period It is characterized by a ban on exercise, which must be minimal. At first, it is recommended to roll over the side on the side, in order to avoid education laying out.

The recovery schedule depends on the set of factors and is determined by the doctor individually. First allowed to sit down. Then walk within the chamber and separation, then in the fresh air. The final stage is the lifts and lists of the stairs.

To eliminate swelling on the leg where the shunt was taken, it is recommended to use a special compression knitwear (pulling stocking).

When remove the seams?

Seven or ten days on the leg, on the chest - immediately before discharge.

Rules of behavior after discharge

• The ban on lifting weights weighing more than five kilograms (the time is negotiated with the doctor).
• The car driving permit is usually 60-70 days after discharge.
• Exploration to work - six weeks (mental work), after two or three weeks in the case of sedentary of simple activity.
• Sexual life - Dates are negotiated with a doctor.

Practice is paid to meals. Improper nutrition will quickly lead to the formation of new atherosclerotic plaques and aggravate disease. Such patient actions can lead to a fatal outcome. The diet is required throughout life, regularly passing laboratory tests (lipids and cholesterol).

Forecasts

The first two weeks. There is a possibility of blockage due to blood clot formed. Such a process is possible both throughout the first two weeks, so in the next 12 months. Aspirin reduces risks by 50%.

The next five years. The formation of scar tissue is possible. Risk of atherosclerosis.

Next ten years. The probability of blockage, because it is necessary to tune in to the constant reception of special drugs that the doctor recommends.

The history of the president's disease

Of course, it is impossible not to guess that it is about Clinton.

How much you will not open articles about the aorto-coronary shunting, clinton name will be called in 99% of cases.

You did not think - why?

It's very simple, because the history of the disease of the President of America is very typical for anyone, anyone who is not famous in the man, whether he is a resident of the prosperous power, or the depths in Russia, a district center, which in America never heard ever.

In America, unlike Russia, and other countries of the former USSR, they attach great importance to an external sporting attitude and in every way promote healthy eating and an active lifestyle.

This is not surprising, after all, America is a country of very thick citizens who eating fast Wood and drinking all this with tens of liters of Coca-Cola. The passion for such food and drinks led to the fact that the doctors began to beat the alarm - you need to do something about it!

Now many other countries are being like a similar path, including Russia. Food in bags that does not have any food valueAll sorts of crackers, chips and all garbage in bright attractive wraps with an abundance of fats, carbohydrates, chemical ingredients in the form of sweeteners, taste improvers, dyes, faddles, etc. And so on. All this can not not "shoot"!

As for Clinton, then the case was both in burdened heredity and in the enthusiasm of the restaurant, not always useful food. The president, the age of which at the time was only 58 years old, was shocked. How? He does not have excess weight, and sometimes engaged in sports. The tightened figure is associated with health, everything was the opposite.

The clinton survey showed - a violation of blood flow was recorded already in four coronary arteries, and the narrowing was 90%. There were four anastomosis.

Given the launched process, the operational intervention was produced on a stopped heart muscle. Cardiac surgery Craig Smith conducted an operation almost all day - from eight in the morning to half the fifth evening.

The rehabilitation period was good, and the forecast was optimistic. But the state of health has not come to normal and left much to be desired, although enough time has passed.

The presidents are no celestial, they are also people. The survey showed the development of a rare complication - a scarsing process, which was found in the chest.

As the president's attending physician later, such a process was observed in all ten people (from 6,000 cases).

The situation was aggravated by the fact that often measures to remove scar tissue give only a temporary effect, since the process is used to repeat. In such cases, repeated operations are required, but there will be no one - no one knows.

What can be concluded?

Any pathology is much easier and easier to prevent than then to walk through the cabinets of doctors. Moreover, if there is a genetic predisposition, it is worth paying attention to every trifle in his life - that I ate that I drank, as he left, as he worked as it was in the fresh air and how many packs of cigarette smoked the day before.

Conclusion. The operation of the Aorto-Coronary Shunting is carried out in cases where the reception of drugs does not give effect. For the success of the operation, it is necessary to behave correctly in the postoperative period. Special diet, receiving prescribed drugs and general preventive measures make prediction favorable.

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Dear visitors to Pharmamir site. The article is not medical Council And can not serve as a substitute for advice with the doctor.

The surgery of coronary shunting today is a fairly widespread procedure. Surgical intervention is necessary to patients suffering from coronary heart disease in the ineffectiveness of drug treatment and progression of pathology.

Coronary shunting is an operation on heart vessels, during which arterial blood flow is restored. In other words, the shunting is the creation of an additional way to bypass the narrowed area of \u200b\u200bthe Vernoe vessel. Actually the shunt is an additional vessel.

What is ischemic heart disease?

Ischemic heart disease is an acute or chronic decrease in the functional activity of myocardium. The reason for the development of pathology is insufficient receipt arterial blood To the heart muscle, resulting in oxygen starvation of fabrics.

In most cases, the development and progression of the disease is due to the narrowing of the coronary arteries responsible for the supply of myocardium oxygen. Vessel patency decreases against the background. Insufficiency of blood supply is accompanied by painful syndrome, which initial stages Pathology appears with a significant physical or psycho-emotional burden, and as progressing - and at rest. Pain in the left side of the breast or behind the sternum was called angina ("chest toad"). They are usually irradiating to the neck area, left shoulder or the angle of the lower jaw. During the attack, patients feel the lack of oxygen. It is also characterized by the appearance of a feeling of fear.

Important: In clinical practice there are t. N. "Burely" forms of pathology. They represent the greatest danger, because they are often diagnosed in the later stages.

The most dangerous complication of ischemic disease is myocardial infarction. With a sharp limitation of oxygen flow in the heart muscle section, necrotic changes are developing. Infarcates are the leading cause of mortality.

The most accurate method of diagnosis of IBS is an x-ray-contrast study (coronary art), in which the contrasting agent is introduced into the coronary artery by means of catheters.

Based on the data obtained during the study, the question of the possibility of stepping, balloon angioplasty or coronary shunting of the heart vessels is resolved.

Coronary shunt operation

This operation is planned; The patient is usually placed in the hospital 3-4 days before intervention. In the preoperative period, the patient passes a comprehensive examination and learns deep breathing and cleanement techniques. He has the opportunity to get acquainted with the surgical brigade and get detailed information about the essence and course of intervention.

On the eve, preparatory procedures are carried out, including the cleansing enema. An hour before the start, premedication is carried out; The patient gives drugs that reduce the feeling of anxiety.

In a timely manner, the operation warns the development of irreversible changes in myocardium. Thanks to the intervention, the reduction capacity of the heart muscle is significantly increased. Surgical treatment makes it possible to improve the quality of life of the patient and increase its duration.

The average duration of the operation is from 3 to 5 hours. In most cases, the patient's connection is required to the apparatus of artificial blood circulation, but in some situations there may be an intervention on a beating heart.

Surgical treatment without a patient connection to the artificial blood circulation apparatus there are several advantages, including:

• lower intervention duration (up to 1 hour);
• reduction of recovery time after coronary shunting;
• elimination of possible damage to uniform elements of blood;
• the absence of other complications associated with the patient's connection to the IR apparatus.

Access is carried out through an incision performed in the middle of the chest.

Additional cuts are made in the area of \u200b\u200bthe body from which the count is taken.

The course and duration of the operation depends on the following factors:

• type of vessel damage;
• the severity of the pathology (the number of shunts created);
• the need to parallel elimination of the aneurysm or reconstruction of cardiac valves;
• some individual features of the patient's body.

In the course of the operation, the graft is laid to the aorta, and the other end of the graft is to the branch of the coronary artery bypassing the narrowed or indiffered area.

To create a shunt as a graft take fragments of the following vessels:

• large subcutaneous vein (from the lower limb);
• internal chest artery;
• raduing artery (from the inner surface of the forearm).

Note: The use of a fragment of the artery allows you to create a more complete in functionality of the shunt. The preference of the fragments of the subcutaneous veins of the lower extremities is given for the reason that the vessels are usually not amazed atherosclerosis, i.e. are relatively "clean". In addition, the fence of such a transplant subsequently does not lead to health problems. The remaining veins of the legs take on the load, and the blood circulation in the limb is not disturbed.

The ultimate goal of creating a similar workaround is to improve myocardial blood supply to prevent angina attacks and heart attacks. After coronary shunting, the life expectancy of patients with IHD increases significantly. In patients, physical endurance increases, efficiency is restored and the need for the reception of pharmacological preparations is reduced.

Aorticoronary artery shunting: postoperative period

After the end of the operation, the patient is placed in the resuscitation department, where it is carried out around the clock observation. The drugs for anesthesia negatively affect the respiratory function, so the operated person is connected to a special apparatus supplied by oxygen-enriched air through a special tube in the mouth. With rapid restoration, the need to use this device usually disappears during the first day.

Note: In order to avoid uncontrolled movements, which can lead to the development of bleeding and disconnecting drippers, the patient's hand is fixed until a complete coming into consciousness.

Catheters are put in the vessels on the neck or thigh, through which medicinal products are introduced and blood is taken for tests. From the cavity of the chest, tubes are displayed to suck the accumulating liquid.

To the body of the patient who suffered an aortocortonary shunting, special electrodes fasten in the postoperative period, allowing to monitor cardiac activity. To the lower part of the chest, wiring is recorded by which, if necessary (in particular, when the development of ventricular fibrillation) is carried out electrostimulation of myocardium.

Note: While the effect of drugs for general anesthesia continues, the patient may be in a state of euphoria. It is also characteristic of disorientation.

