Review
Open heart surgery is surgical intervention, in which the chest is opened and the muscles, valves or arteries of the heart are affected.
According to the US National Institute of Heart, Pulmonology, and Hematology (NHLBI), coronary artery bypass grafting is the most common heart surgery in adults. During this surgery, a healthy artery or vein is transplanted (attached) to a blocked coronary (heart) artery. As a result, the grafted artery delivers blood to the heart bypassing the blocked artery (NHLBI).
Open heart surgery is sometimes called traditional heart surgery. Today, many new heart procedures require only small incisions rather than large incisions. That is, the concept of open heart surgery can sometimes be misleading.
Causes
Open heart surgery allows for coronary artery bypass grafting. Coronary artery bypass grafting may be required in patients with coronary artery disease.
Coronary artery disease occurs when the vessels that carry blood and oxygen to the heart become narrow and inelastic. This disease is known as atherosclerosis.
Atherosclerosis occurs when fatty deposits create plaques on the walls coronary arteries. Plaques narrow the arteries, making it difficult for blood to pass through them. If blood does not flow to the heart properly, a heart attack can occur.
Open heart surgery is also performed to:
repair or replace blood vessels, allowing blood to pass through the heart; repair damaged or abnormal areas of the heart; install medical devices that will help the heart function properly; replace a damaged heart with a donor one (transplantation).
Operation
Operation
According to National Institutes healthcare, coronary artery bypass surgery takes four to six hours. Let's look at what it is, step by step.
The patient receives general anesthesia. He falls asleep and does not feel pain from the operation. Having made an incision in chest measuring 20 to 25 centimeters, the surgeon cuts through the chest bone, either completely or partially, to gain access to the heart. Once the heart opens, the patient is connected to a heart-lung machine. It diverts blood away from the heart so the surgeon can operate. Some new technologies make it possible to abandon this device. The surgeon uses a healthy vein or artery to create a new path around the blocked artery. The rib cage is held together with wires that remain inside the body. The initial incision is sutured. (NIH)
Sometimes when operating on patients with high risk A chest plate is used, especially in the elderly and in those who have undergone repeated surgery. In this case, the breast bone is connected after surgery with small titanium plates.
Risks
Risks of coronary artery bypass grafting:
wound infection of the chest (most common in obesity, diabetes, repeated bypass operations); heart attack or stroke; heart rhythm disturbance; damage to the lungs or kidneys; chest pain, low-grade fever bodies; memory loss or blurred memories; blood clots; blood loss; difficulty breathing.
According to the University of Chicago Medical Center (UCM), using a heart-lung machine increases the risks. These risks will include stroke and memory problems (UCM).
Preparation
Preparation
Tell your doctor about all the medications you take, including over-the-counter drugs, vitamins, and herbs. Report any health problems, including herpes, infection, colds, flu, fever.
Two weeks before surgery, your doctor may ask you to avoid smoking and stop taking vasoconstrictor medications such as aspirin, ibuprofen, or naproxen.
On the eve of the operation, you will be asked to wash yourself with special soap. It kills bacteria on the skin and reduces the chance of infection after surgery. You may be asked not to eat or drink anything after midnight.
You will receive further instructions when you arrive at the hospital for surgery.
Rehabilitation
Rehabilitation
When you wake up after surgery, you will have two or three tubes in your chest. They are necessary to remove fluid from the area around the heart.
You may have intravenous tubes that will give you fluids.
You may have a catheter (thin tube) placed in your bladder to remove urine.
You may also have machines connected to you to monitor your heart function. Nurses will be nearby to help you if necessary.
Most likely, you will spend the first night in the department intensive care. After three to seven days you will be transferred to a regular ward.
Long
Long
You must be prepared for gradual recovery. Improvement will occur in about six weeks, and after about six months you will feel the full benefits of the operation. So, the outlook is optimistic for many people, the shunt can work for many years.
However, the operation does not exclude re-occlusion of the vessels. The following measures will help maintain your health:
proper nutrition; restriction of salty, fatty and sweet food; maintaining physical activity; to give up smoking; control high blood pressure and cholesterol levels.
Heart operations are performed very often today. Modern cardiac surgery and vascular surgery very developed. Surgical intervention is prescribed when conservative drug treatment does not help, and accordingly, normalization of the patient’s condition is impossible without surgery.
For example, a heart defect can only be cured surgically, this is necessary in the case when blood circulation is severely impaired due to pathology.
And as a result of this, the person feels unwell and begins to develop severe complications. These complications can lead not only to disability, but also to death.
