How long does it take for the sternum to heal after heart surgery? Rehabilitation after heart surgery Woman after open heart surgery

Every year, the country carries out the most complex operations on blood vessels and the heart, the staff of cardiac surgeons is improved, and the latest equipment is purchased. As a result, there are more and more patients who have successfully undergone heart surgery. Whether such a person will return to normal life after surgery depends 50% on the success of the surgery, and 50% on proper rehabilitation after heart surgery. What rehabilitation measures are carried out after cardiac surgery? To answer this question more completely, it is necessary to have an idea of ​​what types of heart surgeries there are.

1 Heart surgery

Surgery on the heart and blood vessels may be required in case of ineffectiveness of therapeutic treatment and progressive deterioration of the patient’s well-being, with congenital and acquired heart defects, and anomalies of the heart vessels. Significant damage to the coronary arteries by plaques of atherosclerosis, severe ischemic heart disease, heart attack, pathologies of the heart valve apparatus - all these diseases can become indications for surgical treatment.

The very first, most traumatic operations were performed on open heart with the opening of the chest, during such operations the patient is connected to a heart-lung machine, and the heart is turned off (stopped) for the duration of the operation. And today such operations do take place, but surgical interventions on the beating heart or closed ones, as well as minimally invasive surgical procedures, are becoming increasingly common.

Minimally invasive techniques allow surgical treatment without opening the chest, through several punctures, sometimes under local anesthesia. Coronary artery bypass grafting, coronary artery stenting, radiofrequency ablation, elimination of some valve defects, and pacemaker placement today can be performed minimally invasively endoscopic method without an incision in the sternum, on a beating heart. This allows you to reduce the number of complications after surgery, speed up the rehabilitation period, and increase the recovery rate.

2 Why is rehabilitation needed?

Many are confident that successful heart surgery is a guarantee of a return to full, healthy life. In fact, the postoperative and rehabilitation period is very important. The extent to which the patient carefully follows all the recommendations of the attending physician and responsibly approaches the implementation of the rehabilitation program depends on how much he can restore the lost health function and improve the level of quality of life.

For cardiac patients who have undergone heart surgery, a simple equation can be derived: surgery + rehabilitation = improved quality of life. This equation works in the following data: high professionalism of cardiac surgeons, a well-designed rehabilitation plan, and the responsibility of the patient.

3 What does the rehabilitation plan include?

A rehabilitation plan after heart and vascular surgery is drawn up individually for each person by a rehabilitation physician, cardiologist, physiotherapist, and occupational therapist. When drawing up a rehabilitation program, doctors take into account:

• volume and type of operation performed. Open heart surgery requires more gentle and somewhat delayed rehabilitation measures than minimally invasive interventions, especially in the early postoperative period;
• age. Age is necessarily taken into account by rehabilitation specialists, since the older the patient, the less pronounced the restorative ability of the heart muscle and its energy intensity, the rehabilitation plan is drawn up taking this indicator into account;
• related chronic diseases. Some loads and physical exercise during the recovery period may be contraindicated for people suffering from other chronic diseases in the subcompensation stage;
• presence or absence postoperative complications.

The main rehabilitation measures include physical rehabilitation (breathing, therapeutic exercises, feasible physical activity and exercises), as well as psychosocial rehabilitation (consultation with a psychotherapist, organization of a patient school where group classes are held, teaching patients a healthy lifestyle, proper nutrition, return to social activity).

4 Rehabilitation stages

When do rehabilitation activities begin? Most patients will probably answer: after the person leaves the hospital feeling well. Not at all, the first stage of rehabilitation should begin in the hospital, literally at the patient’s bedside. What are the rehabilitation stages?

1. Sanatorium-resort stage,
2. Outpatient stage.

5

The goal of rehabilitation in the postoperative period and during hospital stay: elimination and prevention of postoperative complications, early verticalization of the patient and physical activity in an accessible volume, psychological adaptation before undergoing surgery, selection of medications. The sooner the activities begin, literally hospital bed- all the better. It is mandatory to carry out breathing exercises for a bedridden patient, massage, and preparation for physical therapy exercises in the form of turns in bed, weak contractions of muscle groups.

As the muscles strengthen, pain in the area of ​​the postoperative wound decreases, and the patient’s well-being improves, the list of exercises expands and the load increases slightly. Physical exercises can be carried out first in the ward, and then on special simulators, always under the supervision of a physical therapy doctor with a daily analysis of the patient’s well-being, pulse and respiration rate, blood pressure, periodic ECG recording, or daily ECG monitoring.

If the patient has undergone a dissection of the sternum, for better fusion and speedy healing of the sutures, the patient is recommended to wear a postoperative bandage or corset for 2-3 months; such patients are recommended to sleep only on their back for the first month. According to indications, patients are prescribed physical therapy - UHF, electrical stimulation, ultrasound. The patient should be explained how to care for a postoperative wound, how to independently maintain physical activity after discharge, perform breathing exercises how to eat right.

All activities at the hospital stage should pursue the following goal: the patient should leave the hospital as early as possible. But not in the interests of the hospital and medical staff, but because his good health allows him to do this.

6 Sanatorium-resort stage

Patients after heart surgery, upon the recommendation of the attending physician, can be sent for further rehabilitation to specialized cardiology sanatoriums. The sanatorium continues to restore both physical and psychological state patient. A patient admitted to the sanatorium first undergoes an examination. The doctor interviews him, collects anamnesis, clarifies complaints, gets acquainted with medical documentation patient, history of heart disease, prescribes additional examination if necessary.

Based on all the data received, doctors draw up an individual plan for managing the patient during his stay in the sanatorium. Rehabilitation measures include physiotherapy, therapeutic nutrition, therapeutic exercises, massage. At the sanatorium, diagnostic examinations and drug therapy can be adjusted if necessary. A few days before the end of the sanatorium-resort treatment, the patient undergoes a full examination again; upon discharge, the doctor gives personal recommendations, notes them in the discharge summary, because they may be necessary for the subsequent outpatient rehabilitation stage.

7 Outpatient stage

The longest in time and, perhaps, the most important for the patient. After all, it includes regular medical observation of the patient in the clinic, rational employment of patients, compliance healthy image life, proper nutrition. At this stage, doctors annually draw up an individual rehabilitation program (IRP) for each patient, which includes drug therapy, physical therapy, diet therapy, physiotherapy and other rehabilitation measures as indicated.

Cardiac surgery is a branch of medicine devoted to the surgical treatment of the heart. For pathologies of cardio-vascular system such intervention is a last resort. Doctors try to restore the patient’s health without surgery, but in some cases only cardiac surgery can save the patient. Today, this field of cardiology uses the latest advances in science to return the patient to health and a full life.

Indications for operations

Invasive cardiac interventions are complex and risky work; it requires skill and experience, and the patient – ​​preparation and implementation of recommendations. Because such operations involve risks, they are performed only when absolutely necessary. In most cases, they try to rehabilitate the patient with the help of medications and medical procedures. But in cases where such methods do not help, heart surgery is needed. The surgery is performed in a hospital setting and in complete sterility, the patient being operated on is under anesthesia and under the control of the surgical team.

Such interventions are needed for congenital or acquired heart defects. The first include pathologies in the anatomy of the organ: defects of the valves, ventricles, impaired blood circulation. Most often they are discovered during pregnancy. Heart defects are also diagnosed in newborns; often such pathologies need to be eliminated urgently in order to save the baby’s life. Among acquired diseases, coronary disease is the leader; in this case, surgery is considered the most effective method of treatment. Also in the heart area there are: impaired blood circulation, stenosis or valve insufficiency, heart attack, pericardial pathologies and others.