As the patient's condition improves, they are transferred to the usual chamber specialized branch hospital. During the first days after the shunting, it is often noted to increase the total body temperature, which is not a reason for concern. This is the normal response of the body into extensive damage to the tissues during the operation. Immediately after coronary shunting, patients may make complaints about unpleasant sensations at the scene of the cut, but the pain syndrome is successfully borne by the introduction of modern analgesics.

In the early postoperative period, strict control of diuresis is required. The patient is invited to enter the special diary on the number of drilled liquid and the volume of separated urine. For the prevention of the development of such a complication, as postoperative patient's pneumonia, introduce a complex of breathing exercises. The position lying on the back contributes to the rest of the fluid in the lungs, so the patient a few days after the operation is recommended to be rotated on the side.

To prevent the accumulation of the secret (improvement of the cleanement), a cautious local massage with tapping in the projection of the lungs is shown. The patient needs to be informed that the flawling will not lead to the discrepancy of the seams.

Note: Look acceleration of the healing process is often used a thoracic corset.

Consult fluid patient can already after a half or two hours after removal of the respiratory tube. At first, food must be semi-liquid (rubbed). The transition term to conventional power is determined strictly individually.

Restoration of motor activity should be gradual. At first, the patient is allowed to occupy a sedentary position, a little later - for a short time to tall on the ward or corridor. Shortly before the discharge is allowed and even recommended to increase the time of walking and climbing the staircase.

The first days the bandage is regularly changed, and the seams are washed with an antiseptic solution. As the wound is delayed, the bandage is removed, since the air contributes to the drying. If the regeneration of tissues proceeds normally, the seams and electrode for stimulation are removed on the 8th day. 10 days after the operation, the cuts area are allowed to rinse with conventional warm water with soap. As for common hygienic procedures, it is possible to take a shower only in a week and a half after the removal of the seams.

The chest is completely restored in only a few months. While she grows, the patient can appear pain. In such cases, the reception of non-scientific analgesics is shown.

Important: Until the full healing of the bones of the sternum excludes weight lifting and making sharp movements!

If the transplant was taken from the legs, the first time of the patient can disturb burning in the area of \u200b\u200bthe cut and the edema of the limb. After some time, these complications pass without a trace. While the symptoms are preserved, it is advisable to use elastic bandages or stockings.

After coronary shunting, the patient is in the hospital for another 2-2.5 weeks (subject to the absence of complications). The patient is discharged only after the attending physician is fully confident in the stabilization of its condition.

To prevent complications and reduce the risk of developing cardiovascular diseases, the dietary diet is required. The patient is recommended to reduce the consumption of the cooking salt and minimize the number of products containing saturated fats. Persons suffering from nicotine addiction should be completely abandoned.

Reducing the risk of recurrence will help complexes of exercises. Moderate physical exertion (including regular hiking) contribute to the early rehabilitation of the patient after coronary shunting.

Statistics of mortality after aorto-coronary shunting

According to the data obtained in the course of many years of clinical observations, 15 years after the successful operation, mortality among patients is the same as in the population as a whole. The survival in many ways depends on the volume of surgical intervention.

The average life expectancy after the first shunting is about 18 years.

Note: At the time of completion of a large-scale study, the purpose of which was to compile mortality statistics after aorto-coronary shunting, some patients who have had an operation in the 70s of the last century, have already managed to celebrate the 90th anniversary!

The shunting of the coronary arteries of the heart is the restoration of blood flow in large arteries of the heart, narrowed as a result of the CHA (coronary heart disease) operational way. The operation of the Aorticoronary artery shunting received its name from the word "Shunts" - that is, anastomoses that surgeons put to create a workaround on the vessels to increase blood flow in the heart.

When is the operation?

Prognostic states when the cardiologist must offer the operation of the Aorticoronary charm of the patient, only three, this:

1. Non-employment by 50% and more left corned artery.
2. The narrowing of all blood vessels by 70% or more.
3. Strong stenosis of the proximal department of the front interventricular artery, which is combined with another two stenosis arteries of the heart.

In Cardiology, there are three groups of indications for the aorticon-artistic shunting:

First indication group for surgery:

It includes patients with ucheshized myocardium in a large volume, as well as patients with angina with indicators of myocardial ischemia and the lack of a positive response to drug therapy.

• Patients with acute ischemia after suffering shining or angioplasty.
• Patients with ischemic lung swelling (which most often accompanies angina in older women).
• Stress test in a patient before planned operation (vascular or abdominal), which showed a sharply positive result.

The second group of indications for the aortockor-art shunting:

The operation is shown by a patient having pronounced angina or refractory ischemia, in which the aorticoronary shunting is capable of improving the distant forecast, while maintaining the pump function of the left ventricle of the heart and prevents myocardium ischemia.

• With a 50% stenosis and the left heart artery.
• Stenosis of 50% and more than three coronary vessels, including with pronounced ischemia.
• The defeat of one-two coronary vessels with the risk of ischemia of a large amount of myocardium in cases where it is technically impossible to perform angioplasty.

Third reading group for coronary heart shunting:

This group includes cases where the patient for the upcoming operation on the heart will need additional support in the form of an aorticoronary shunting.

• Before cardiac operations on heart valves, Miodeptectomy, etc.
• During operations over the complications of myocardial ischemia: acute mitral insufficiency, left ventricular aneurysm, post-infarction defect of the interventricular partition.
• With the anomalies of the coronary arteries in the patient, when there is a real risk of it sudden death (for example, when the vessel is located between pulmonary artery and aorta).

Indications for the operation of the Aorticoronary artery shunting are always established on the basis of the data of the patient's clinical examination, as well as on the basis of coronary anatomy indicators in each case.

How is the operation of aorto-coronary shunting - stages on video

As before any other surgical intervention in cardiology, the patient prescribes a full survey, including the patient's coronary shunt surveillance coronaryography, electrocardiography and heart ultrasound.

During the operation for the shunt, this patient takes part of the Vienna from the lower limb, less likely, part of the inner chest or radial arteries. This in no way disrupts blood circulation in this area, and is not fraught with complications.

Aorticoronary artery shunt operation is performed under. Preparations for this operation is no different from the preparation for any other cardiac surgical operations.

Video operations of the Aorto-Coronary Shunting You can find on the Internet.

The main stages of the surgery of the coronary shunting of the heart:

1 Stage: anesthesia and preparation for the operation

The patient laid on the operating table. An anesthesiologist intravenously introduces a anesthetic drug, and the patient falls asleep. To control the patient's breath during surgery, an endotracheal tube is introduced into the trachea, which serves respiratory gas from the IVL apparatus ( artificial ventilation lungs).

A probe is introduced into the stomach to control the gastric contents and prevent it in casting into the respiratory tract. The patient is set to the urinary catheter for the removal of urine during the operation.

Stage 2: Surgical incision, opening of the chest cavity

Cardiac surgery makes a vertical section (30-35 cm) on the middle line of the chest.
The chest is revealed as much as it will provide sufficient access to the heart, to the operation zone.

3 Stage: Direct installation of shunt on the heart

The next step is to stop the patient's heart and the connection of the artificial circulation apparatus. But in some cases, the surgery of coronary shunting is possible without stopping the heart - that is, on a beating heart.

Another surgeon at this time takes out the fence of the part of the vein on the foot of the patient.

One end of the shunt is sewn to aorta, the other end to the coronary artery, above the location of the narrowing. Immediately after the sewing shunt, the work of the heart is restored.

4 Stage: Closing Operating Wound

As soon as the surgeon was convinced that the patient's heart started and the shunt works, it spends the hemostasis of the cavity, sets drainage. The cavity of the chest closes, the fabrics on the place of the cut are stood.

Operation of the Aorticorona Shunting lasts 3-4 hours. After the operation of the patient transported to the resuscitation department. If there was no complications of the patient's condition during the day, and the condition has stabilized, it is transferred to the usual chamber of the cardiac surgery.

Advantages and Possible Complications

Advantages of the Operation of Aorticoronary Shunting

• Bloodstock is restored in the coronary arteries zone, where there was a narrowing of their lumen.
• The patient can be put not alone, but several shunts to normalize the blood flow.
• After surgery, the patient has the ability to return to normal life, with very few restrictions.
• The risk of myocardial infarction is reduced.
• Angina retreats, the attacks are no longer observed.
• Aorticoronary artery shunt operation provides long-term therapeutic effect - The patient increases the duration and increases the quality of life.

Technique Operations of Aorticorona Shunting has long been adjusted scientifically, honed with cardiac surgeons in practice and is very effective.

But, like any other intervention, this operation has the risk of developing complications.

What complications may occur during or after the operation of the Aortocairknoy shunting?

• Bleeding.
• Deep veins thrombosis.
• Cleaning arrhythmia.
• Myocardial infarction.
• Brain circulation disorders
• Infection of the operating room.
• The narrowing of the shunt.
• Discussion of operating seams.
• MediaSenitis.
• Chronic pain in the operated area.
• Keloid postoperative scar.

Most often complications arise if a history of the patient:

1. Recently was observed acute coronary syndrome.
2. Unstable hemodynamics.
3. Dysfunction of the left ventricle heart.
4. Heavy, unstable angina.
5. Atherosclerosis of peripheral and carotid arteries.

According to medical statistics, complications occur more often from:

1. Women are less than the diameter of the coronary vessels, which complicates the operation.
2. Elderly patients.
3. Patients with diabetes.
4. Patients with chronic lung diseases.
5. Patients with renal failure.
6. Persons with violations of blood clotting.