Surgical treatment of coronary heart disease is often prescribed. Since it can lead to myocardial infarction. As a result of a heart attack, the walls of the cavities of the heart or aorta become thinner and protrusion appears. This pathology can also be cured only by surgery. Surgeries are often performed due to abnormal heart rhythm (RFA).
They also perform heart transplantation, that is, transplantation. This is necessary in the case when there is a complex of pathologies due to which the myocardium is not able to function. Today, such an operation prolongs the patient’s life by an average of 5 years. After such an operation, the patient is entitled to disability.
Operations can be performed urgently, urgently, or scheduled intervention. This depends on the severity of the patient's condition. Emergency surgery carried out immediately, immediately after diagnosis. If such intervention is not carried out, the patient may die.
Such operations are often performed on newborns immediately after birth with congenital heart disease. In this case, even minutes matter.
Emergency operations do not require quick implementation. In this case, the patient is prepared for some time. As a rule, this is several days.
A planned operation is prescribed if given time There is no danger to life, but it must be carried out to prevent complications. Doctors prescribe myocardial surgery only if it is necessary.
Invasive research
Invasive methods for examining the heart involve catheterization. That is, the study is carried out through a catheter, which can be installed both in the heart cavity and in a vessel. Using these studies, you can determine some indicators of heart function.
For example, blood pressure in any part of the myocardium, as well as determine how much oxygen is in the blood, estimate cardiac output, vascular resistance.
For the treatment of heart disease vascular diseases Elena Malysheva recommends a new method based on Monastic tea.
It contains 8 useful medicinal plants, which are extremely effective in the treatment and prevention of arrhythmia, heart failure, atherosclerosis, ischemic heart disease, myocardial infarction, and many other diseases. Only natural ingredients are used, no chemicals or hormones!
Invasive methods make it possible to study the pathology of the valves, their size and the degree of damage. This study takes place without opening the chest. Cardiac catheterization allows you to take an intracardiac electrocardiogram and phonocardiogram. This method is also used to monitor the effectiveness of drug therapy.
Such studies include:
Angiography. This is a method for which a contrast agent is used. It is injected into the heart cavity or vessel for accurate visualization and determination of pathologies. Coronary angiography. This study allows you to assess the degree of damage to the coronary vessels, it helps doctors understand whether it is necessary surgery, and if not, what therapy is suitable for this patient. Ventriculography. This is a study using an x-ray contrast method, which will determine the condition of the ventricles and the presence of pathology. All ventricular parameters can be studied, such as cavity volume measurements, cardiac output, measurements of cardiac relaxation and excitability.
In selective coronary angiography, contrast is injected into one of the coronary arteries (right or left).
Having studied Elena Malysheva’s methods in the treatment of HEART DISEASE, as well as restoration and cleansing of VESSELS, we decided to bring it to your attention...
Coronary angiography is often performed in patients with angina pectoris of functional class 3-4. In this case, it is resistant to drug therapy. Doctors need to decide what kind of surgical treatment is needed. It is also important to carry out this procedure in case of unstable angina.
Invasive procedures also include punctures and probing of the heart cavities. Using sounding, you can diagnose heart defects and pathologies in the left ventricle, for example, these could be tumors or thrombosis. For this they use femoral vein(right), a needle is inserted into it through which a conductor passes. The needle diameter becomes about 2 mm.
When performing invasive examinations, local anesthesia is used. The incision is small, about 1-2 cm. This is necessary to expose the desired vein for installing the catheter.
These studies are carried out in different clinics and their cost is quite high.
Review from our reader Victoria Mirnova
I recently read an article that talks about Monastic tea for treating heart disease. With this tea you can FOREVER cure arrhythmia, heart failure, atherosclerosis, coronary heart disease, myocardial infarction and many other diseases of the heart and blood vessels at home.
I’m not used to trusting any information, but I decided to check and ordered a bag. I noticed changes within a week: the constant pain and tingling in my heart that had tormented me before receded, and after 2 weeks disappeared completely. Try it too, and if anyone is interested, below is the link to the article.
Surgery for heart disease
Heart defects include
heart valve stenosis; heart valve insufficiency; septal defects (interventricular, interatrial). 
Valve stenosis
These pathologies lead to many disturbances in the functioning of the heart, that is, the goals of operations for defects are to relieve the load on the heart muscle, restore the normal functioning of the ventricle, as well as restore contractile function and reduce pressure in the cavities of the heart.