Heart surgery is prescribed in situations where conservative treatment does not help the patient, the disease progresses rapidly and is life-threatening, in pathologies that require urgent and immediate correction, and in advanced forms of diseases, late application to the doctor.

The decision to prescribe an operation is made by a council of doctors or. The patient must be examined to establish an accurate diagnosis and type of surgical intervention. They identify chronic diseases, stages of the disease, assess risks, in this case they talk about elective surgery. If needed emergency help, for example, when a blood clot breaks off or an aneurysm dissects, minimal diagnostics are performed. In any case, the function of the heart is surgically restored, its parts are rehabilitated, and blood flow and rhythm are normalized. In severe situations, the organ or its parts can no longer be corrected, then prosthetics or transplantation are prescribed.

Classification of heart operations

There can be dozens of different diseases in the area of ​​the heart muscle, these are: failure, narrowing of the lumens, ruptures of blood vessels, stretching of the ventricles or atria, purulent formations in the pericardium and much more. To solve each problem, surgery has several types of operations. They are distinguished by urgency, effectiveness and method of influencing the heart.

The general classification divides them into operations:

1. Buried - used to treat arteries, large vessels, aorta. During such interventions, the chest of the person being operated on is not opened, and the heart itself is also not touched by the surgeon. That’s why they are called “closed” - the heart muscle remains intact. Instead of a strip opening, the doctor makes a small incision in the chest, most often between the ribs. Closed types include: bypass surgery, balloon angioplasty, stenting of blood vessels. All these manipulations are designed to restore blood circulation, sometimes they are prescribed to prepare for future open surgery.
2. Open – carried out after opening the sternum and sawing the bones. During such manipulations, the heart itself can also be opened to get to the problem area. Typically, the heart and lungs must be stopped for such operations. To do this, they connect the artificial blood circulation machine - AIK, it compensates for the work of the “disabled” organs. This allows the surgeon to carry out the work carefully, and the procedure under AI control takes longer, which is necessary when eliminating complex pathologies. During open operations AICs may not be connected, but only stop the desired zone of the heart, for example, during coronary artery bypass surgery. Opening the chest is necessary to replace valves, prosthetics, and eliminate tumors.
3. X-ray surgery - similar to a closed type of operation. The essence of this method is that the doctor blood vessels moves a thin catheter and gets to the very heart. The chest is not opened; the catheter is placed in the thigh or shoulder. A contrast agent is supplied through the catheter, which stains the vessels. The catheter is advanced under X-ray control, and the video image is transmitted to the monitor. Using this method, the lumen in the vessels is restored: at the end of the catheter there is a so-called balloon and a stent. At the site of narrowing, this balloon is inflated with a stent, restoring normal patency of the vessel.

The safest are minimally invasive methods, that is, x-ray surgery and closed type operations. With such work there is the least risk of complications, the patient recovers faster after them, but they cannot always help the patient. Complex operations can be avoided with periodic examinations. The earlier the problem is identified, the easier it is for the doctor to solve it.

Depending on the patient’s condition, there are:

1. Planned surgery. It is carried out after a detailed examination, within a specified time frame. Planned intervention is prescribed when the pathology does not pose any particular danger, but it cannot be postponed.
2. Emergency are operations that need to be done in the next few days. During this time, the patient is prepared and all the necessary studies are carried out. The date is set immediately after receiving the necessary data.
3. Emergency. If the patient is already in serious condition, the situation can worsen at any moment - surgery is scheduled immediately. Before it, only the most important examinations and preparations are carried out.

In addition, surgical assistance can be radical or auxiliary. The first implies complete elimination of the problem, the second - elimination of only part of the disease, improving the patient’s well-being. For example, if a patient has a pathology of the mitral valve and stenosis of a vessel, the vessel is first restored (auxiliary), and after a while valve plastic surgery is prescribed (radical).

How the operations are done

The course and duration of the operation depends on the pathology being treated, the patient’s condition, and the presence of concomitant diseases. The procedure may take half an hour or may take 8 hours or more. Most often, such interventions last 3 hours, take place under general anesthesia and control of an artificial cardiologist. First, the patient is prescribed a chest ultrasound, urine and blood tests, an ECG, and consultation with specialists. After receiving all the data, the degree and location of the pathology is determined, and it is decided whether there will be an operation.

As part of the preparation, a diet low in fatty, spicy and fried foods is also prescribed. 6-8 hours before the procedure, it is recommended to refuse food and drink less. In the operating room, the doctor assesses the patient’s well-being and puts the patient into medical sleep. For minimally invasive interventions, sufficient local anesthesia, for example in x-ray surgery. When the anesthesia or anesthesia takes effect, the main actions begin.

Heart valve surgery

The heart muscle has four valves, all of which serve as a passage for blood from one chamber to another. The most commonly operated valves are the mitral and tricuspid valves, which connect the ventricles to the atria. Stenosis of the passages occurs when the valves are insufficiently widened, and blood flows poorly from one section to another. Valve insufficiency is a poor closure of the valves of the passage, and there is an outflow of blood back.

The plastic surgery is performed openly or closed; during the operation, special rings or sutures are applied manually along the diameter of the valve, which restore normal lumen and narrowing of the passage. Manipulations last on average 3 hours; for open types, an AIK is connected. After the procedure, the patient remains under the supervision of doctors for at least a week. The result is normal blood circulation and functioning of the heart valves. In severe cases, the original valves are replaced with artificial or biological implants.

Elimination of heart defects

In most cases, defects are congenital; the reason for this may be hereditary pathologies, bad habits of parents, infections and fever during pregnancy. At the same time, children may have different anatomical abnormalities in the heart area; often such anomalies are poorly compatible with life. The urgency and type of surgery depend on the child’s condition, but they are often prescribed as early as possible. For children, heart surgery is performed only under general anesthesia and under the supervision of medical equipment.

At older ages, heart defects develop due to atrial septal defects. This happens with mechanical damage to the chest, infectious diseases, due to concomitant heart disease. To eliminate this problem, open surgery is also needed, often with artificial cardiac arrest.

During the manipulations, the surgeon can “patch” the septum using a patch, or sutured the defective part.

Bypass surgery

Coronary artery disease (IHD) is a very common pathology that mainly affects the generation over 50 years of age. Appears due to impaired blood flow in the coronary artery, which leads to oxygen starvation myocardium. There is a chronic form, in which the patient has constant attacks of angina, and an acute form, which is myocardial infarction. They try to eliminate chronic ones conservatively or using minimally invasive techniques. Acute requires urgent intervention.

To prevent complications or alleviate the disease, use:

• coronary artery bypass grafting;
• balloon angioplasty;
• transmyocardial laser revascularization;
• coronary artery stenting.

All these methods are aimed at restoring normal blood flow. As a result, enough oxygen is supplied to the myocardium with blood, the risk of heart attack is reduced, and angina is eliminated.

If it is necessary to restore normal patency, angioplasty or stenting is sufficient, in which the catheter is moved through the vessels to the heart. Before such an intervention, coronary angiography is performed to accurately determine the blocked area. Sometimes blood flow is restored bypassing the affected area, while a bio-shunt (often a section of the patient’s own vein from the arm or leg) is sutured to the artery.

Recovery after interventions

After surgery, the patient remains in the hospital for another 1-3 weeks, during which time doctors will evaluate his condition. The patient is discharged after verification and approval by the cardiologist.

The first month after surgical procedures is called the early postoperative period; during this time it is very important to follow all the doctor’s recommendations: diet, a calm and measured lifestyle. Nicotine, alcohol, junk food and exercise are prohibited regardless of the type of intervention.