To reduce the risk of developing complications, before and after the operation, a number of preventive measures are carried out - this is a medical correction of violations, the identification of a risk group, the use of new technologies in the activation of the activation of the patient's postoperative monitoring.

How is the recovery process after surgery?

On the day of the operation

The patient is in intensive care. Radioscopy is performed, electrocardiography with help, take blood for analysis.

The breathing tube is removed, self-breathing resumes.

Remove the urinary catheter and drainage in the operation zone.

Antibiotics are prescribed to the patient, painkillers, other medicines as needed.

The patient can be carefully turned over in bed, eat, drink water.

First day after surgery

The patient remains in intensive care, or it is transferred to the department of cardiology.

Antibiotics and painkillers continues.

Assigns gentle diet nutrition.

Second day after surgery

Medicase therapy continues.

The patient is recommended to gradually increase the physical activity - independently, with support, walk to the toilet, on the chamber, along the corridor, do simple physical exercises. Elastic bandages are recommended to continue to wear.

Diet food is prescribed to the patient, taking into account its condition.

Third day after surgery

The patient must fulfill all the appointments of the doctor.

It continues to do physical exercises with gradual increase in load, respiratory gymnastics. Elastic bandages to the patient is recommended to wear constantly. He can already walk along the corridor several times a day.

Fourth day after surgery

Patient power expands, portions increase, although it still remains dietary.

The doctor assesses the physical condition of the patient and gives recommendations to further restore, change the lifestyle, nutrition, physical exertion, etc.

If everything is fine, then on the 5th day after the operation, the patient is discharged home.

Further postoperative period

The operation of the aortocortonary shunting radically corrects the problem that occurred in the patient's health. But she cannot save him from the disease, which brought this problem - from atherosclerosis. In order for the disease to be returned, the patient is recommended to exclude risk factors from their life, which lead to the acceleration of the formation of atherosclerotic plaques:

• Hypertension - the patient has a permanent correction of blood pressure.
• Smoking - Exclude completely.
• Excess body weight - Strict diet should be followed in order to get rid of extra kilograms, get enough vitamins and nutrients, and at the same time - not to gain weight. It should be achieved normal indicator Body masses - two recent growth numbers minus 10%.
• High cholesterol - It is necessary to strictly stick to the diet recommended by the doctor.

1. What is angina? What are the causes of angina?

Angina is a reflection of myocardial ischemia (coronary heart disease - IBS). Patients often describe their feelings as compression, suffocation and silent in the chest. Angina is usually caused by an imbalance between the myocardial supply of oxygen and the need for it. A classic representative of the disease is a man (men suffer from 4 times more often than women), removing the snow in a cold late evening after a dense dinner and a fight with his wife.

2. How is angokard treated?

The treatment of angina is to drug therapy or myocardial revascularization. Drug therapy is aimed at reducing the needs of myocardium in oxygen. Strategic treatment includes nitrates (nitroglycerin, isosorbide), which minimally expand the coronary arteries, also reduce arterial pressure (post-load) and, consequently, the need of myocardium in oxygen; beta-adrenoblays that reduces heart rate, contractile ability of the heart and post-load; and calcium channel blockers that reduce the weakload and prevent spasming of coronary arteries.

An important role also plays aspirin (antithrebocitary action).

If the angina is resistant to drug therapy, it may be necessary to revascularize myocardium by percutaneous crystrous coronarylasty (CLCP) with a stent installation of a stent or without any aortocortonary shunting (AKSH).

3. What are the testimony for AKS?

but) Stenosis of the left coronary artery. Stenosis of the left coronary artery more than 50% is a bad prognostic factor for patients receiving medicinal therapy. Left coronary artery blemizes a significant part of myocardium, so the CCCP is very risky. Even in the asymimomatic patients, survival rate increases significantly after AKSH.

b) IHS with the defeat of three vessels (70% stenosis) and with the oppression of the function of the left ventricle or the IBS with the defeat of the two vessels and the proximal part of the front descending branch of the left coronary artery. Randomized studies have shown that in patients with a three-sided lesion and oppression of the function of the left ventricle, survival after AKSH is much higher than during drug therapy.

ACH also provides a higher survival with a two-axisite lesion and stenosis of the proximal part of the anterior downward branch of the left coronary artery 95% or more. However, the patients with the oppressed function of the left ventricle are a serious problem: so with the initial decrease in the emission fraction below 30% operational mortality increases.

in) Angina, resistant to intensive drug therapy. Patients with restrictions on the lifestyle due to IBC are candidates for AKSH. The results of surgical interventions on coronary arteries show that in the operated patients are less pronounced symptoms of angina, to a lesser extent, the vital activity is lented and the tolerance of physical exertion is objectively increasing, but compared with patients receiving medicinal therapy.

4. What is the AKS?

Aorto-coronary shunting (AKSH) It is a shunt operation, which can be performed both in conditions of in vitro blood circulation, and without me. Left internal Mammorian artery performs the role of a tubular graft. Extracorporeal blood circulation is connected by cannulating ascending aorta and right atrium, and the heart stops by cold cardioplegia.

The segments of a large subcutaneous vein legs unfold and stitched with a proximal (intake) part of the bypass anastomosis, originating from the ascending aorta, and the peripheral (mining) part of the bypass anastomosis is connected to the coronary artery distal than obliter space.

Left inner Mammorian artery is usually stitched with a proximal part of the anterior descending branch of the left coronary artery. When the imposition of anastomoses is completed, independent blood circulation is restored, and the incision of the chest is sewn. It is usually superimposed 1-6 shunts (hence the term "triple" or "fourth" shunting).

5. Does the AKS do the myocardial function improve?

Yes. With the help of aorto-coronary shunting (ACCH), the function of the hibernating myocardium is improved. Under the hibernation of myocardium, we understand the reversible decrease in the contractile function of the heart muscle, caused by the failure of the coronary blood flow, while maintaining the viability of myocardium. In some patients with a common systolic dysfunction Myocardial after AKS is observed a significant improvement in its contractile function.

6. Does AKS help with stagnant heart failure?

Sometimes. Aksh facilitates symptoms of stagnant heart failure caused by ischemic myocardial dysfunction. On the contrary, if cardiac insufficiency is caused by a long-term infarction area (post-infarction scar), the AKS does not give good results. During a preoperative survey, it is necessary to estimate the viability of non-functioning myocardium. The residual redistribution of radioisotope with a tallonic scan helps to determine even viable myocardial segments.

7. Does Ash help prevent ventricular arrhythmias?

Not. Most ventricular arrhythmias with IHD arise at the border of excitable myocardium surrounding the infarct zone. Patients with life-threatening ventricular takhiaritimia is shown to implant the automatic heart defibrillator (AICD).

8. What is the difference between CLCP and AKSH?

Six randomized controls clinical studies were devoted to the comparing the results of the CLCP and AKSH. Although in the aggregate, the study covered more than 4,700 patients, 75% of them, initially satisfying the selection criteria, were subsequently excluded from the study, since IHD suffered with a defeat of several vessels when the CLCP is not recommended.

As a result of these studies, several important facts were allocated. In 5 of the 6 studies conducted, the general indicators of mortality and morbidity of myocardial infarction after ACCH and CLCP were not different. Only in one of the research conducted in Germany (German Angioplasty Bypass Surgery Investigational Study), the total number of deaths and cases of myocardial infarction in the near postoperative period were higher in the ACHA group.

The main difference between the two treatment strategies was delivered from the angina and the need for repeated surgical interventions. A total of 40% of patients who were performed by CLCP, they needed repeated CCCP or AKSH. At the same time, only 5% of patients after ACCH needed repeated operations. Also, after AKS, the attacks of the angina develop less frequently than after CLCP.

You can draw indisputable conclusion that recommendations for CLCP or ACH should be strictly individual. Both types of treatment should not be considered as exceptional or contradictory. Some patients showed a combination of CLCP and AKSH. AKS allows to achieve a more resistant revascularization, although there is a risk of intraoperative complications.

9. What is the approximate vessel's passability?

Shunt from the inner Mammorna 90% -Protability after 10 years of arteries
Shunt from a large subcutaneous 50% increase after 10 years Vienna legs
CLCP stenked vessel 60% -Productivity after 6 months
CLCP + STENT 80% -Productivity after 6 months

10. What are the surgical and technical problems arising from AKSH?

Surgical complications in a broad sense include technical problems with the imposition of anastomosis, complications from the sternum and complications in the area of \u200b\u200bthe cut after the feet of the subcutaneous leg veins. Technical problems with the imposition of anastomosis of the coronary artery lead to myocardial infarction. Complications from the side of the sternum are usually compressed with sepsis and polyorgan deficiency. Cuts on the leg in the fence of a large subcutaneous vein in the postoperative period can cause edema, infection and pain in the limb.

11. What is the risk of AKSH? What concomitant factors increase the operational risk of AKSH?

Evaluation of operational risk is the most important task of the surgeon before revascularization. The Society of Toracal Surgeons and the Superator Council developed and implemented two large databases. The factors that increase the operational risk with ACH are related to the reduced fraction of emission of the left ventricle before surgery (emergency or planned), the age of the patient, the disease of peripheral vessels, chronic obstructive disease of the lungs and decompensated heart failure by the time of operation.

These associated factors are of the most important for the outcome of the operation. Simply put, general mortality rates for AKS can be misleading. So, the surgeon A and B can perform identical operations, but have different indicators of overall death if the surgeon A operates the young athletes suffering from IBS, and the Surgeon B - the elderly people with a passive way of life, increased nutrition and smoking 2 packs of cigarettes per day. The assessment of the concomitant risk factors gives a more accurate representation, as far as the observed outcome of the operation was predicting.