To eliminate these defects, the following surgical interventions are performed:
Valve replacement (prosthetics)
This type of operation is performed on an open heart, that is, after opening the chest. In this case, the patient is connected to a special machine for artificial blood circulation. The operation consists of replacing the damaged valve with an implant. They can be mechanical (in the form of a disk or ball in a mesh, they are made of synthetic materials) and biological (made of biological material animals).
Valve implant placement
Plastic surgery of septal defects
It can be carried out in 2 options, for example, suturing the defect or plastic surgery. Suturing is carried out if the hole size is less than 3 cm. Plastic surgery is performed using synthetic fabric or autopericardium.
Valvuloplasty
In this type of operation, implants are not used, but simply expand the lumen of the affected valve. In this case, a balloon is inserted into the lumen of the valve and inflated. It should be noted that such an operation is performed only on young people; as for older people, they are only entitled to open-heart surgery.
Balloon valvuloplasty
Often, after surgery for a heart defect, a person is given disability.
Surgeries on the aorta
Open surgical interventions include:
Prosthetics of the ascending aorta. In this case, a valve-containing conduit is installed; this prosthesis has a mechanical aortic valve. Prosthetics of the ascending aorta, without the aortic valve being implanted. Prosthetics of the ascending artery and its arch. Surgery to implant a stent graft in the ascending aorta. This is an endovascular intervention.
Ascending aorta replacement is the replacement of this section of the artery. This is necessary in order to prevent serious consequences, such as rupture. To do this, prosthetics are used by opening the chest, and endovascular or intravascular interventions are also performed. In this case, a special stent is installed in the affected area.
Of course, open heart surgery is more effective, since in addition to the main pathology - aortic aneurysm, it is possible to correct the accompanying one, for example, stenosis or valve insufficiency, etc. But the endovascular procedure gives a temporary effect.
Aortic dissection
When replacing the aortic arch, the following is used:
Open distal anastomosis. This is when the prosthesis is installed so that its branches are not affected; Half-replacement of the arc. This operation consists of replacing the artery where the ascending aorta meets the arch and, if required, replacing the concave surface of the arch; Subtotal prosthetics. This is when, when replacing an artery arch, replacement of branches (1 or 2) is required; Complete prosthetics. In this case, the arch is prosthetic along with all supra-aortic vessels. This is a complex intervention that can cause neurological complications. After such an intervention, the person is entitled to disability.
Coronary artery bypass grafting (CABG)
CABG is an open-heart surgery that uses the patient's blood vessel as a shunt. This heart surgery is needed to create a bypass for blood that will not affect the occlusive portion of the coronary artery.
That is, this shunt is installed on the aorta and brought to a section of the coronary artery unaffected by atherosclerosis.
This method is quite effective in the treatment of coronary heart disease. Due to the installed shunt, blood flow to the heart increases, which means ischemia and angina pectoris do not occur.
CABG is prescribed if there is angina pectoris in which even the smallest loads cause attacks. Also, indications for CABG are lesions of all coronary arteries, and if a cardiac aneurysm has formed.
Coronary artery bypass grafting
When performing CABG, the patient is put under general anesthesia, and then after opening the chest, all manipulations are carried out. This operation can be performed with or without cardiac arrest. And also, depending on the severity of the pathology, the doctor decides whether the patient needs to be connected to a heart-lung machine. The duration of CABG can be 3-6 hours, it all depends on the number of shunts, that is, on the number of anastomoses.
As a rule, the role of a shunt is performed by a vein from lower limb, also sometimes use part of the internal mammary vein, radial artery.
Today, CABG is performed, which is performed with minimal access to the heart and at the same time the heart continues to beat. This intervention is considered not as traumatic as others. In this case, the chest is not opened; an incision is made between the ribs and a special expander is used so as not to affect the bones. This type of CABG lasts from 1 to 2 hours.
The operation is performed by 2 surgeons, while one makes an incision and opens the sternum, the other operates on the limb to take a vein.
After carrying out all the necessary manipulations, the doctor installs drains and closes the chest.
CABG significantly reduces the likelihood of a heart attack. Angina pectoris does not appear after surgery, which means the patient’s quality and life expectancy increases.
Radiofrequency ablation (RFA)
RFA is a procedure performed under local anesthesia, as the basis is catheterization. This procedure is carried out in order to exfoliate the cells that cause arrhythmia, that is, the focus. This occurs through a guide catheter that conducts an electrical current. As a result, tissue formations are removed using RFA.
Radiofrequency catheter ablation
After conducting an electrophysical study, the doctor determines where the source that causes the rapid heartbeat is located. These sources can be formed along pathways, resulting in a rhythm anomaly. It is RFA that neutralizes this anomaly.