The doctor's recommendations must also contain a warning about dangers and complications. Upon discharge, the doctor will set a date for the next appointment, but you need to seek help unscheduled if the following symptoms occur:

• sudden fever;
• redness and swelling at the incision site;
• discharge from the wound;
• constant chest pain;
• frequent dizziness;
• nausea, bloating and stool disorders;
• difficulty breathing.

During routine examinations, the cardiologist will listen to your heartbeat, measure your blood pressure, and listen to your complaints. To check the effectiveness of the operation, ultrasound is prescribed, CT scan, X-ray studies. Such visits are scheduled once a month for six months, then the doctor will see you once every 6 months.

Often, in addition to surgical care, medications are prescribed. For example, when replacing valves with artificial implants, the patient takes anticoagulants for life.

In the postoperative period, it is important not to self-medicate, since the interaction permanent medications and other medications can give negative results. Even regular painkillers need to be discussed with. To keep in shape and restore health faster, it is recommended to visit more often fresh air, to walk.

Life after heart surgery will gradually return to normal; full recovery is predicted within a year.

Cardiac surgery offers a variety of methods for cardiac rehabilitation. Such operations are designed to restore physical and moral strength to the patient. There is no need to be afraid or avoid such procedures; on the contrary, the sooner they are carried out, the greater the chances of success.

While you are in the intensive care unit, your heart rate, breathing rate, blood pressure, urine output, blood tests, chest x-ray and a variety of other data will be continuously assessed to ensure that no problems arise in the critical first post-operative hours. Nurses, support staff, special doctors called intensivists, and your surgeon will receive minute-by-minute reports of your progress.

Your memory will probably retain some fragments of your time in the intensive care unit, but for most patients, the time spent there is a blur.

If everything goes according to plan, within twenty-four hours your doctor will tell you everything is fine and you will leave the intensive care unit. On the permanent floor nursing care You will be looked after by one nurse (who has several other patients), one technician, and a team of doctors (who do rounds on many patients). They will help you make steady progress towards leaving the hospital in a week.

That's the plan. But sometimes things go wrong. Almost half of patients who have heart surgery will experience a bump in the road to recovery. The most common occurrence is atrial fibrillation, a temporary disorder heart rate, what will be reflected on your heart monitor; it is rarely serious and is easily treated.

Other complications can be insidious and more difficult to recognize. Moving quickly from patient to patient, your nurses and doctors may not notice important signs. This is where you, your relatives and friends should come to the rescue. Often the patient himself or his relatives are the first to notice the disorder. Pay attention to the warning signs listed below and speak up if you experience them. Your vigilance can speed up recovery or even save your life.

You should also be alert for signs and symptoms of depression, which often occurs in people with cardiovascular disease. One third of patients develop symptoms of depression after CABG or thyroid surgery. heart valve. Patients at particular risk are those who were already depressed before surgery and older women. If you have a history of depression, let your doctors know about it before surgery so they can take action to help you avoid it again.

Depressed cardiac surgery patients stay in the hospital longer, return there more often than others, recover more slowly, experience more pain, and have a reduced quality of life. For reasons that are not entirely understood, they are also more likely to have heart attacks and die in the first year after surgery. Poor adherence to medical prescriptions and unhealthy habits (smoking, poor diet, lack of physical activity) that affect blood clotting, inflammation and heart rate may be associated with depression.

The main problem with depression is its diagnosis. Your medical team will regularly take standard medical tests from you, including blood tests, chest x-rays, and ECGs. But a diagnosis of depression requires more than a glance at a computer screen and a five-minute visit to ward rounds. We repeat, this is where your family and friends should come to the rescue.

Depression after heart surgery: signs and symptoms:

• loss of energy, fatigue;
• feelings of hopelessness or worthlessness;
• loss of interest in activities that you previously enjoyed;
• loss of appetite;
• inability to concentrate;
• recurrent thoughts of death or suicide.

Depression usually occurs within the first three months after surgery.

If you develop these symptoms, either in the hospital or in the first few weeks after you come home, tell your doctor. Most depression goes away over time. But if the depression is particularly severe, treatment is required. Whether it's a short-term antidepressant or several visits to a therapist, successful intervention will speed recovery and improve outcomes. So don't ignore depression after heart surgery. This is a common occurrence. Is it dangerous. But it is curable.

Is it worth enrolling in a cardiac rehabilitation group?

You've just made a huge investment in your health. You did it through open heart surgery. You spent several days away from home in the hospital. Now you have a month or two ahead of you full recovery. Get them right. Join a cardiac rehabilitation group near your home. Follow Nike's motto: "Just Do It!"

You may not realize it, but you have already started a cardiac rehabilitation program. Phase I of cardiac rehabilitation includes walking, climbing stairs and educational activities, which you completed in the hospital.

Phase II cardiac rehabilitation begins one to three weeks after surgery. It is much more than a medically supervised exercise program. It also covers diet, risk factor modification, medication and lifestyle optimization, and counseling. Instructors and other participants provide emotional and psychological support. Patients realize that they are not alone, and hearing the stories of others, they calm down and gain new strength. This feature of the rehabilitation program is especially useful for those who suffer from depression, or for those who have been deeply affected by the feeling that nothing lasts forever, which often accompanies those who have undergone heart surgery. And make it a family affair: Patients tend to make beneficial and lasting changes if their significant other or others they listen to accompany them in their rehabilitation sessions.

Patients participating in a cardiac rehabilitation program after cardiac surgery have increased exercise capacity, improved lipid levels, decreased chest pain and shortness of breath, and return to independence more quickly. With such benefits, the numbers are hard to swallow: only 10 to 20% of Americans and 35% of Europeans participate in a cardiac rehabilitation program after heart surgery. This is especially true for older people and women.

One of the reasons for such low participation in rehabilitation programs is that many people think that their heart has been “fixed” and no additional efforts are needed after the operation. Of course this is not true. Heart surgery is just the beginning of a second chance. Grab this opportunity! Others worry that the rehabilitation program will be expensive. Don't worry about the costs. Medicare and most insurance companies cover cardiac rehabilitation; in fact, it is cost-effective because it improves health, reduces future costs and gets you back to work faster.

The road to recovery after heart surgery

Over the course of two to three months after surgery, you will gradually return to normal, resuming your usual activities. But is this rate of recovery good? What activities are required and when will you be able to participate in them? How soon after surgery can you climb stairs, drive a car, or have sex? Is there a special diet that you should follow? When can you say your recovery is on track? Let's answer these and other commonly asked questions. The answers will help you make sure you stay on the path to recovery.

Exercise after heart surgery

You should exercise daily. Plan a daily walk. For the first two to four weeks, include 20 to 30 minutes of walking per day. You can go up the stairs immediately. Stop all activities if you experience shortness of breath, chest pain, weakness, or dizziness and call your doctor if these symptoms do not go away within 20 minutes. When sitting, raise your feet on an ottoman or chair. If you have had a sternotomy, avoid lifting more than 5 kilograms for six weeks - this is the time it takes for the bone to heal. If you have an incision on the side of your chest, do not lift anything heavy with this arm. Four weeks.

Strenuous exercise can begin three months after surgery. After three months, runners and weightlifters have no restrictions. After that, make sure that daily exercise remains an important part of your life; they will not harm any “repair work” done on your heart.

Diet after heart surgery

No matter what type of surgery you have had, avoid highly salty foods for two to four weeks. People tend to gain between 1.5 and 5 kilograms from fluid intake during heart surgery. Most of this weight will disappear before you leave the hospital, and limiting salt once you're home will help you shed any remaining excess fluid and prevent post-surgery swelling. In the first few weeks after surgery there is usually poor appetite and decreased ability to taste food. This will pass, but make sure you are consuming enough calories to ensure recovery. Many people find it easier to eat little, but often. Milkshakes and high-energy liquid supplements may help. Once your recovery is complete, follow a healthy Mediterranean diet to maintain the benefits of your surgery.