12. What actions should be taken if the patient fails to turn off from the vitro blood circulation?

In fact, the surgeon is dealing with shock. As in the case of hypovolemic shock (with gunshot damage to the aorta), the main activities are as follows:
a) restoration of the volume of circulating blood to the optimal values \u200b\u200bof the filling pressure in the left and right ventricles.
b) After normalizing the filling pressure, start inotropic support.
c) Enter the inkido inotropic drug before the appearance of signs of intoxication (usually ventricular tachyarhythmias) and start the intra-director balloon condense. The last step is to introduce auxiliary devices for the left and / or right ventricle. They can support blood circulation, contributing to the functional recovery of myocardium.

13. Are all arterial shunts have an advantage in revascularization?

The logical conclusion made on the basis of observations that the inner Mammorian artery retains a higher permeability compared to the subcutaneous vein of the leg, awakened interest in total arterial revascularization. Instead of the subcutaneous veins of the legs, some surgeons as shunts use the right inner mammor artery, gastrointestinal artery and radiation artery.

The convincing evidence suggests that the use of left-handed internal Mammor artery as shunt reduces legality and reduces the number of angina recurrences. Data testifying in favor of total arterial revascularization is not so obvious.

14. Is it necessary to cut the patient in half? Are there less invasive surgical techniques?

In parallel with the introduction of minimally invasive surgical methods In general surgery (for example, laparoscopic cholicytectomy), there was an interest in less traumatic operations on coronary arteries. Now it is possible to perform an AKCH without vitro blood circulation through a small incision of the sternum. This technique was called the name of the minimally invasive direct antector-art shunting (MidCab). The special platform stabilizes the epicardial surface of the coronary artery for the imposition of anastomosis.

The heart continues to fight under this platform and therefore you can do without vitro blood circulation.

On another technique, called Heartpoit, the kolasilation of the aorta and the drainage of the venous system is carried out perch. Trocars are introduced through small cuts. Extracorporal blood circulation is connected, and the anastomoses are superimposed using a special chamber through small thoracoscopic ports. The long-term results of minimally invasive shunt methods are still unknown. Early messages indicate a significantly larger number of occlusion of shunts, which means that the results of revascularization with new methods may be worse than after traditional interventions.

In the latter case, the shunt (bypass track) is supplied to coronary arteries during the operation, bypassing the blockage zone of the artery, due to which the blood flow is restored, and the heart muscle gets a sufficient amount of blood. As a shunt between the coronary artery and the aorta, the inner breast or radial artery is used, as well as the subcutaneous vein of the lower limb. Internal chest artery is considered the most physiological autoshunt, and its wear is extremely low, and the functioning is calculated in decades in decades.

Conducting such an operation has the following positive moments - an increase in life expectancy in patients with myocardial ischemia, reducing the risk of myocardial infarction, improving the quality of life, improving the portability of physical exertion, reducing the need to use nitroglycerin, which is often very poorly tolerated by patients. About the coronary shunting The lion's share of patients responds more than good, since they are practically not disturbed in the chest pain, even with a significant load; There is no need for the constant presence of nitroglycerin in his pocket; The fears of infarction and death are disappearing, as well as other psychological nuances characteristic of persons with angina.

Indications for the operation

Indications for carrying out ACH are detected not only by clinical features (frequency, duration and intensity of the prudged pain, the presence of myocardial infarction and the risk of developing acute infarction, reducing the contractile function of the left ventricle according to echocardioscopy), but also according to the results obtained during coronaryogiography (kAg ) - an invasive diagnostic method with the introduction of an X-ray-repeat substance into the clearance of the coronary arteries, which is most accurately showing the place of occlusion of the artery.

The main indications identified during coronaryographics are the following:

• Left cornese artery is impassable by more than 50% of her lumen,
• All coronary arteries are impassable by more than 70%,
• Stenosis (narrowing) of three coronary arteries, clinically manifested by the attacks of angina.

Clinical readings for AKSH:

1. Stable angina 3-4 functional classes, poorly accompanying drug therapy (multiple seizures of progressary pains during the day, not allowed by the reception of short and / or long-term nitrates),
2. Acute coronary syndrome, which can stop at the stage of unstable angina or develop in a acute myocardial infarction with lifting or without lifting the ST segment for ECG (large-scale or finely focal respectively),
3. Acute myocardial infarction no later than 4-6 hours from the beginning of an uncontrolled pain attack,
4. Reduced tolerance of physical exertion, identified when conducting samples with load - Tredmil test, bicycle ergometry,
5. Pronounced solemn ischemia, identified during the daily monitoring of Hell and ECG on Holter,
6. The need for surgical intervention in patients with heart defects and concomitant myocardial ischemia.

Contraindications

Contraindications for shunt operation include:

• Reducing the contractile function of the left ventricle, which is determined according to echocardioscopy as a decrease in the emission fraction (FV) less than 30-40%,
• The general severe condition of the patient due to terminal renal or liver failure, acute stroke, lung diseases, onco-scabers,
• The diffuse lesion of all coronary arteries (when the plaques are postponed throughout the vessel, and it becomes impossible to bring the shunt, because the artery does not affect the artery),
• Heavy heart failure.

Preparation for the operation

The shunt operation can be performed in the planned or in an emergency order. If the patient enters vascular or cardio surgery department With acute myocardial infarction, he immediately after a short preoperative preparation is performed by coronary survey, which can be expanded before stenting or shunting. In this case, only the most necessary analyzes are performed - the definition of a blood group and blood coagulation system, as well as an ECG in dynamics.

In the event of a patient's planned receipt with myocardial ischemia, a full-fledged survey is held in the hospital:

1. Echocardioscopy (ultrasound of the heart),
2. Radiography of chest organs,
3. General blood tests and urine
4. Biochemical blood test with determination of blood coagulation,
5. Analyzes for syphilis, viral hepatitis, HIV infection,
6. Coronoangiography.

How is the operation?

After preoperative preparation, which includes intravenous administration of sedatives and tranquilizers (phenobarbital, phenazepam, etc.) to achieve a better effect of anesthesia, the patient is delivered to the operating room, where the operation will be carried out over the next 4-6 hours.

Shunting is always carried out under general anesthesia. Previously, operational access was carried out using sternotomy - sternum dissection, recently operations are increasingly carried out from mini-access in the intercostal interval to the left in the projection of the heart.

In most cases, during surgery, the heart is connected to the artificial blood circulation unit (AIC), which during this period of time carves blood flow instead of the heart. It is also possible to carry out shunting on a working heart, without connecting aics.

After shifting the aorta (as a rule, for 60 minutes) and connecting the heart to the device (in most cases, by half an hour), the surgeon selects the vessel that will be a shunt and leads it to the affected coronary artery, labeling another end to the aorta. Thus, blood flow to coronary arteries will be carried out from the aorta, bypassing the site in which the plaque is located. Shunts can be somewhat - from two to five, depending on the number of affected arteries.

After all shunts were linked to the right places, brackets made of metal wire are superimposed on the edges of the sternum bone soft fabrics And the aseptic bandage is superimposed. Drainages are also derived, for which hemorrhagic (blood) fluid flows from the pericardial cavity. After 7-10 days, depending on the postoperative wound healing paces, the seams and the bandage can be removed. During this period, daily dressings are performed.

How much is the shunt operation?

Operation AKSH refers to high-tech species medical care, Therefore, its cost is quite high.

Currently, such operations are carried out by quotas allocated from regional and federal budgetif the operation is carried out in planned procedures to persons with IBS and angina, and also for free on polisams OMS In the event that the operation is carried out as far as patients with acute myocardial infarction.

To obtain a quota, the patient must be implemented by examination methods confirming the need for operational intervention (ECG, coronary artwork, heart ultrasound, etc.), supported by the direction of the attending physician and cardiac surgeon. Waiting for a quota can take from a few weeks to a pair of months.

If the patient does not intend to expect quotas and can afford to carry out surgery for payable services, then it can contact any state (in Russia) or in a private (abroad) clinic, practicing such operations. The approximate cost of shunting is from 45 thousand rubles. Operational interference itself without the cost of consumables up to 200 thousand rubles. with the cost of materials. With joint prosthetics of the shunt valves with shunting, the price is respectively from 120 to 500 thousand rubles. Depending on the number of valves and shunts.

Complications

Postoperative complications can develop both from the heart and other organs. In the early postoperative period, cardiac complications are represented by acute perioperative myocardial necrosis, which can develop in acute myocardial infarction. The risk factors of the development of a heart attack are mainly in the time of operation of the artificial blood circulation apparatus - the longer the heart does not fulfill its contractile function during the operation, the greater the risk of myocardial damage. Postoperative infarction is developing in 2-5% of cases.

Complications from other organs and systems are rarely developed and are determined by the age of the patient, as well as the presence of chronic diseases. Complications include acute heart failure, stroke, aggravation of bronchial asthma, diabetes decompeensation, and other prevention of such states is a full-fledged survey before shunting and comprehensive patient preparation for the operation with the correction of the function of the internal organs.

Lifestyle after surgery

The postoperative wound begins to heal after 7-10 days after the shunting. Busty, being a bone, heals much later - 5-6 months after surgery.

In the early postoperative period, rehabilitation activities are held with the patient. These include:

• Dietary food
• Respiratory gymnastics - the patient is offered a semblance of a balloon, inflating which, patient spreads the lungs, which prevents development venous stagnation in them
• Physical gymnastics, first lying in bed, then walking along the corridor - Currently, patients strive as early as possible, if it is not contraindicated due to the general severity of the state, to prevent blood stagnation in veins and thromboembolic complications.