RFA is performed in the following cases:
When drug therapy does not affect arrhythmia, and also if such therapy causes side effects. If the patient has Wolff-Parkinson-White syndrome. This pathology is perfectly neutralized by RFA. If a complication such as cardiac arrest may occur.
It should be noted that RFA is well tolerated by patients, since there are no large incisions or opening of the sternum.
A catheter is inserted through a puncture in the thigh. Only the area through which the catheter is inserted is numbed.
The guide catheter reaches the myocardium, and then a contrast agent is injected. With the help of contrast, the affected areas become visible, and the doctor points an electrode at them. After the electrode has acted on the source, the tissues become scarred, which means they will not be able to conduct the impulse. After RFA, a bandage is not needed.
Carotid artery surgery
There are the following types of operations on the carotid artery:
Prosthetics (used for large lesions); Stenting is performed if stenosis is diagnosed. In this case, the lumen is increased by installing a stent; Eversion endarterectomy - this involves removing atherosclerotic plaques together with the inner lining of the carotid artery; Carotid endarectomy.
Such operations are performed under both general and local anesthesia. More often under general anesthesia, since the procedure is performed in the neck area and there are discomfort.
The carotid artery is pinched, and in order for the blood supply to continue, shunts are installed, which are bypass routes.
Classic endarterectomy is done if long plaque lesions are diagnosed. During this operation, the plaque is detached and removed. Next, the vessel is washed. Sometimes it is still necessary to fix the inner shell; this is done with special stitches. Finally, the artery is sutured using a special synthetic medical material.
Carotid endarterectomy
Eversion endartectomy is performed in such a way that inner layer The carotid artery at the site of the plaque is removed. And after that they fix it, that is, sew it on. To perform this operation, the plaque should be no more than 2.5 cm.
Stenting is performed using a balloon catheter. This is a minimally invasive procedure. When the catheter is located at the site of stenosis, it inflates and thereby expands the lumen.
Rehabilitation
The period after heart surgery is no less important than the operation itself. At this time, the patient’s condition is monitored by doctors, and in some cases cardio training is prescribed, therapeutic diets etc.
Other recovery measures are also needed, for example, you need to wear a bandage. The bandage secures the suture after the operation, and of course the entire chest, which is very important. This type of bandage should only be worn if open heart surgery is performed. The cost of these products may vary.
The bandage worn after heart surgery looks like a T-shirt with tightness fixers. You can purchase men's and female options this bandage. The bandage is important because it is necessary to prevent congestion of the lungs, for this you need to cough regularly.
Such prevention of stagnation is quite dangerous because the seams can come apart; in this case, the bandage will protect the seams and promote durable scarring.
Also, the bandage will help prevent swelling and hematomas, promotes correct location organs after heart surgery. And the bandage helps relieve stress on the organs.
After heart surgery, the patient needs rehabilitation. How long it will last depends on the severity of the lesion and the severity of the operation. For example, after CABG, immediately after heart surgery, you need to begin rehabilitation, this is simple exercise therapy and massage.
After all types of heart surgery, drug rehabilitation, that is, maintenance therapy, is needed. In almost all situations, the use of antiplatelet agents is mandatory.
If there is an increased arterial pressure, then ACE inhibitors and beta-blockers are prescribed, as well as drugs to lower blood cholesterol (statins). Sometimes the patient is prescribed physical therapy.
Disability
It should be noted that disability is given to people with diseases of the cardiovascular system even before surgery. There must be evidence for this. From medical practice It can be noted that disability is necessarily given after coronary artery bypass grafting. Moreover, there may be a disability of both groups 1 and 3. It all depends on the severity of the pathology.
People who have circulatory disorders, stage 3 coronary insufficiency, or have suffered a myocardial infarction are also entitled to disability.
Regardless of whether the operation has been performed or not yet. Patients with heart defects of the 3rd degree and combined defects can apply for disability if there are persistent circulatory disorders.