Sex after heart surgery

You can resume sexual activity as soon as you feel able to do so. This usually occurs two or more weeks after leaving the hospital. There may be concerns at first, but don't worry. With your new, well-functioning heart, everything will be fine. Men who take Viagra or other erectile dysfunction medications can resume taking such medications in almost all cases, but check with your doctor first.

Postoperative scar care after heart surgery

You can take a shower; You've probably already taken a shower in a hospital. Wash your grout daily with soap and water. Do not apply any creams or oils. Don't take a bath for the first two weeks after returning home from the hospital. Avoid tanning the scar area for at least twelve months, as sun exposure can cause permanent dark pigmentation of the scar.

Driving after heart surgery

If you have had a sternotomy, we recommend avoiding driving for six weeks from the date of surgery. However, you can ride as a passenger. If your incision was on the side of your chest, you can start driving seven to ten days after surgery. Of course, avoid driving while taking prescription pain medications.

Pain control after heart surgery

Take your painkillers. When you leave the hospital, you will be given a prescription for narcotic pain medication. Use it. Even if you had minimally invasive surgery, it is still a major operation. Limiting your discomfort will allow you to breathe deeper and exercise regularly

This will speed up your recovery and reduce the risk of complications such as pneumonia and blood clots in the veins of your legs. To ensure a good night's rest, consider taking painkillers before bed for the first two to four weeks. Remember that drugs can cause constipation; include fruits and fiber in your diet and. If constipation does occur, ask your doctor to prescribe a mild laxative.

Returning to work after heart surgery

After a sternotomy, it makes sense to stay away from work for six to eight weeks, especially if your job is strenuous. physical activity. Office workers often start by going to work for a couple of hours three or four weeks after surgery. But your main job after heart surgery is to take care of yourself. Before returning to work, make sure your recovery is going according to plan.

Monitoring your recovery after heart surgery

Buy a notebook and write down the following information every day for the first month after surgery.

Daily Checklist: First Month After Returning Home:

• record your weight (at the same time every day);
• check your legs for swelling;
• record the temperature;
• check the seam (dry, wet or red; clicks when moving);
• note the duration of the walk;
• record use of incentive spirometer1 (5 times daily).

Danger signs after heart surgery

Your recovery will be gradual and you may not feel better the next day. Modest changes in how you feel from day to day are normal and there is no cause for concern. However, certain signs or symptoms indicate that you need timely medical attention, either immediately or within twenty-four hours.

Constant vigilance at home will prevent complications and promptly identify problems, ensure fast treatment, which will return your recovery process to the right path.

Finally, let's address the most difficult question of all: "When will I feel completely normal?" The answer depends on the specific case. A young person who has minimally invasive surgery may feel quite normal after four to six weeks. After a sternotomy, most patients will take three months to return to normal. After this, they will feel better than before the operation, and many will notice an increase in energy and stamina.

Life goes on after heart surgery, and it is usually of excellent quality. More than 75% of people report a significant improvement in quality of life. By following our recipes, you will find yourself in this majority.

With the help of the created pressure, the intercostal muscles are unloaded. The pressure on the internal organs is redistributed, which allows increasing the rate of healing of bones and soft tissues and speeding up rehabilitation.

The need for a postoperative bandage

Wound healing after abdominal surgery- a long process associated with features thoracic spine.

The participation of the ribs in breathing, the connection with the diaphragm causes an effect on the spine, cervical region, lower back and abdominal cavity.

The bandage is necessary to temporarily fix the chest and reduce pain during breathing.

Fixed tissues heal faster and become scarred. Weakened in postoperative period the muscles cannot support the spine, so the bandage effectively removes some of the load from them.

After surgery, it is important to hold the internal organs in place to prevent suture dehiscence and hernias.

The bandage is a vest made of dense elastic material with fasteners with wide Velcro, which allow you to adjust it to the volume of the chest.

After bypass surgery for men, the corset is equipped with supporting straps. Women's orthoses have a cutout for the chest, and Velcro connects under the collarbone, providing a snug fit.

Why is fixation needed after surgery?

In coronary artery bypass surgery, the sternum is cut and stapled. A bone that can withstand significant loads is mobile. It does not grow together completely, but only becomes overgrown with soft tissues over the course of six months.

It will take several weeks for the skin to heal. A medical bandage eliminates postoperative risks:

• cutting staples;
• sternal discrepancies;
• the emergence of a strong pain syndrome.

The pain after surgery persists for a long time and radiates to the arm. Bandage, along with painkillers, massage relaxation techniques and light exercise, serves to reduce pain.

A cardiac surgeon talks about how to wear a corset after bypass surgery. Some patients are recommended to wear it at night, and are allowed to sleep for 2-3 months only on their back to avoid chest deformation.

The mobility of the ribs decreases after three months, which is why this period is important. The surgeon determines how long to wear a corset based on the patient’s condition, taking into account age, activity, and the process of tissue scarring.

Patients usually do not want to wear a corset for a long time, since it is noticeable under clothing, especially in the summer. If the work is physical, then after a long sick leave, sanatorium treatment, the bandage is a daily necessity.

Physical therapy begins in the hospital with light leg movements to increase the outflow of venous blood. Breathing exercises are needed to straighten lung tissue and prevent stagnation. During gymnastics using balls, the chest corset is sometimes removed.

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Chest pain after CABG surgery

Coronary artery bypass grafting (CABG) is performed with an incision in the sternum. It is then secured with metal staples, since the massive bone of the sternum is constantly subjected to heavy loads. Regeneration of the skin above it occurs within several weeks. The sternum bone does not fuse, but is overgrown with soft tissue in 4-6 months. After CABG, it is necessary to wear corsets (medical bandages) to prevent cutting through the staples and divergence of the sternum.

There will be pain in the chest area for 4-6 months, and it will go into your arms. During this period, you need to take painkillers prescribed by your doctor, do a massage and gradually perform relaxation exercises. To rule out angina, a treadmill test or bicycle ergometry is performed. 2-3 months after CABG, the patency of new bypass tracts and the level of oxygen supply to the myocardium are assessed using a VEM stress test or using Treadmil.

If there is no pain and the ECG shows no changes, then the patient is fine. However, smoking, eating fatty pork and other fatty, especially fried foods, and stopping taking medications is PROHIBITED. Otherwise, new plaques will begin to grow, and a new operation will be needed.

Contact your doctor immediately if:

• when moving, clicks are heard in the sternum;
• signs of infection appeared: constant severe pain and high temperature;
• fistulas have appeared in the suture area, and liquid exudate is released;
• swelling does not go away or a new one has appeared;
• The skin around the incision became red.

How long does it take for the sternum to heal after heart surgery?

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Currently, another step has been taken towards combining into a single whole a complex of achievements of the global medical industry and science, focused on restoring the health of patients.

question about sternum

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question about sternum

question about sternum

How long does it take to grow together and what does it feel like?

How did your stitch (heal quickly?) not become inflamed?

For better fusion of the sternum in adults, a bandage should be worn.

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Non-union of the sternum. Osteosynthesis of the sternum

Non-union of the sternum is a far from rare and very unpleasant phenomenon that occurs as a consequence of previously performed open operations on the heart, lungs, and mediastinal organs. The imperfection of methods and systems for attaching a dissected sternum leads to the fact that the patient experiences constant pain in the chest area, is limited in loads and essentially becomes disabled, although he has been cured of problems with internal organs. Vladimir Aleksandrovich Kuzmichev, thoracic surgeon, Ph.D., told us about the causes of sternal nonunion, the features and methods of treating this consequence.