In the late postoperative period (after discharge and subsequent), the exercises recommended by the doctor continues medical physical education (physician physical physician), which strengthen and train the heart muscle and vessels. Also, a patient for rehabilitation is necessary to follow the principles of a healthy lifestyle, which include:

1. Full refusal to smoking and drinking alcohol,
2. Compliance with the basics of healthy nutrition - an exception of oily, fried, acute, salted food, more eating fresh vegetables and fruit equal milk products, low-fat varieties of meat and fish,
3. Adequate exercise - walking, light morning gymnastics,
4. Achieving the target level of blood pressure carried out by hypotensive drugs.

Design of disability

After the operation of shunting the vessels of the heart, temporary disability (on the hospital sheet) is drawn up for up to four months. After that, patients are sent to ITU (medical and social expertise), during which the patient is decided by a patient a person or another group of disabilities.

The Group III is assigned to patients with the uncomplicated passage of the postoperative period and with 1-2 classes (FC) of angina, as well as without heart failure or with it. It is allowed to work in the field of professions that are not carrying the threat of heart activities to the patient. Prohibited professions include - work at height, with toxic substances, in field conditions, driver's profession.

The group II is assigned to patients with complicated passage of the postoperative period.

The group is assigned to persons with severe chronic heart failure, requiring the care of unauthorized persons.

Forecast

The prognosis after the operation of the shunting is determined by a number of indicators such as:

• The duration of the functioning of the shunt. The very long-term is considered the use of internal chest artery, since its consistency is determined five years after the operation of more than 90% of patients. The same good results are noted when using radial artery. The large subcutaneous vein has less wear-resistance, and the validity of the anastomosis after 5 years is observed in less than 60% of patients.
• The risk of myocardial infarction is only 5% in the first five years after surgery.
• The risk of sudden cardiac death is reduced to 3% in the first 10 years after surgery.
• The portability of physical exertion is improved, the frequency of angina attacks is reduced, and in most patients (about 60%) angina, it does not return a wall.
• Mortality statistics - postoperative mortality is 1-5%. The risk factors include preoperative (age, number of infarction suffered, myocardial ischemia zone, the number of affected arteries, the anatomical features of the coronary arteries before intervention) and postoperative (the nature of the shunt and the time of artificial blood circulation).

Based on the foregoing, it should be noted that the operation of the AKS is an excellent alternative to the long-term drug treatment of the CHD and angina, as it will significantly reduces the risk of developing myocardial infarction and the risk of sudden cardiac death, as well as to significantly improve the quality of the patient's life. Thus, in most cases the shunt operation, the prognosis is favorable, and patients live after shunting of heart vessels for more than 10 years.

Contraindications to Aquash

AKSH refers to surgical methods for the treatment of ischemic heart disease (IBS), which have a direct increase in coronary blood flow, i.e. Myocardial revascularization.

Indications for myocardial revascularization (coronary shunting operations)

The main testimony to the reflause of myocardium are:

Coronirogram of the left coronary artery: critical stenosis of a draft barrel with a good distal

general

The operation is carried out under general multicomponent anesthesia, and in some cases, especially when performing operations on a beating heart, the high epidural anesthesia is additionally used.

10) Turning off IR;

Different surgeons are used various formulations Cardioplegic solutions: pharmacolic sharpening crystalloid cardioplegia (cooled to 4 ° C solution of saint thomas, console, curzodiol) or blood cardioplegia. In case of severe damage, the coronary bed besides the antitegrand (in the root of the aorta), the cardioplegia is also used to ensure a uniform distribution of the solution and cooling the heart. Drain the left ventricle through the right upper pulmonary vein or through the ascending aorta.

Most of the surgeons first impose distal anastomoses of the aortocortonary shunts. The heart rotates to access the appropriate branch. The coronary artery is opened longitudinally on a relatively soft area below atherosclerotic plaques. Anastomosis is imposed in terms of graft and coronary artery. First form distal anastomoses of free conduits, and the last place is a mammaroconary anastomosis. The internal diameter of the coronary arteries is usually 1.5-2.5 mm. Most often, the three coronary artery shunts: the front interventricular, the branch of the stupid edge of the envelope of the artery and the right coronary artery. Approximately 20% of patients require four or more distal anastomoses (up to 8). At the end of the imposition of distal anastomoses after the prevention of the air embolism, the clamp with an ascending aorta is removed. After removing the clamp, cardiac activity is restored independently or by electrical defibrillation. Then the proximal anastomoses of free contradients form on an invoicially pressed ascet. The patient warms. After turning on the blood flow on all shunts, IK gradually finish. Then followed by decanulation, heparin reversion, hemostasis, drainage and stitching of the Russian Academy of Sciences.

Aorticoronary artery shunting: species, contraindications, general recommendations

• Heavy shape of angina;
• The damage to the coronary channel with a narrowing of the main vessels at least by 75%;
• The reduction function of the left ventricle is at least 40%.

• Diffuse damage to the coronary arteries;
• Stagnant heart failure;
• Reduced left ventricular emission function to 30% and lower.

• Chronic lung diseases;
• Oncological diseases;
• Renal failure.

Varieties of operation

• Using small cuts. This can also include operations with endoscopic instruments;
• Using artificial blood circulation;
• Using a special "stabilizer" for shunting.

1. Cuts are made on the chest and legs. The first cut is needed to provide access to the heart, and the vessels will be taken from the feet. Vienna are not always taken from the legs, but very often. This is due to the fact that the vessels are the most pure from atherosclerosis.
2. Then the selected area is attached to the damaged vessel in the heart, and one side is attached to the blood flow from the affected segment, and the other to the artery from which blood will flow.

• Smaller discomfort after surgery;
• Less pain;
• Less blood loss during surgery;
• Less risk of infection;
• More chances to breathe deeper and the ability to fade well after surgery;
• A good forecast for the speedy rehabilitation after AKS at home.

• Stress;
• Smoking;
• Diabetes;
• High blood pressure;
• Sedentary lifestyle;
• Obesity;
• High cholesterol.

Diet

Contraindications when shunting the heart

Indications for the operation of aorto-coronary shunting

Treatment of patients with IBS is based on the following provisions:

The proximal thrombotic occlusion of the coronary artery is the cause of myocardial infarction (im);

After the sudden and prolonged occlusion of the coronary artery, irreversible necrosis of the myocardial zone is developing (in most cases, this process is completed for 3-4 hours, a maximum of 6 hours);

The size of them is a critical determinant of the left ventricular function (LV);

The LV function in turn is the most important determinant of the early (intra-hospital) and remote (after discharge) of mortality.

If the percussion is impartial interference (pronounced stenosis of the left coronary artery barrel, diffuse multi-sized lesion or calcification of coronary arteries) or angioplasty and stenting turned out to be unsuccessful (the inability to pass by stenosis, intrauterine restenosis), the operation in the following cases is shown:

I Group of Indications for Operation.

Patients with rafissal angina or large volume of urban myocardium:

Tintroducture III-IV FC, refractory to drug therapy;

Unstable angina, refractable to drug therapy (the term "acute coronary syndrome" is applicable to various versions of unstable angina and them. Defining the levels of troponin helps differentiate unstable angina Without it from them without lifting the ST segment).

Acute ischemia or instability of hemodynamics after an attempt of angioplasty or stenting (especially during dissection and impaired blood flow by artery);

Developing for them within 4-6 hours from the beginning of the chest or later in the presence of continuing ischemia (early post-infarction ischemia);

Sharply positive stress test before planned abdominal or vascular operation;

Ischemic pulmonary edema (frequent equivalent of angina in women of old age).

II group of indications for the operation.

Patients with pronounced angina or refractory ischemia, in which the operation will improve a distant prognosis (pronounced degree induced under stress-test of ischemia, meaningful coronary lesion and state of contractile function of LV). This result is achieved by preventing them and maintaining the pump function of LV. The operation is shown to patients with a disturbed function of LV and ischemia induced in which the forecast for conservative therapy is unfavorable:

Stenosis of the left coronary artery trunk\u003e 50%;

Three-sided defeat with fV<50%;

Three-sided lesion with FV\u003e 50% and expressed ischemia induced;

One and two-axisy defeat with a large amount of myocardium at risk, while angioplasty is impossible due to anatomical features Defeat.

III group of indications for surgery

Patients who are planned for a heart surgery, an aortocortonary shunting is performed as a concomitant intervention:

Operations on valves, miodeptectomy, etc.;

Concomitant intervention in operations over the mechanical complications of them (aneurysm of LV, post-infarction DMCP, acute MN);

Anomalies of the coronary arteries with a risk of sudden death (the vessel passes between the aorta and the pulmonary artery);

The American Heart Association and the American College of Cardiologists distribute testimony for the operation in accordance with the classes of the proof of their effectiveness I-III. At the same time, the testimony is set primarily on the basis of clinical data and in the second data of the coronary anatomy.

Indications for Aorticoronary Criming

Highlighting the main indications of the shunting of the heart vessels and the states under which the conducting of an aortocortonary shunting is recommended. The main testimony of only three and each cardiologist must either eliminate these criteria or reveal them and send the patient to the operation:

The obstruction of the left corona artery is more than 50%;

Narrowing of all coronary vessels by more than 70%;

Meaning stenosis of the front interventricular artery in proximal Department (i.e. closer to the place of disheaval from the main barrel) in combination with two other significant stenosis of the coronary arteries;

These criteria refer to the so-called prognostic indications, i.e. Those situations in which non-surgical treatment does not lead to a serious change in the situation.