Clinics
| Research Institute of SP named after. N.V. Sklifosovsky | Moscow, Bolshaya Sukharevskaya square, 3 | CABG without IR CABG with valve replacement Angioplasty and stenting of coronary arteries RFA Aortic stenting Valve replacement Valve plastic surgery | 64300 rub. 76625 rub. 27155 rub. 76625 rub. 57726 rub. 64300 rub. 76625 rub. |
| KB MSMU im. Sechenov | Moscow, st. B. Pirogovskaya, 6 | CABG with valve replacement Angioplasty and stenting of coronary arteries RFA Aortic stenting Valve replacement Valvoplasty Aneurysm resection | 132,000 rub. 185500 rub. 160,000-200,000 rub. 14300 rub. 132200 rub. 132200 rub. 132000-198000 rub. |
| FSCC FMBA | Moscow, Orekhovy Boulevard, 28 | CABG Angioplasty and stenting of coronary arteries RFA Aortic stenting Valve replacement Valve plastic surgery | 110000-140000 rub. 50,000 rub. 137,000 rub. 50,000 rub. 140,000 rub. 110000-130000 rub. |
| Research Institute of SP named after. I.I. Dzhanelidze | St. Petersburg, st. Budapestskaya, 3 | CABG Angioplasty and stenting of coronary arteries Aortic stenting Valve replacement Valve plastics Multivalve replacement Probing of cardiac cavities | 60,000 rub. 134400 rub. 25,000 rub. 60,000 rub. 50,000 rub. 75,000 rub. 17,000 rub. |
| St. Petersburg State Medical University named after. I.P. Pavlova | St. Petersburg, st. L. Tolstoy, 6/8 | CABG Angioplasty and stenting of coronary arteries Valve replacement Multivalve replacement RFA | 187000-220000 rub. 33,000 rub. 198000-220000 rub. 330,000 rub. 33,000 rub. |
| Sheba MC | Derech Shiba 2, Tel Hashomer, Ramat Gan | CABG Valve replacement | $30,000 $29,600 |
| MedMira | Huttropstr. 60, 45138 Essen, Germany 49 1521 761 00 12 |
Angioplasty CABG Valve replacement Cardiac examination Coronary angiography with stenting | 8000 euros 29000 euros 31600 euros 800-2500 euros 3500 euros |
| Greekomed | Central Russian office: Moscow, 109240, st. Verkhnyaya Radishchevskaya, house 9 A |
CABG valve replacement | 20910 euros 18000 euros |
Do you still think that it is impossible to get rid of HEART DISEASES!?
Do you often experience discomfort in the heart area (pain, tingling, squeezing)? You may suddenly feel weak and tired... Constantly felt high blood pressure... There’s nothing to say about shortness of breath after the slightest physical exertion... And you’ve been taking a bunch of medications for a long time, going on a diet and watching your weight...
Bondarenko Tatyana
Project expert DlyaSerdca.ru
Diseases of cardio-vascular system rightly called one of the most current problems modernity. Around the world, up to 20 million people die from them every year. These diseases cause fear because they creep up unnoticed. Few people will go to an appointment with a cardiologist until signs of malaise clearly manifest themselves. Cardiac surgery, which comes to the rescue when conservative treatment becomes ineffective, saving the lives of thousands of patients every year. These operations are becoming more and more complex and high-tech, doctors are starting to treat cases that until relatively recently were considered hopeless. Despite the increase in the severity of the operated cardiac surgery patients Over the past 15-20 years, mortality in cardiac surgery has decreased significantly, and today it is about 1-2% in uncomplicated cases. According to publications in medical publications in 1965, the mortality rate was about 15%. However, the complication rate still remains high. Modern medicine has learned to treat well many complications that until recently were fatal. But we have not yet learned how to prevent their appearance. The frequency of their occurrence still remains very high. high level. Finding ways to prevent postoperative complications in cardiac surgery is the foundation on which patient safety should be based before, during and after surgery.
An important problem in the prevention of postoperative complications, including the prevention of infection in the surgical area, is the low level of knowledge of our patients.
The main causes of postoperative complications and/or readmission of patients undergoing reconstructive cardiac surgery are often due to behavioral factors:
· Violation of drug therapy.
· Incorrect wearing of postoperative bandages.
· Violation of the physical activity regime.
· Lack of self-control.
· Non-compliance with diet.
Taking into account the relevance of this problem, a study was conducted in the cardiac surgery departments of the Samara Cardiac Dispensary to determine the level of awareness of cardiac surgery patients about the prevention of postoperative complications. The order to conduct the study was approved by the Ethics Committee of the State budgetary institution health
"Samara Regional Clinical Cardiological Dispensary" and the Board of the Samara Regional public organization nurses.
The object of the study was a group of men and women 50-65 years old, numbering 125 people, who were treated in the 4th and 11th cardiac surgery departments of the Samara Regional Clinical Cardiological Dispensary in the period from 01.08.2015 to 30.09.2015 who underwent open heart surgery (coronary artery bypass grafting , aortic replacement, mitral valve and others).
The effectiveness of the activities was assessed through conversations and questionnaires conducted with patients before and after the training.