Corr.: Vladimir Aleksandrovich, what is sternal nonunion and why does it occur?

V.A.: Sternal nonunion is a disease that is a consequence of the development of cardiovascular surgery. The fact is that heart surgeries, especially coronary artery bypass grafting (CABG), are being done more and more. And Russia even lags behind many countries in terms of the number of their implementation. Therefore, the total number of heart operations, on the one hand, and, on the other hand, the increase in operations in older patients leads to an increase in the number of complications from the sternum, which are quite unpleasant. Indeed, in this case the patient is cured of heart disease, but at the same time he cannot be called a healthy person. Even if he is cured inflammatory process, it still does not become complete, since the integrity of the sternum is very important for ensuring the stability of the spine, normal breathing, and arm movement.

And the cause of nonunion of the sternum is precisely all those associated factors that affect the healing process. And among them is a violation of bone metabolism in old age. In addition, with coronary artery bypass grafting, the internal mammary artery, which is also the source of blood supply to the sternum itself, is used to polarize the myocardium. Therefore, in addition to the fact that the patient may have impaired healing properties, the blood supply may also be impaired, which complicates the process of normal healing of the sternum.

Corr.: So, we can say that nonunion of the sternum is more typical for older people?

V.A.: It can happen to everyone, but it still happens with greater frequency and probability in elderly, obese patients, people suffering from diabetes mellitus, osteoporosis, as well as in the presence of lung diseases, since in this case the severity of the cough is greater and, as a result, the chest stretches more in the postoperative period. The greater the load, the more likely it is that the seam we used to tighten it will not hold up.

Corr.: Do I understand correctly that non-union of the sternum is still a complication after surgery, and not a consequence of poor-quality fastening of the edges of the sternum or a poorly performed operation?

V.A.: Yes, this is exactly a complication after the operation. Because they sew everyone the same way.

Corr.: Are there any statistics on these operations? How often are they held in Russia?

V.A.: You know, it’s very difficult to say here, because no one gives real statistics. Moreover, very often, when you ask cardiac surgeons how often this happens, they say that it is extremely rare. But in reality there are many of these patients. Based on publications from European countries Where the level of medicine is no worse than in Russia, the number of these complications can reach 1-2% of operations. This is quite a lot if you imagine how many operations are performed, and this is, in general, tens of thousands.

Corr.: Vladimir Alexandrovich, what is the situation with this problem abroad?

V.A.: Large funds are attracted abroad and, accordingly, it is possible to use methods with a lower probability of developing complications. Traditionally, the sternum is simply sutured with wire. A more expensive method, but currently available in Russia, is the use of special nitinol retainers, which, however, you need to know how to use and be able to select the correct sizes. These fixatives certainly improve healing capabilities. It is interesting that these nitinol fixatives are manufactured by a Russian company, while in Europe they are known under the Italian brand. An Italian company completely bought the right to sell these clamps, and there they are sold as Italian ones, and much more expensive than ours.

Corr.: Are these clamps installed for life?

V.A.: Yes, they, like the wire, remain for life and are removed only if any complications arise.

Corr.: Vladimir Aleksandrovich, what methods and systems do you use to reduce and secure the sternum?

V.A.: In my opinion, the most effective method of performing osteosynthesis of a dissected sternum is the use of the Swiss TFSM design (a set of surgical instruments and plates from Synthes). Its main advantage is that fixation is carried out with special screws not only on the sternum, but also on the ribs. The fact is that after a sternotomy, especially if internal mammary vessels were used, a year after the operation, when the question of restoring the sternum arises, the sternum tissue itself can be very poorly expressed due to osteoporosis. Also, sometimes when performing a sternotomy, especially if there was a narrow original sternum, the surgeon may make a mistake and make the incision line so that it actually runs along the ribs, and not along the middle of the sternum. This often happens on a narrow chest. Then there are very few areas left that can be fixed, so in this case, osteosynthesis using the Swiss system is the only way to restore something.

Another advantage of this system is that it has a connector in the middle so the staple can be removed if there is a need to re-cut the sternum. This is potentially possible. In general, the Synthes TFSM system is intended for sternal osteosynthesis, but not necessarily for reoperations. It can also be used during primary heart surgery, when the surgeon assumes that there will be problems with healing, under accompanying circumstances.

Practice shows that, if necessary, it is better to perform both operations at once: for example, perform heart surgery and reduce the sternum with plates. At the same time, it is not necessary to install Swiss plates, as they are expensive. More often simpler plates are used, but it is still much more reliable than wire. For example, the nitinol fixative method we mentioned. There are clinics that have completely abandoned wires and use only nitinol fixatives.

Corr.: I see. Tell me, what is the cost of the Swiss Synthes TFSM system?

V.A.: In general, all osteosynthesis systems are very expensive. They can cost about dollars. But, of course, it is not used for all cases, but primarily for recovery.

Corr.: Tell me, is this operation included in compulsory medical insurance?

V.A.: The operation itself is included in high-tech medical care, but the fact is that the cost of the plate itself is not covered by any types of state aid, so the solution here is either to look for an opportunity to purchase a plate through a budget, or to buy a plate yourself.

Corr.: How complicated is this operation?

V.A.: This operation requires a certain understanding of the details, and it is also complicated because we are operating on an already operated person, that is, it takes more time to separate the scars, isolate the sternum from the heart and achieve a situation where we can bring and match the sternum. The actual application of the plate to the sternum is not very difficult, but it does require experience and understanding, because the plates must be bent correctly and the screws that secure the plates must be correctly adjusted.

Corr.: How long does rehabilitation take after such a complex operation?

V.A.: Recovery is quite fast, since the fixation is very reliable. The very next day the patient gets up and walks. The only thing is, of course, we recommend limiting physical activity for a month, and after a month, dosed exercises agreed with your doctor.

V.A.: I think it is not entirely correct to interfere in this process, because in principle, an operation with dissection of the sternum is a very common intervention, this is the main access for cardiac surgeons. It's all worked out. We do not specifically touch upon the issues of healing of the sternum after sternotomy; our work begins when the patient has a divergence of the sternum. Our patients are those people who have undergone cardiac surgery and their sternum has not fused. When people have waited some time to recover, but the sternum has not fused and they begin to look for a way out, they end up with thoracic surgeons.

Corr.: How soon can a person discover this problem?

V.A.: As a rule, this becomes noticeable within a month. It's easy to diagnose. But, unfortunately, cardiac surgeons around the world often do not deal with this problem themselves. This is due to the fact that this is considered a somewhat “dirtier” job in medical terms, because cardiac surgery is an extremely clean job, the appearance of such patients in the cardiac surgery department threatens its closure. In addition, almost all cardiac surgery departments operate on the basis high-tech quotas, and this operation is not included in these quotas. Therefore, even from an organizational and administrative point of view, it is difficult to provide assistance to these patients.

Vladimir Alexandrovich, thank you very much for your story! We wish you success in your work!

What can a patient expect after coronary artery bypass surgery?

Typically, patients remain on the machine for some time after CABG. artificial ventilation lungs. After recovery spontaneous breathing it is necessary to combat congestion in the lungs; a rubber toy is well suited for this, which the patient inflates once a day, thereby ventilating and straightening the lungs.

The next problem is the problem of large wounds of the sternum and legs; their treatment and dressings are necessary. After 7-14 days, the skin wounds heal and the patient is allowed to take a shower.

Now it must be said that during the operation the sternum is dissected, which is then fastened with metal sutures, since it is a very massive bone and bears a large load on it. The skin over the sternum heals in a few weeks, but the bone itself takes at least 4-6 months. For faster healing, it is necessary to provide her with rest; for this purpose, special medical bandages are used. Of course, you can do it without a corset, but in my memory there are several patients whose sutures have cut through and the sternum has separated, and of course it was not possible without a repeat operation, even if not such a major one. Therefore, it is better to purchase and use a chest bandage.