There are symptomatic testimony to the Aorticoronary artery shunting (AKSH) - this is primarily the symptoms of angina. Medicia treatment It can eliminate symptomatic readings, but in a remote period, especially if it is chronic angina, the likelihood of repeated attacks of angina chains above, rather than AKSH.

Coronary shunting is a gold standard in the treatment of many cardiacacitifiers and is always discussed by an individual opportunity to conduct it if there is no absolute testimony to the operation, but the cardiologist recommends this procedure due to the inconvenience of long-term drug therapy and its reduced effects in remote periods, such as mortality and Complications of the aortocamonary shunting.

If we consider from the point of view of mortality, then compared with symptomatic anti-inanal therapy, the death rate after AKSH is three times lower and two times lower than after long-term anti-chemical heart therapy. Mortality itself in absolute numbers is approximately 2-3% of all patients.

Related diseases are able to reconsider the need for an aorticoronary artery shunting towards it. Especially if this pathology of cardiac origin (for example, the vices of the heart) or one way or another worsening the flow of oxygen to the tissues of the heart.

The shunting of the heart vessels is shown by the elderly and weakened patients, since the operation does not require a large operating field and the decision on its conduct is justified by life testimony.

Aorticoronary simulator shunting (AKSH)

Aorticoronary artery shunting (AKSH) or coronary shunting (CSH) is an operation that allows you to restore blood flow in the arteries of the heart (coronary arteries) by bypassing the place of narrowing the coronary vessel with shunts.

AKSH refers to surgical methods of treatment of ischemic heart disease (IBS). who have a direct increase in coronary blood flow, i.e. Myocardial revascularization.

2) the prognostically unfavorable damage to the coronary channel - proximal hemodynamically significant lesions of the draft barrel and the main coronary arteries with narrowings of 75% and more and passable distal channel,

3) The preserved contractual function of myocardium with the left ventricle is 40% and higher.

Indications for the reference of myocardium in chronic IHD are based on three main criteria: gravity of the clinical picture of the disease, the nature of the damage damage, the state of the contractile function of myocardium.

The main clinical indication for the myocardial revascularization is heavy angina resistant to drug therapy. The severity of the angina is estimated at the subjective indicators (functional class), as well as on objective criteria - tolerance to the physical exertion, determined according to cyergometry or threaded test. It should be borne in mind that the degree of clinical manifestations of the disease does not always reflect the severity of the lesion of the coronary direction. There is a group of patients who, with relatively scarce clinical picture Diseases are noted by pronounced changes in the ECG of rest in the form of so-called nonsense ischemia according to Halter monitoring. The effectiveness of drug therapy depends on the quality of drugs, correctly selected dosages, and in most cases, modern drug therapy is very effective in eliminating pain syndrome and myocardial ischemia. However, it should be remembered that the catastrophe during the IBS is usually associated with a violation of the integrity of an atherosclerotic plaque and therefore the degree and nature of the damage to the coronary channel according to coronary frames are the most important factors in determining the testimony to operation of the AKSH. Selective coronorography remains the most informative diagnostic method, which allows you to verify the diagnosis of coronary arteries, to verify the diagnosis of IHD, determine the exact localization, degree of damage to the coronary arteries and the state of the distal channel, as well as predict the course of the IBS and indicate surgical treatment.

The accumulated huge experience of coronaryographic studies has confirmed the fact known for another pathological data the fact of a predominantly segmental nature of the damage to the coronary arteries in atherosclerosis, although diffuse damage forms are often found. Angiographic indications for the revascularization of myocardium can be formulated as follows: proximally located, hemodynamically significant obstruction of the main coronary arteries with a passable distal channel. Hemodynamically significant are lesions, leading to narrowing the lumen of the coronary vessel by 75% and more, and for lesions of the draft barrel - 50% or more. The more proximal is the stenosis, and the higher the degree of stenosis, the more pronounced the shortage of the coronary blood circulation, and the more shown the intervention. The most prognostically unfriendly defeat of the draft barrel, especially with the left type of coronary blood circulation. An extremely dangerous proximal narrowing (above 1 of the septal branch) of anterior interventricular artery, which can lead to the development of an extensive myocardial infarction of the front wall of the left ventricle. An indication for surgical treatment is also a proximal hemodynamically significant defeat of all three main coronary arteries.

One of of most important conditions The implementation of direct changes in myocardium is the presence of a passing channel distal than hemodynamically significant stenosis. It is customary to distinguish between good, satisfactory and bad distal. Under a good distal channel, it is implied to the end departments, without irregularity of the contours, satisfactory diameter of the vessel section below the last hemodynamically significant stenosis. The satisfactory distal bed is spoken if there are irregularity of contours or hemodynamically insignificant stenosis in the distal departments of the coronary artery. Under the bad distal roller understand sharp diffuse changes vessel all over or absence of contrasting of his distal departments.

Coronirogram: diffuse damage of coronary arteries with the involvement of the distal bed

The most important factor in the success of the operation is the preserved contractile function, the integral indicator of which is the emission fraction (FV) of the left ventricle (LV), determined by echocardiography or by X-ray-contrast ventriculography. It is believed that the normal value of FV is 60-70%. With a decrease in FV, less than 40% risk of operation increases significantly. The decrease in FV can be both the result of scars and ischemic dysfunction. In the latter case, it is due to the "hibernation" of myocardium, which is an adaptive mechanism under conditions of chronic blood supply deficit. In determining the testimony to AKSH in this group of patients, the differentiation of irreversible scar and mixed cetting and ischemic dysfunction is the most important. Stress-echocardiography with dobutamin allows you to identify local disorders of the contractility in the myocardial zones and their reversibility. Ischemic dysfunction is potentially reversible and can regress with successful revascularization, which gives grounds to recommend surgical treatment with these patients.

Contraindications to Aorticorona shunting are traditionally considered: diffuse damage to all coronary arteries, a sharp decrease in the PV of the left ventricle to 30% and less as a result of cutting lesions, clinical signs stagnant heart failure. There are I. general Contraindications in the form of severe concomitant diseases, in particular, chronic nonspecific diseases of lungs (CHNZL), renal failure, oncological diseases. All these contraindications are relative. An old age is also not an absolute contraindication to the implementation of myocardial revascularization, that is, it is more correct to talk about contraindications to AKS, but about operating risk factors.

MOCARD ECHINE OPERATION OPERATION

The operation of the AKS is to create a coaching path for the blood permitting (swallowed or occlusive) proximal segment of the coronary artery.

There are two main methods for creating a workaround of a workaround: Mammaroconse anastomosis and bypass Aortocamonary shunting by auto-veneous (own vein) or an auto-organizational (own artery) transplant (Conduit).

Schematic image of the imposition of Mammarno-coronary anastomosis (shunt between the inner chest artery and the coronary artery)

In the mammaroconal shunting, an inner chest artery (VGA) is used, it usually "switches" to the coronary direction by anastomosing with the coronary artery below the last stenosis. VGA is filled with natural pathway from the left connector artery, from which it leaves.

Schematic representation of the imposition of aorto-coronary anastomosis (shunt between the aorta and the coronary artery)

With an aorticonial shunting, the so-called "free" conjitis (from a large subcutaneous vein, radiation artery or VGA) is used to anatomize with a coronary artery below the stenosis, and the proximal - with an ascending aorta.

First of all, it is important to emphasize that AKS is a microsurgical operation, since the surgeon operates at an arterier with a diameter of 1.5-2.5 mm. It was the awareness of this fact that the introduction of precision microsurgical techniques ensured that success that was achieved in the late 70s - early 80s. last century. The operation is carried out using surgical binocular LUCs (increase in x3-x6), and some surgeons operate with the use of an operating microscope, which allows to achieve an increase in X10 - X25. Special microsurgical tools and the finest atraumatic threads (6/0 - 8/0) make it possible to maximize precision to form distal and proximal anastomoses.

The operation is carried out under general multicomponent anesthesia. And in some cases, especially when performing operations on a beating heart, the heart additionally use high epidural anesthesia.

Aorticoronary artery shunt technique.

Operation is carried out in several stages:

1) access to the heart, usually carried out by middle sterotomy;

2) WGA selection; the fence of autogenous grafts performed by another team of surgeons simultaneously with the production of sternotomy;

3) the cannulation of the upward part of the aorta and hollow veins and the connection of IR;

4) Pressing the upward part of the aorta with a cardioplegic heart stop;

5) the imposition of distal anastomoses with coronary arteries;

6) removal of the clamp with the ascending part of the aorta;

7) the prevention of air embolism;

8) restoration of cardiac activity;

9) the imposition of proximal anastomoses;

10) Turning off IR;

12) Surfing a sternotomic cut with the drainage of the pericardia cavity.

Access to heart is carried out by full of median sternotomy. Allocate VGA to the place of disheaval from the subclavian artery. In parallel, the fence is performed by the autogenous (large subcutaneous vein of the leg) and the auto-organizerial (radiation artery) of the Conduits. Open pericardium. Conduct complete heparinization. The artificial circulation apparatus (AIC) is connected according to the scheme: hollow veins - ascending aorta. Artificial blood circulation (IR) is carried out under conditions of normathermia or moderate hypothermia (32-28 ° C). To stop the heart and the protection of myocardium, you use cardioplegia: the ascending aorta is shifted between the aortal cannula AIK and the mouths of the coronary arteries, after which a cardioplegic solution is introduced into the root of the aorta.