The results of the initial survey revealed:
ü 26% of respondents know that violation of drug therapy and physical activity regimen are risk factors for postoperative complications,
ü 35% of patients are aware that smoking and alcohol are risk factors for CHF,
ü to the question: “Do you know about the principles of nutrition in the postoperative period?” - 18% answered “yes”,
ü 11% are aware of the main symptoms of complications in the early postoperative period,
ü “Do you know about self-care in the early postoperative period?” - only 10% answered positively,
ü 100% of respondents are afraid of the upcoming operation and the future,
ü 80% of cardiac surgery patients do not have healthy sleep.
The results of the survey show that patients' awareness of the prevention of postoperative complications is low. Patients' quality of life is sharply reduced. Only 15 out of 125 people knew about the use of elements of self-help and self-care before training.
During their hospital stay, patients were given classes on the following topics:
· risk factors for cardiovascular diseases;
· general information about open heart surgery;
risk factors for postoperative complications;
· symptoms of complications and principles of self-control;
· diet in the early and late postoperative period;
principles of self-care:
· physical activity;
Practical classes were conducted where patients learned correct technique self-measurement of blood pressure, pulse counting, weighing, training in how to properly wear a bandage and the technique of applying an elastic bandage in the area of a postoperative wound on the leg.
All patients received educational materials on self-control and a “After Heart Surgery” leaflet. It contains information about frequently asked questions:
ü “How will the preparation for the operation proceed?”
ü “What will happen to me on the day of the operation?”
ü “How long will the operation take?” And the most pressing questions:
ü “What will the suture be like and will it get infected after the bandage is removed?”
ü “When and how to put on a bandage?”
ü “When should I start bandaging my leg with an elastic bandage and how long should I wear it?”
ü and other useful information.
After repeated questioning, the level of patients' knowledge about the prevention of postoperative complications increased significantly. 84% of patients acquired self-help skills and 100% learned elements of self-care. After completing the training course, patients began to understand that responsibility for the effectiveness of the prescribed treatment largely depends on themselves.
The introduction of nursing research into practice has made it possible to increase the status of nursing staff and responsibility for the work performed. Maintaining nursing documentation allows you to systematize information obtained during the examination of patients. With daily registration nursing card nurses learn to understand patients better and more deeply by collecting information about their life history and illness. In the process of working in new conditions, nurses develop new qualities: compassion, empathy, the ability to put themselves in the patient’s place and see the world through his eyes. There is a constant increase in professional knowledge. Implementation of independent nursing care required nurses to study special medical literature on care. Nursing standards have been developed to allow more effective implementation nursing interventions. The quality of care has increased, which has ensured the prestige of working in the departments.
Bibliography
1. Glushchenko T.E. Features of clinical-functional and clinical-social indicators of adaptation of patients before and after coronary artery bypass surgery depending on the level of personal anxiety // Siberian Medical Journal. – 2007. – Volume 22, No. 4. – P. 82–86.
2. Ivanov S.V. Mental disorders associated with open-heart surgery // Psychiatry and psychopharmacotherapy named after. Gannushkina. – 2005. – No. 3. – P. 35–37.
3. Moiseeva T.F. Experience in managing nursing staff at the Omsk Regional Clinical Hospital: improving the professional level of nursing staff. // Home nurse. - 2012 - No. 6. - P. 26-27.
4. Niebauer J. Cardiac rehabilitation. Practical guide. – M., 2012. – 328 p.
5. Sopina Z.E., Fomushkina I.A. Quality management of nursing care. CRM system for business. GEOTAR-Media, 2011. – 178 p.
Open heart surgery is one of the methods of treating cardiovascular diseases, in which special surgical procedures. General principle boils down to the fact that there is interference in human body in order to carry out the necessary activities with an open heart. In other words, this is an operation during which an opening or dissection of the human sternum area is performed, affecting the tissues of the organ itself and its vessels.
Open heart surgery
Statistics say that the most common intervention of this type among adults is an operation that creates artificial blood flow from the aorta to healthy areas of the coronary arteries - coronary artery bypass grafting.
This operation is performed to treat severe coronary heart disease, which occurs due to the development of atherosclerosis, in which the vessels supplying blood to the myocardium narrow and their elasticity decreases.
The general principle of the operation: the patient’s own biomaterial (a fragment of an artery or vein) is taken and sewn into the area between the aorta and the coronary vessel to bypass the area affected by atherosclerosis, in which blood circulation is impaired. After the operation is performed, the blood supply to a certain area of the heart muscle is restored. This artery/vein supplies the heart with the necessary blood flow, while the artery in which it flows pathological process, works around.