Due to blood loss during surgery, all patients develop anemia, it does not require special treatment, eat boiled beef, liver, and as a rule, in a month the hemoglobin level will return to normal.

The next stage of rehabilitation is to increase the motor mode. Despite the pain of the wounds and weakness, coronary artery bypass grafting was not performed in order to make you a bedridden patient, but on the contrary, so that you could perform all the loads that healthy people perform. And now that angina pectoris is no longer a concern, discuss with your doctor how you need to increase the pace. Usually they start by walking along the corridor up to 1000 meters per day. and gradually build up, over time you will be able to walk as much as you want. Just don’t need to do everything here on character and don’t need fanaticism - everything should be gradual.

It’s not a bad idea to go to a sanatorium after being discharged from the hospital for final recovery.

2-3 months after surgery, it is recommended to conduct a VEM or Treadmill stress test in order to assess how passable the new bypass paths are and how well the myocardium is supplied with oxygen. If there is no pain or changes in the ECG during the test, then everything is fine.

But keep in mind, this does not mean that you can now start smoking again, overeat on fatty pork and stop taking all medications. No one is immune from the growth of new plaques, and in this case, the chances that you will be taken for a repeat operation are not great. In the best case, they can stent new narrowings. But your task is to prevent this from happening!

CARDIOVASCULAR DISEASES

Reminder for patients undergoing open heart surgery

The primary recovery period lasts approximately a day. During this time, the patient gradually returns to normal activities.

The pace and characteristics of the recovery period are individual for each person. Each patient should increase the load at their own pace.

During the recovery process there may be periods of improvement and deterioration, which are expected and should not cause alarm to the patient.

Daily care of seams is to wash them with soap and water (using a soft washcloth is allowed).

If there is discharge from a postoperative wound, after washing it should be covered with a sterile gauze cloth and sealed with an adhesive plaster on top.

In case of changes in the wound such as redness, copious discharge or increased body temperature - you must consult your doctor.

It is possible that sensations of loss of sensitivity, itching and pain at the operation site will occur over time.

These symptoms are normal, common, and resolve over time.

If they become pronounced, prolonged and interfere Everyday life– It is recommended to consult your doctor.

Taking painkillers as directed by your doctor. Massage and relaxation exercises also help.

Instructions about taking medications or stopping them can only be given by a doctor!

If the patient, for any reason, does not take the medicine on time, you cannot take a double dose during the next appointment!

• name of medicine

• medication doses

• how many times a day should you take the medicine and at what hours

• side effects medicines(this data will be communicated by the attending physician upon discharge)

• when side effects medications, such as stomach pain, vomiting, diarrhea, rash, etc., should be reported to your doctor.

Bandages should be removed at night. This time can be used to wash them for reuse.

The healthy leg must be bandaged for 2 weeks after surgery. If the leg is not swollen, you can stop bandaging at an earlier date.

Instead of an elastic bandage, you can use an elastic knee socks of a suitable size, which can be purchased at a pharmacy and put on after the stitches are removed.

It is advisable to avoid eating fried and fatty foods, and also reduce the intake of salty, sweet and offal foods.

Body weight must correspond to height! ( Overweight is one of the risk factors for cardiovascular diseases).

Meal times should be constant. Excessive eating should be avoided.

You will need to contact a cardiologist to obtain permission to drive a car, since after the operation your reactions will be slowed due to weakness and fatigue, as well as under the influence of medications, and rotational movements will remain difficult until the sternum is completely healed.

If you have to travel long distances, you should make stops along the way and let your legs rest and relax to improve blood circulation in them.

You should constantly try to straighten your back and straighten your shoulders.

The energy required for intimate relationships corresponds to the energy required to walk and climb approximately two floors of stairs.

After visiting a cardiologist, undergoing a routine check-up and obtaining his permission, it is possible to enter into an intimate relationship. You may have difficulty in certain poses - you should change them according to your feelings.

It is advisable to reduce visits to young children who may be carriers of various viral infections.

• Each patient returns to the volume of usual activity at his own individual pace. You should not compare yourself to other patients who have undergone heart surgery and compete with them.

• If you have any problems related to your surgery, do not hesitate to contact us directly.

• In a moment of fatigue, leave your guests and lie down to rest. Reduce visiting friends.

• Try to rest at noon.

• For some time, pain in the area of ​​​​the surgical stitches will interfere with your sleep, listen to the radio or music to distract yourself, or get up and walk a little and then try to fall asleep again. Use sleeping pills only as a last resort.

• The recovery period is characterized by frequent mood swings, which resolve over time.

• Walking on level ground is recommended. Choose your walking route. Walking should be fun. You should not walk until you get tired. Try to rest while traveling.

• It is recommended to wear cotton or knitted clothing that will not irritate the postoperative suture.

• It is important to tell every doctor you see that you have had open heart surgery.

After heart surgery

Coronary artery bypass grafting has been used in cardiology for more than half a century. The operation consists of creating an artificial path for blood to enter the myocardium, bypassing the thrombosed vessel. In this case, the heart lesion itself is not affected, but blood circulation is restored by connecting a new healthy anastomosis between the aorta and coronary arteries.

Synthetic vessels can be used as a material for coronary artery bypass grafting, but the patient’s own veins and arteries have proven to be the most suitable. The autovenous method reliably “solders” the new anastomosis and does not cause a rejection reaction to foreign tissue.

Unlike balloon angioplasty with stent installation, the idle vessel is completely excluded from the blood circulation and no attempts are made to open it. A specific decision about the use of the most effective method is accepted after a detailed examination of the patient, taking into account age, concomitant diseases, and the preservation of coronary circulation.

Who was the “pioneer” in the use of aortic bypass?

The most famous cardiac surgeons from many countries worked on the problem of coronary artery bypass grafting (CABG). The first operation on a human was performed in 1960 in the USA by Dr. Robert Hans Goetz. The left thoracic artery, branching from the aorta, was selected as an artificial bypass. Its peripheral end was attached to the coronary vessels. Soviet surgeon V. Kolesov repeated a similar method in Leningrad in 1964.

Autovenous bypass surgery was first performed in the United States by Argentinean cardiac surgeon R. Favaloro. A significant contribution to the development of intervention techniques belongs to the American professor M. DeBakey.

Currently, similar operations are performed in all major cardiac centers. The latest medical equipment has made it possible to more accurately determine indications for surgery, operate on a beating heart (without a heart-lung machine), and shorten the postoperative period.

How are indications for surgery selected?

Coronary artery bypass grafting is performed when balloon angioplasty and conservative treatment are impossible or there are no results. Before surgery, coronary angiography of the coronary vessels is mandatory and the possibilities of using a shunt are studied.

The success of other methods is unlikely if:

• severe stenosis of the left coronary artery in the area of ​​its trunk;
• multiple atherosclerotic lesions of coronary vessels with calcification;
• the occurrence of stenosis inside the installed stent;
• inability to pass the catheter into a too narrow vessel.

The main indications for the use of coronary artery bypass grafting are:

• confirmed degree of obstruction of the left coronary artery by 50% or more;
• narrowing of the entire bed of the coronary vessels by 70% or more;
• a combination of the above changes with stenosis of the interventricular anterior artery in the area of ​​its branch from the main trunk.

There are 3 groups of clinical indications, which are also used by doctors.