Numerous studies convincingly proved that the operations of direct changes in myocardial increase the life expectancy, reduce the risk of developing myocardial infarction and improve the quality of life compared with drug therapy, especially in groups of patients with prognostically unfavorable defeat of the coronary direction.

Myocardial revascularization

The current procedure of the aorto-coronary shunting allows to successfully cope with the blocking of the coronary arteries. They are responsible for the nutrition of the heart muscle.

With a narrowing of the lumen or full blocking of the artery, the heart muscle becomes easily vulnerable. Most often, the operation of the shunting is assigned if other treatment methods turned out to be invalid, did not lead to positive dynamics. Surgical intervention is performed with the mandatory use of general anesthesia, as it is necessary to make a fairly large incision in the chest area. The procedure passes with the connection of the artificial circulation apparatus, which temporarily replaces the heart.

However, modern medicine stepped far ahead and in most medical centers the operation passes with the continuing heart. However, this technology is used only in case of confidence that the muscle will endure the load or if the artificial blood circulation unit cannot be connected due to the existing contraindications.

The essence of the procedure is to perform bypass blood flow, bypassing the locked area. Used to create a new bloodstream, own veins of the patient who take out of their legs. Breast inner aorta can be used for this purpose. Its end is so connected to the bloodstream in the heart. Therefore, surgeons are only required to connect the second end with a coronary artery.

The usual duration of the operation is 4 - 6 hours. To further restore the patient placed in the separation of intensive therapy. Like any surgical intervention, the shunting is associated with some risks. Among postoperative complications - The possibility of blood cloves that can penetrate into pulmonary fabrics, infectious processes affecting the lungs, chest area and urinary system, large blood loss.

Because of this, the operation "Shunting of the Heart", the reviews of which make it possible to judge the high success of the procedure requires preliminary training. First of all, the patient is obliged to inform the doctor about the reception of pharmacological preparations and various ragners of plants. Approximately 14 days before the date of the appointed operation, it is necessary to eliminate the likelihood of use. medicinesreduced blood clotting. First of all, they include such common medicines as: aspirin, naproxen, ibuprofen. The operation will be postponed if the patient suffered immediately in front of it with flu, herpes cold.

It is recommended not to eat and eat liquid, starting from midnight before surgery. Dry in the mouth can be eliminated by the usual rinsing. If necessary, take drug Treatment, it is necessary to drink it with a small sip of water.

The lifespan after shunting the heart largely depends on the patient himself. The complete restoration of the body occurs in about 6 months. However, the operation does not mean the lack of such a problem in the future in the non-compliance with the Doctor's recommendations. These include a complete refusal to eat alcohol-containing beverages and smoking, transition to healthy eating with a limitation of fats and carbohydrates, physical activity, control over blood sugar concentration and cholesterol levels. In addition, the patient is obliged to treat hypertension, which often accompanies diseases cardiovascular vascular system. Also, the patient must constantly take drugs that prevent thrombosis.

Indications for the shunting of the heart - ischemic disease, which every year is detected from an increasing number of people. Female outcome from ischemia is one of the highest rates. The blockage of the coronary artery deprives the heart of oxygen and nutritional elements. As a result, angina develops, accompanied by painful sensations in the chest. When the process is delayed, the lesion of the muscle areas of necrotic formations is not excluded. It is the death of a portion of the heart muscle tissue and call myocardial infarction. In the future, it is possible to grow the connecting tissues that completely replace the affected portion of the heart. This negatively affects the functionality of the muscles, unable to cope with the load on blood pumping. This condition is called heart failure. Its main signs become swelling caused by stagnation of blood and reduce the performance of all systems.

Previously, the ischemic disease was treated with the appointment of pharmacological preparations. Only in the 60s of the last century began to use the aorto-coronary shunting, which is used today, as the most efficient means of eliminating the problem. Technique is constantly improving. So, now you can expand the clearance of the vessel, without resorting to the surgical cut. Balloon angioplasty allows you to enter a stent in the lumen, which supports the walls of the artery, not allowing them to come.

Extremely important to achievements in the field of treatment of ischemia for patients who are not available to the aorto-coronary shunting for a number of reasons. Contraindications include a difficult state at which the operational intervention is associated with the risk of fatal outcome; the presence of cancer; serious problems with light, liver, kidneys; uncontrolled hypertension; recently transferred stroke; Distal and diffuse stenosis; Critically low reduction in myocardium left ventricle. The operation may be denied due to the pronounced obesity of the patient, noncompensated diabetes mellitus.

Aorto-coronary shunting is not a panacea. But, subject to the recommendations, a person can live for decades without experiencing problems with the work of the main muscle of his body.

Often, in our time there are various diseases associated with poor vessels. One of these is ischemic heart disease. This pathology is characterized by a violation of equilibrium between the bloodstream and the needs of the heart muscle.

To solve this problem, they make an operation that is called an aortocortonary shunting or simply an AKSH. What it is? Briefly can be described as follows: the essence of this operation is that with the help of various means (depends on a specific case) bypass the location of the coronary vessel. Another operation can be another operation - stenting coronary arteries, which allows you to expand the area that prevents normal blood flow.

In what cases is carried out AKS and contraindications

Aorticoronary artery shunting is carried out with the following testimony:

Heavy shape of angina; The damage to the coronary channel with a narrowing of the main vessels at least by 75%; The reduction function of the left ventricle is at least 40%.

But there are also contraindications to the use of AKSH. The main ones are the following:

Diffuse damage to the coronary arteries; Stagnant heart failure; Reduced left ventricular emission function to 30% and lower.

In addition, there are other cases in which the use of AKSH is unacceptable. Among them are the following:

Chronic lung diseases; Oncological diseases; Renal failure.

All these contraindications are not absolute, but are relative. Therefore, they are sometimes called the factors of the operational risk of AKSH.

Varieties of operation

The shunting of the heart vessels is to create a coating path by the affected portion of the coronary artery using special means.

Currently, there are two ways to create this path: Mammaroconal shunting (during this operation, an internal chest artery is used, which is transferred to a new course. It is filled with naturally) and an aortocortonary shunting (in this case, areas of radiation artery or large subcutaneous veins are used).

The coronary shunting of the blood vessels is the following types:

Using small cuts. This can also include operations with endoscopic instruments; Using artificial blood circulation; Using a special "stabilizer" for shunting.

The technique of surgical intervention is chosen after evaluating the degree of damage to coronary arteries by experts and carrying out coronary frames (X-ray-contrast method with the most reliable results).

Aorticoronary artery shunt technique

In short, the technique of operation consists of the following steps:

Cuts are made on the chest and legs. The first cut is needed to provide access to the heart, and the vessels will be taken from the feet. Vienna are not always taken from the legs, but very often. This is due to the fact that the vessels are the most pure from atherosclerosis. Then the selected area is attached to the damaged vessel in the heart, and one side is attached to the blood flow from the affected segment, and the other to the artery from which blood will flow.

If the vein site was taken from her legs, then for several more weeks the patient may experience pain in his leg. This applies to long walking or standing.

Advantages of endoscopic operations

Smaller discomfort after surgery; Less pain; Less blood loss during surgery; Less risk of infection; More chances to breathe deeper and the ability to fade well after surgery; A good forecast for the speedy rehabilitation after AKS at home.

Life after shunting of heart vessels

Coronary shunting of the blood vessels is the main step of return to normal life. This surgical intervention is carried out in order to treat the pathologies of the coronary arteries and allows them to eliminate pain syndrome, but does not guarantee full disposal from atherosclerosis, which is fraught with repeated appeals to the cardiac surgeon about the manifestations of this disease.

Tip: In order to minimize the effect of atherosclerosis on the heart vessels, it is necessary to fundamentally change their habits in nutrition and lifestyle.

Factors affecting the appearance of atherosclerotic changes that can be adjusted:

Stress; Smoking; Diabetes; High blood pressure; Sedentary lifestyle; Obesity; High cholesterol.

To eliminate these reasons with medical professionals will be not much difficult, unless, of course, it will want. But the predisposing factors are such as heredity, gender and age, unfortunately, with all the wishes of the patient not to eliminate.

Diet

After surgical intervention about the ischemic heart disease, special attention should be paid to the diet in the rehabilitation period.

Tip: At this stage, recovery is important to reduce the consumption of salt and saturated fats, that is, it should be abandoned from various kinds of pickles, smoked and fried food.

Proper nutrition, as you know, - Pledge of health and longevity

It should not be naive to believe that life after shunting of the heart vessels will not be overshadowed by any complications. This is a real misconception, fraught with the emergence of numerous consequences. The patient should devote himself to a healthy lifestyle during the remaining life. That is, to engage in wellness gymnastics, refuse smoking and excessive consumption of strong alcoholic beverages, adhere to the heads of healthy nutrition.

In the daily diet of people with heart problems and vessels, it is necessary to include more fresh vegetables and fruits. They contain vitamins and the necessary trace elements, as well as fiber, which contributes to the purification of the body. From the flour and sweet is better to abandon at all. These products contribute to the extra kilograms, which is unacceptable when chronic pathologies Blood system.

In compliance with all the recommendations of the attending physician, after a few days after surgery, the patient will be able to assess its beneficial effect. Paines will decrease. Over time, a complete rejection of drugs is possible, and this will radically contribute to improving the quality of life.

Video

Attention! The information on the site is represented by specialists, but is familiarized and cannot be used for independent treatments. Be sure to advise your doctor!