Coronary artery bypass grafting Today, taking into account progress in medicine, for surgical treatment of the heart it is enough to make only small incisions in the appropriate area. Another intervention, more complex, will not be needed. Therefore, the concept of “open heart surgery” sometimes misleads people.
Reasons for prescribing open heart surgery
There are a number of indications for open heart surgery:
- The need to replace or restore the patency of blood vessels for the correct flow of blood into the heart.
- The need to restore defective areas in the heart (for example, valves).
- The need to place special medical devices to maintain heart function.
- The need for transplantation operations.
What do you need to know about coronary artery bypass surgery?
Time spending
According to medical data, this type of operation takes at least four and no more than six hours. In rare, especially severe cases, when the operation requires a larger volume of work (creation of several shunts), an increase in this period may be observed.
The first night after heart surgery and all medical manipulations patients spend in the intensive care unit. After three to seven days have passed (the exact number of days is determined by the patient’s well-being), the person is transferred to a regular ward.
Dangers during surgery
Despite the qualifications of doctors, no one is immune from unplanned situations. What is the danger of surgical intervention, and what risk can it carry:
- infection of the chest due to the incision (this risk is especially high for people who are obese, have diabetes, or are undergoing repeated surgery);
- myocardial infarction, ischemic stroke;
- heart rhythm disturbances;
- thromboembolism;
- increased body temperature for a long time;
- cardiac discomfort of any nature;
- pain of various types in the chest area;
- pulmonary edema;
- short-term amnesia and other transient memory problems;
- loss of a significant amount of blood.
These negative consequences, as statistics show, occur much more often when using an artificial blood supply.
Risk unpleasant consequences always present Preparation period
In order for the planned operation and general treatment were successful, it is important not to miss anything significant before they begin. To do this, the patient must tell the doctor:
- ABOUT medicines which are currently in use. These may include medications prescribed by another doctor, or those that the patient purchases himself, including dietary supplements, vitamins, etc. This is important information, and it should be announced before surgery.
- About all chronic and past diseases, health deviations available on this moment(runny nose, herpes on the lips, upset stomach, fever, sore throat, fluctuations in blood pressure, etc.).
The patient should be prepared for the fact that two weeks before the operation the doctor will ask him to refrain from smoking, excessive alcohol consumption, and taking vasoconstrictor medications (for example, nasal drops, ibuprofen, etc.).
On the day of the operation, the patient will be asked to use a special bactericidal soap, which significantly reduces the risk of infection during the procedure. In addition, several hours before the intervention you should not eat or drink water.
Carrying out the operation
When open heart surgery is performed, the following steps are performed sequentially:
- The patient is placed on the operating table.
- He is given general anesthesia.
- When the anesthesia begins to take effect and the patient falls asleep, the doctor opens the chest. To do this, he makes an incision in the appropriate area (usually it is no more than 25 centimeters in length).
- The doctor cuts the sternum, partially or completely. This allows access to the heart and aorta.
- Once access is secured, the patient's heart is stopped and connected to a heart-lung machine. This allows the surgeon to calmly perform all manipulations. Today, technologies are used that in some cases make it possible to perform this operation without stopping the heartbeat, and the number of complications is lower. than with traditional intervention.
- The doctor creates a shunt to bypass the damaged section of the artery.
- The cut part of the chest is secured with a special material, most often a special wire, but in some cases plates are used. These plates are often used for elderly people or for people who have undergone frequent surgical operations.
- After surgery carried out, the incision is sutured.
Postoperative period
After the operation is completed and the patient awakens, he will find two or three tubes in his chest. The role of these tubes is to drain excess fluid from the area around the heart (drainage) into a special vessel. In addition, an intravenous tube is installed to supply therapeutic and nutritional solutions to the body and a catheter is installed in the bladder to remove urine. In addition to tubes, devices are connected to the patient to monitor heart function.
The patient should not worry; in case of questions or discomfort, he can always contact medical workers, which will be assigned to monitor him and promptly respond if necessary.
The duration of the recovery period depends not only on physiology, but also on the person himself Every patient should understand that rehabilitation after surgery is not a quick process. After six weeks of treatment, some improvements can be observed, and only after six months will all the benefits of the operation become visible.
But each patient is able to speed up this rehabilitation process, while avoiding new heart ailments, which reduces the risk of reoperation. To do this, it is recommended to take the following measures:
- follow the diet and special diet prescribed by your doctor;
- limit salty, fatty, sweet foods);
- devote time to physical therapy, walks in the fresh air;
- stop frequent drinking of alcohol;
- monitor blood cholesterol levels;
- monitor blood pressure.