Group I includes patients resistant to drug therapy or having a significant ischemic area of ​​the myocardium:

• with angina pectoris of functional classes III–IV;
• with unstable angina;
• with acute ischemia after angioplasty, impaired hemodynamic parameters;
• with developing myocardial infarction up to 6 hours from the onset of pain (later if signs of ischemia persist);
• if the ECG stress test is strongly positive and the patient requires elective abdominal surgery;
• with pulmonary edema caused by acute insufficiency hearts with ischemic changes(accompanies angina pectoris in elderly people).

Group II includes patients in need of very probable prevention acute heart attack(without surgery the prognosis is unfavorable), but difficult to treat with medications. In addition to the main reasons already given above, the degree of dysfunction of the heart’s ejection function and the number of affected coronary vessels are taken into account:

• damage to three arteries with a decrease in function below 50%;
• damage to three arteries with function above 50%, but with severe ischemia;
• damage to one or two vessels, but with a high risk of heart attack due to the large area of ​​ischemia.

Group III includes patients for whom coronary artery bypass grafting is performed as a concomitant operation with a more significant intervention:

• during operations on valves, to eliminate anomalies in the development of the coronary arteries;
• if the consequences of a severe heart attack (aneurysm of the heart wall) are eliminated.

International Heart Associations recommend putting clinical signs and indications first, followed by anatomical changes. It is estimated that the risk of death from a possible heart attack in a patient significantly exceeds mortality during and after the operation.

When is surgery contraindicated?

Cardiac surgeons consider any contraindications relative, since additional vascularization of the myocardium cannot harm a patient with any disease. However, the potential risk must be taken into account fatal outcome, which increases sharply, and inform the patient about it.

Classic general contraindications for any surgery are considered to be those the patient has:

• chronic lung diseases;
• kidney disease with signs of renal failure;
• oncological diseases.

The risk of mortality increases sharply with:

• coverage of atherosclerotic lesions of all coronary arteries;
• a decrease in left ventricular ejection function to 30% or lower due to massive cicatricial changes in the myocardium in the post-infarction period;
• availability severe symptoms decompensated heart failure with congestion.

What is the additional bypass vessel made of?

Depending on the vessel chosen for the role of bypass, bypass operations are divided into:

• mammarocoronary - the internal mammary artery serves as a shunt;
• autoarterial - the patient’s own radial artery is isolated;
• autovenous - the great saphenous vein is selected.

The radial artery and saphenous vein can be removed:

• openly through skin incisions;
• using endoscopic technology.

The choice of technique affects the duration of the recovery period and the residual cosmetic defect in the form of scars.

What is the preparation for the operation?

Upcoming CABG requires a thorough examination of the patient. Standard tests include:

• clinical blood test;
• coagulogram;
• liver tests;
• blood glucose, creatinine, nitrogenous substances;
• protein and its fractions;
• Analysis of urine;
• confirmation of the absence of HIV infection and hepatitis;
• Dopplerography of the heart and blood vessels;
• fluorography.

Special studies are carried out in the preoperative period in the hospital. A coronary angiography is required ( X-ray vascular pattern of the heart after administration of a contrast agent).

Complete information will allow you to avoid complications during the operation and in the postoperative period.

To prevent thromboembolism from the veins in the legs, 2-3 days before the scheduled operation, tight bandaging is performed from the foot to the thigh.

It is forbidden to have dinner the night before and have breakfast in the morning to prevent possible regurgitation of food from the esophagus and its entry into the trachea during the period of narcotic sleep. If there is hair on the skin of the anterior chest, it is shaved off.

An examination by an anesthesiologist consists of an interview, measuring blood pressure, auscultation, and re-examining previous diseases.

Pain relief method

Coronary artery bypass surgery requires complete relaxation of the patient, so it is used general anesthesia. The patient will only feel the prick of the intravenous needle as the IV is inserted.

Falling asleep occurs within a minute. A specific anesthetic drug is selected by the anesthesiologist taking into account the patient’s health status, age, functioning of the heart and blood vessels, and individual sensitivity.

It is possible to use different combinations of painkillers for introductory and main anesthesia.

Specialized centers use equipment for monitoring and control of:

• pulse;
• blood pressure;
• breathing;
• alkaline blood reserve;
• oxygen saturation.

The question of the need for intubation and transfer of the patient to artificial respiration is decided at the request of the operating doctor and is determined by the technique of the approach.

During the intervention, the anesthesiologist informs the chief surgeon about life support indicators. At the stage of suturing the incision, the administration of the anesthetic is stopped, and by the end of the operation the patient gradually wakes up.

How is the operation performed?

The choice of surgical technique depends on the capabilities of the clinic and the experience of the surgeon. Currently, coronary artery bypass grafting is performed:

• through open access to the heart with an incision in the sternum, connection to a heart-lung machine;
• on a beating heart without artificial circulation;
• with a minimal incision - access is used not through the sternum, but through a mini-thoracotomy through an intercostal incision up to 6 cm long.

Bypass surgery with a small incision is only possible to connect to the left anterior artery. Such localization is considered in advance when choosing the type of operation.

It is technically difficult to carry out the approach on a beating heart if the patient has very narrow coronary arteries. In such cases, this method is not applicable.

The advantages of surgery without the support of a blood pump include:

• virtual absence of mechanical damage to blood cellular elements;
• reducing the duration of the intervention;
• decrease possible complications, caused by equipment;
• faster postoperative recovery.

In the classical method, the chest is opened through the sternum (sternotomy). Special hooks are used to move it apart, and the device is attached to the heart. During the operation, it works like a pump and moves blood through the vessels.

Cardiac arrest is induced using a cooled potassium solution. When choosing a method of intervention on the beating heart, it continues to contract, and the surgeon enters the coronary arteries using special devices (anticoagulators).

While the first one is engaged in access to the heart area, the second one ensures the release of autovascular vessels to transform them into shunts, and injects a solution with heparin into them to prevent the formation of blood clots.

A new network is then created to provide a circumferential route for blood delivery to the ischemic area. The stopped heart is restarted using a defibrillator, and artificial circulation is turned off.

To stitch the sternum, special tight staples are applied. A thin catheter is left in the wound to drain blood and control bleeding. The entire operation lasts about four hours. The aorta remains clamped for up to 60 minutes, artificial circulation is maintained for up to 1.5 hours.

How does the postoperative period proceed?

From the operating room the patient is taken on a gurney under a drip to the intensive care unit. Usually he stays here for the first 24 hours. Breathing is carried out independently. In the early postoperative period, monitoring of pulse and pressure and control of blood flow from the installed tube continue.

The frequency of bleeding in the coming hours is no more than 5% of all operated patients. In such cases, repeated intervention is possible.

It is recommended to start exercise therapy (physical therapy) from the second day: make movements with your feet that imitate walking - pull your socks towards you and back so that you can feel the work calf muscles. Such a small load makes it possible to increase the “pushing” of venous blood from the periphery and prevent thrombus formation.

During the examination, the doctor pays attention to breathing exercises. Taking deep breaths straightens the lung tissue and protects it from congestion. For training, balloon inflation is used.

A week later, the suture material is removed from the sampling sites. saphenous vein. Patients are recommended to wear an elastic stocking for another 1.5 months.

It takes up to 6 weeks for the sternum to heal. Heavy lifting and physical work are prohibited.

Discharge from the hospital is carried out after a week.

In the first days, the doctor recommends a slight fasting with light food: broth, liquid cereals, fermented milk products. Taking into account the existing blood loss, it is proposed to include dishes with fruits, beef, and liver. This helps restore hemoglobin levels within a month.

The motor mode is expanded gradually, taking into account the cessation of angina attacks. You shouldn’t force the pace and chase sports achievements.

The best way to continue rehabilitation is transfer to a sanatorium directly from the hospital. Here the patient’s condition will continue to be monitored and an individual regimen will be selected.

How likely are complications?