Aorticoronary artery shunting is an operation on the arterial vessels of the heart, the morphological substrate of which, is the creation of parallel blood flow of the affected coronary artery with the help of Hello and autotransplants. The so-called operational intervention in the heart, thanks to which the surgeon establishes bypass shunt on the damaged blood vessel.

Varieties of operation

If one artery is damaged, one shunt is required. If two or more damaged, then two or more shunts are injected.

There are certain types of AKS in the world:

When the artificial circulation and the creation of a complex of measures to protect myocardials during the time of temporary disconnection of the heart; Without connecting the vitral blood circulation, the risk of complications decreases, but care and experienced surgeon are required; With endoscopic surgical interventions, the smallest cuts are made with the inclusion of an extracorporeal blood circulation or without it, with this form of operation there is rapid healing of the wound.

Used for shunt vascular transplant of aorticoronary artery shunting:

aukotenoic - patient venous vessel; Autiaryine - radiation artery patient; Mammoconal - internal thoracic patient artery.

Aorticononal type of shunting is selected for patients individually.

Indications for the operation of the Aorticoronairchnych

It should be known that pain in the chest can contribute to multiple or only one affect of coronary vessels.

Cardiac pain is a dangerous signal that requires an immediate campaign to a doctor for a complete examination.

The emerging discomfort can last from a few minutes and is sometimes tightened to several hours. Pain keeps in foot, neck, in left. With some actions: exercise, after meals, stressful situations or calm condition may also have a tendency to pain.

A long-term state can attract a hearth creek cell (ischemia). First of all, ischemia damages cells and causes myocardial infarction. The reason leading to this procedure is ischemic heart disease (code on the ICD 10, I20-I25, unexpected chest pain), aneurysm, atherosclerosis, providing food and oxygenation to the heart.

Passing the full examination is assigned to the beginning of medicines. If they do not help, the operation is necessary here. The meaning of the shunting is as if in carrying out a damaged blood flow artery with the help of a bypass direction - Shunts.

Basic indications for the operation:

With the thrombotic blockage of the coronary artery, the myocardial infarction (im) is manifested; With the sudden or long blockage of the coronary artery in the myocardial part, decompensation arises (the duration of this process is from 3 to 6 hours maximum); If the volume is the critical characteristic of the left ventricle function (LV);

Contraindications

The main contraindications to the operation on AKS are:

With total changes in coronary arteries; Chronic violation heart work; Reducing the blood release fraction with left ventricle to thirty percent and lower.

The remaining cases in which the shunting is unacceptable:

In cancer; In chronic obstructive diseases of the lungs; With renal failure.

Effect of procedure

The effect of the co-coronary artery shunt procedure leads to the restoration of blood supply, but does not guarantee the liberation of the patient from the excitation of atherosclerosis. It is necessary to adhere to the recommendations of the doctor, diets after the aortocortonary shunting - this will help to further avoid complications that can lead to a re-conducting operation. Watch the best active lifestyle, control exercise, then risk factors will be reduced. It is not recommended to use alcohol drinking drinks and tobacco products, reduce the consumption of carbohydrates and fats. Thus, the risk factor of the disease after the operation will be reduced.

Methodology

In the preoperative period, the patient introduces intravenously soothing drugs, placed on the operating table, the anesthesiologists team performs vein catheterization, check the electrocardiography, respiratory frequency and blood saturation with oxygen.

Anesthesia is administered to the patient, and the tracheal intubation is carried out using the introduction of the tracheal tube to ensure the passability of the respiratory tract.

There is a different technique of an aorticoronary artery shunting, which is divided into steps:

The passage to the heart is supplied. For this make a section in the middle of the sternum; According to the identified angiogram, the place of imposing shunt is determined; Conduct the shunt, they can take a vein from the lower limb, breast or radial artery. The operation is made during the temporary disconnection of the heart and connecting the devices for extracorporeal or artificial blood circulation; On a functioning heart in the myocardial zone, a compound of two hollow organs is carried out, stabilizers are applied; The shunt is applied: one of the ends of the arteries or veins are laid to the aorta, and the other end to the coronary artery; Restore the health of the heart. Install drainage and sewing wound.

The duration of the operation varies from four to six hours and depends on the number of imposed shunts and the individual characteristics of the patient's body.

Preparation for the operation

The operation is planned in advance, and the patient signs documents for an operational agreement:

When entering the hospital to the prescribed day of the shunt operation, the patient is not recommended to take about a week of drugs that contribute to a decrease in blood coagulation (aspirin, cardiomagnet, ibuprofen, platinum, clopill). For this period, doctors recommend taking anticoagulants: low molecular weight heparin (kleksan 0.4). Before carrying out the operation, the patient is prescribed to pass fibrogastroscopy, for the presence of bleeding erosion or stomach ulcers, in order to prevent postoperative hemorgia. Doppler of brain vessels is performed, ultrasonic examination of the veins of the lower extremities, and the abdominal organs. During the day before the operation, the patient cannot be eaten after midnight. Also the study of electron diffraction, inspect the doctors cardiologist and cardiac surgery. Before the operation, the patient needs to clean the intestines, take a warm shower, to cut the hair in the zone where they will be operated on to appoint a physician drug. After midnight, it is allowed to drink only water, but on the day of operation it is strictly forbidden to eat food.

The time of operation occurs, the patient is transferred to the operal table. The patient is carried out under anesthesia, so that it does not feel pain. Connect devices tracking all organs. The operation can be carried out both with artificial blood circulation with a temporary stop of the heart, and without it.

After the shunting impose seams onto the skin. Later, the patient is translated into intensive care, so that the patient come to a normal state and take care of the patients for about 2-3 days after the operation. When the patient's condition is normalized, they are transferred to the surgical department for a further course of treatment.

Possible consequences complications

When shunting a new vessel section, the patient's condition changes.

When normalizing to myocardium blood flow, the life of the patient after the operation on the heart changes in the positive side:

Does not torment the attack of angina; The risk factor of the resumption of infarction is low; The condition is improved; Increases efficiency; An increase in the volume of physical exertion; High probability to live a long life; The need for medication only can be in demand to be for prevention.

Most patients (50-60%) disappear after surgery all possible violations, according to statistical data, 10-30% of the state improves. 85% of patients do not occur (occlusion) of vessels, in connection with this, no longer attracted to the re-operation.

Complications of Aquash

Usually complications after operating rarely happens, mainly occurs inflammatory process or swelling. A rare case when the wound can open. Disadvantaged, weakness, sore pain, arthralgia, heart rate disruption, the temperature rises - all this is accompanied by an inflammatory process.

Complications manifested with AKSH:

Wound infection; Inconsistency of seams; Mediastinitis; Left ventricle dysfunction; Rejection of the suture thread; Pericarditis; Renal failure; Chronic suture pains; Postperfusion syndrome.

Such complications are quite rare, the risk factor of which is the condition for the postoperative moment of the patient.

Characteristically affecting risk factors for further state:

Nicotinism (tobacocco); Limited physical activity; Lipomatosis (painful fullness); Kidney disease; Raising cholesterol; Diabetes 1 and 2 types.

The patient for the purposes of normal continuation of life is simply vital to comply with the requirements of doctors so that atherosclerotic plaques appear repeatedly occur.

If the recommendations were not respected and an atherosclerotic plaque or a new blockage arose, it is quite possible that you will be denied re-holding Operations. This is exactly necessary using new narrowings.

Recovery after surgery

After the operation, the patient's operation is delivered to the resuscitation separation, where the health of the heart muscle and the functioning of the lungs is restored. The duration of the period is 10 days. The initial rehabilitation is carried out in the hospital, further procedures are already under the rehabilitation center. The seam on the chest at the place where the shunt material was taken, washed with antiseptics to avoid contaminants and suppuration. Seams are usually removed on day 7. The wound some time can disturb the burning and pain, over time it will pass. And only after one or two-weeks of the skin is allowed to take a shower. Bone in the chest heals a very long time - 4-6 months. Breast bandages are used for rapid healing. To avoid on the legs of stagnation in the veins and elastic stockings are worn to prevent thrombosis, but the most important thing is necessary for a while to abandon physical exertion. Because of the high blood loss during the operation, anemia may appear in a patient, so everything that is necessary is to feed the products containing iron, after a certain time, the hemoglobin will resume. To avoid inflammation of the lungs, with the restoration of normal respiration, the patient will need to make breathing gymnastics every day. Figure is an important part of the rehabilitation after the operation. For its relief, press to your chest palm. With full recovery, you can gradually increase exercise. Stenicardi attacks stop. Most of the walking. After 2-3 months or earlier, the patient may begin work, depending on which activities are engaged in a person. If the work is time-consuming and is associated with physical exertion, it is recommended whenever possible to change its place of work on a more or less easy. Disability after anorthoconal shunting is given by the patient, which is limited as a state of health in labor activity. Commission is held after rehabilitation to recognize a patient with disabilities. Disability is allocated individually in a particular situation. At a minimum, after 2 months of the patient, they are checked with a special load test to identify pain, ECG changes. If all this turns out to be normal, the patient successfully passed the recovery.

Cost

This treatment requires high accuracy and experience in work. The cost of the operation can be everywhere in different ways, for example, in Moscow, the amount varies from 150 thousand, in other countries about 1.5 million.

The effect of multiple factors for the cost:

The introduced amount of the transplant; Operation methods; Health condition of the patient; Complications; Discomfort from pain.

Aorticoronary artery shunting depends on the chosen hospital, state, private or research institutes. In Israel, let's say, the cost of the operation is very high, judging by the reviews, it is worth it, given that cardiology has the most priority area in health care.