If these measures are followed postoperative period It will pass quickly and without complications. But don't rely on general recommendations, much more valuable is the advice of your attending physician, who has studied your medical history in detail and is able to draw up an action plan and diet during the recovery period.
- Redness, swelling, severe tenderness, or discharge from the incision (a small amount of clear or pink discharge is common postoperatively, but it is best to report this to your surgeon).
- Severe numbness or tingling in the fingers (if the vascular graft was taken from an artery of the upper limb);
- Symptoms of angina pectoris as before surgery (stop what you were doing and take nitroglycerin);
- Pain in the chest, neck, shoulder, aggravated by deep inspiration (the pericardial sac may be inflamed and irritated after surgery);
- Temperature above 39°C for more than 24 hours;
- Chills;
- Flu symptoms (joint pain, chills, fever, loss of appetite, fatigue) for 2 or 3 days;
- Shortness of breath that does not go away after finishing the activity that caused it, or that occurs during rest;
- Weight gain of 900-1400 grams in 2-3 days;
- Severe fatigue that does not go away after 2-3 days;
- Changes in heart rate: the heart beats sometimes faster, sometimes slower, sometimes it seems to you that it is stopping;
- You have a lot of bruises (without apparent reason) or bleeding occurs frequently.
In addition to complications associated with physical condition, some patients may experience neuropsychological impairment after open-heart surgery. Several studies have shown both short-term and long-term neurological and nervous disorders after heart surgery. These include memory, attention, psychomotor reactions. These changes represent general decline cognitive (mental) function, which occurs for several weeks or months after surgery. Psychiatric disorders have also been observed in some patients who have undergone heart surgery. These include post-traumatic stress, agoraphobia, serious depression, etc. As American heart surgeon Scott Mitchell notes, “the cause of postoperative psychoemotional disorders is completely unknown... But it may be a psychological impact before the operation, long time under anesthesia or results from a heart-lung machine...". Over time, your memory, concentration, orientation, and stable mood should return to normal. If the disorders persist, it is better to consult a specialist depending on the nature of the disorders.
What to do if your legs swell?
This problem is most likely if the vascular bypass graft was taken from a lower limb vein.
- When sitting, always try to elevate them so that your toes are higher than your heart
- Don't be on your feet for too long
- Talk to your healthcare provider about using compression stockings.
Don't cross your legs. In this position, the popliteal area is under pressure, and blood flow to the legs is reduced.
Read also:
About concomitant diseases.
There are a number of diseases that can negatively affect the course and prognosis of coronary artery disease, as well as cause early “wear and tear” of shunts, these include:
- diabetes,
- smoking,
- obesity.
If you suffer from at least one of them, you must adhere to the following instructions.
- Arterial hypertension (AH).
Since AG is one of the chronic diseases, then minimizing the risk of developing all complications is possible provided that blood pressure is constantly maintained at a normal level (if possible 120/80 mm Hg). To do this, try to follow the following recommendations:
— Hypertension cannot be treated in courses; its treatment must be constant for life! Take your prescribed medications on time every day. Taking pills once only during high blood pressure is the wrong technique. Consult your doctor; only he can choose the right antihypertensive therapy.
- Monitor your blood pressure levels twice a day.
— Prescription and monitoring of treatment is carried out by your doctor, do not use the advice of friends and acquaintances, do not change or cancel the prescribed treatment yourself because your blood pressure has returned to normal.
- DIABETES MELLITUS (DM)
- follow a strict diet with limited carbohydrate intake, eat regularly,
- constantly use test systems to self-monitor blood glucose levels and keep a diary,
- take regularly hypoglycemic drugs or give insulin injections.
DM compensation indicators:
- Quit smoking.
- reduces ten-year survival after CABG surgery by 16%,
- venous graft patency was 13% lower after 5 years in smokers compared to non-smoking patients.
- OBESITY.
If you are overweight, you will be recommended a hypocaloric diet - this means reducing the amount of food consumed, especially foods high in animal fats and easily digestible carbohydrates. Your doctor may prescribe medications for weight loss.
Remember that with a decrease in body weight by 5-10 kg, the severity of the following symptoms, which is especially important after surgery:
- dyspnea,
- arterial hypertension,
- angina pectoris
- pain in the back, hip and knee joints,
- fatigue, sweating, thirst,
- exposure to stress,
- increased need for glucose-lowering therapy