A study of the statistics of postoperative complications indicates a certain risk for any type of surgical intervention. This should be clarified when deciding whether to consent to surgery.

The fatal outcome during planned coronary artery bypass surgery is now no more than 2.6%, in some clinics it is lower. Experts point to the stabilization of this indicator due to the transition to trouble-free operations for older people.

It is impossible to predict in advance the duration and degree of improvement of the condition. Observations of patients show that coronary circulation indicators after surgery in the first 5 years sharply reduce the risk of myocardial infarction, and in the next 5 years do not differ from patients treated with conservative methods.

The “lifetime” of a bypass vessel is considered to be from 10 to 15 years. Survival after surgery is 88% for five years, 75% for ten years, and 60% for fifteen years.

From 5 to 10% of cases among the causes of death are acute heart failure.

What complications are possible after surgery?

The most common complications of coronary artery bypass grafting are:

Less common ones include:

• myocardial infarction caused by a detached thrombus:
• incomplete fusion of the sternal suture;
• wound infection;
• thrombosis and phlebitis of the deep veins of the legs;
• stroke;
• renal failure;
• chronic pain in the surgical area;
• formation of keloid scars on the skin.

The risk of complications is associated with the severity of the patient’s condition before surgery and concomitant diseases. Increases in case of emergency intervention without preparation and sufficient examination.

Recovery period

The primary recovery period lasts approximately 30-45 days. During this time, the patient gradually returns to normal activities.
The pace and characteristics of the recovery period are individual for each person. Each patient should increase the load at their own pace.
During the recovery process there may be periods of improvement and deterioration, which are expected and should not cause alarm to the patient.

Postoperative sutures

In most cases, the patient is discharged after the sutures are removed.
Daily care of seams is to wash them with soap and water (using a soft washcloth is allowed).
If there is discharge from a postoperative wound, after washing it should be covered with a sterile gauze cloth and sealed with an adhesive plaster on top.
In case of changes in the wound such as redness, heavy discharge or increased body temperature, you should consult your doctor.
It is possible that sensations of loss of sensitivity, itching and pain at the operation site will occur over time.

Emotional sensations

Some patients experience changes in their emotional sphere, expressed as follows:

• low mood background

• increased emotionality

• lack of appetite

• reluctance to do anything

• anger at others

These symptoms are normal, common, and resolve over time.
If they become severe, prolonged and interfere with everyday life, it is recommended to consult your doctor.

Pain

Possible pain in the surgical area, chest with irradiation into the hands. This pain may continue for several months after surgery. This is a common occurrence and should not cause alarm to the patient.
Taking painkillers as directed by your doctor. Massage and relaxation exercises also help.

Medicines

After surgery, the patient needs to see various medications. Some of them are taken for a limited time (as determined by your doctor), and some are taken permanently.

Instructions about taking medications or stopping them can only be given by a doctor!
If the patient, for any reason, does not take the medicine on time, you cannot take a double dose during the next appointment!

It is important to know the following!

• name of medicine

• medication doses

• how many times a day should you take the medicine and at what hours

• side effects of medications (this data will be reported by the attending physician upon discharge)

• If side effects of medications occur, such as stomach pain, vomiting, diarrhea, rash, etc., you should inform your doctor.

Elastic bandages

It is necessary to bandage the operated leg for 6 weeks from the date of surgery. The leg should be bandaged up to the knee.
Bandages should be removed at night. This time can be used to wash them for reuse.
The healthy leg must be bandaged for 2 weeks after surgery. If the leg is not swollen, you can stop bandaging at an earlier date.
Instead of an elastic bandage, you can use an elastic knee socks of a suitable size, which can be purchased at a pharmacy and put on after the stitches are removed.

Wearing a corset

During CABG surgery, the sternum is dissected, which is then secured with metal sutures, since it is a very massive bone and bears a large load. For faster healing, it is necessary to provide her with rest; for this purpose, special medical bandages (corset) are used.

The corset should be worn while lying down, over cotton or knitted clothing that does not irritate the postoperative suture

Nutrition

IN recovery period A balanced diet is important. It is recommended to consult with a dietician at your healthcare facility.
It is advisable to avoid eating fried and fatty foods, and also reduce the intake of salty, sweet and offal foods.
Body weight must correspond to height! (Excess weight is one of the risk factors for cardiovascular disease).
Meal times should be constant. Excessive eating should be avoided.
It is recommended to use legumes, fresh vegetables and fruits in the diet, chicken meat and fish.

Travel abroad

Before you plan a flight or trip abroad, you should consult your doctor.

Physical exercise

Any physical activity, with the exception of walking, can be allowed only after consultation with a cardiologist or family doctor. You should increase physical activity gradually, moving from easy exercises to more complex ones.
It is recommended to walk in the mornings and evenings, in good weather, preferably on flat terrain, without significant climbs. You should start with 30 minutes.

Lifting weights

You should avoid lifting heavy objects weighing more than 5 kg for three months after surgery (this is necessary for complete healing of the sternum).

Further observation

After discharge, you should make an appointment with your local doctor. You must bring a certificate of incapacity for work to your appointment. The local doctor will continue treatment and extend the certificate of incapacity for work.

Smoking

If you smoke, then you should know that smoking reduces the amount of oxygen in the blood, increases the body's need for oxygen and, in this regard, increases blood pressure and damages arterial vessels.

Housework

At the first stage, you will only be able to do light housework and help with cooking. Gradually it will be possible to increase the amount of household work. Work that requires physical effort should be avoided.

Car driving

Driving should be avoided for one month after surgery.
You will need to contact a cardiologist to obtain permission to drive a car, since after the operation your reactions will be slowed due to weakness and fatigue, as well as under the influence of medications, and rotational movements will remain difficult until the sternum is completely healed.
If you have to travel long distances, you should make stops along the way and let your legs rest and relax to improve blood circulation in them.

Stairs and inclined surfaces

Climbing stairs requires more significant efforts than walking on level ground, so you should go up and down the stairs with stops to rest. The ascent along an inclined surface should be overcome gradually, with stops for rest.

Posture

After the operation, changes in posture are possible: the shoulders are tilted forward, the back is hunched due to weakness and pain.
You should constantly try to straighten your back and straighten your shoulders.

Intimate relationships

After surgery, there is a fear of entering into intimate relationships due to pain and fear of injuring the postoperative wound.
The energy required for intimate relationships corresponds to the energy required to walk and climb approximately two floors of stairs.
After visiting a cardiologist, undergoing a routine check-up and obtaining his permission, it is possible to enter into an intimate relationship. You may have difficulty in certain poses - you should change them according to your feelings.

Reception of guests

During the initial period of your stay at home, you should ask relatives and friends to reduce visits, which are significantly tiring.
It is advisable to reduce visits to young children who may be carriers of various viral infections.

Return to work

Return to work is carried out gradually, after consultation with a cardiologist or attending physician.

Conclusion

• Each patient returns to the volume of usual activity at his own individual pace. You should not compare yourself to other patients who have undergone heart surgery and compete with them.

• If you have any problems related to your surgery, do not hesitate to contact us directly.

• In a moment of fatigue, leave your guests and lie down to rest. Reduce visiting friends.

• Try to rest at noon.

• For some time, pain in the area of ​​​​the surgical stitches will interfere with your sleep, listen to the radio or music to distract yourself, or get up and walk a little and then try to fall asleep again. Use sleeping pills only as a last resort.

• The recovery period is characterized by frequent mood swings, which resolve over time.

• Walking on level ground is recommended. Choose your walking route. Walking should be fun. You should not walk until you get tired. Try to rest while traveling.

• It is recommended to wear cotton or knitted clothing that will not irritate the postoperative suture.

• It is important to tell every doctor you see that you have had open heart surgery.

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