Heart bypass, what are the indications, stages and rehabilitation

Heart bypass what is it

Until the first half of the th century, patients with coronary heart disease could only be treated with medications, and those people whom they stopped helping were doomed to disability and death.

And only in 1964 the first surgical intervention for coronary artery bypass grafting was developed and carried out. It is pleasant to realize that the pioneer was a Russian – Leningrad professor and heart surgeon Kolesov Vasily Ivanovich.

Unfortunately, already in 1966 at the All-Union Congress of Cardiology, it was decided to ban the execution of this dangerous operation.

Kolesov indulged in all kinds of persecution, but the situation changed radically after the world scientific community became interested in this revolutionary method of treating coronary vessels. Extensive research and development has improved this technique and reduced the number of complications.

Coronary artery bypass grafting was constantly upgraded, and the rates of successfully operated patients were constantly increasing. And again, it was thanks to the efforts of our compatriots-scientists that the doctors were able to halve the time for the intervention.

Now life saving of a patient with coronary heart disease can be performed in 4-6 hours (depending on the complexity of the clinical case).

Heart bypass what it is: a description

Coronary artery bypass grafting (CABG) is an operation whose essence is to create anastomoses (detours), bypassing the coronary arteries of the heart affected by atherosclerosis. The first planned CABG operation was performed in the USA at Duke University back in 1962 by Dr. Sabist.

Currently, hundreds of thousands of coronary artery bypass grafting operations have been performed in the world, and in many clinics they have become commonplace. Even 10-15 years ago, in order to have surgery, it was necessary to go to Europe or the Baltic states and the cost of such an operation was simply prohibitive.

No one says that CABG surgery is cheap, but nowadays most patients are able to find funds, especially if there is a question of life and death.

As for the indications for CABG, they are quite obvious and determined after the examination, including the mandatory coronary angiography, a procedure that allows you to determine the condition of the vessels that feed the heart.

There are many disagreements when you need to prefer coronary artery bypass grafting to stenting, but there are undeniable moments when the benefits of CABG are higher than stenting:

  1. Angina pectoris of a high functional class – i.e. such that does not allow the patient to perform even everyday activities (walking, toilet, eating) in case of contraindications to stenting.
  2. The defeat of three or more coronary arteries of the heart (determined by coronarography).
  3. The presence of aneurysm of the heart against the background of atherosclerosis of the coronary arteries.

At present, CABG are equally performed both on a working heart and in cardiopulmonary bypass. When coronary artery bypass grafting is performed on a working heart, the risk of surgical complications is much lower compared to a heart operation, but it is more complex.

There is also an opinion that if CABG is performed on a working heart, then the quality of the workarounds performed suffers from this. That is, according to long-term results, an operation on a working heart can give worse results compared to an operation on an idle heart.

To create bypass shunts, the veins of the legs of the patient are used, as well as the internal thoracic artery, without these vessels a person may well do.

Artery shunts are much more durable and reliable, which can not be said about shunts made of veins. So, about 10% of venous shunts are closed in the first month after CABG, another 10% – during the first year, and about 10% – in the next 6 years after the bypass surgery.

If compared with artery bypasses, then after 15 years more than 95% of anastomoses continue to function, however, it is not always technically possible to use artery bypasses only. If CABG surgery ends favorably, and this is the vast majority of cases, then the patient expects a difficult stage of rehabilitation.

However, all the inconvenience in this period after a few months disappears, and the benefits of coronary artery bypass grafting in the form of the disappearance of angina pectoris become obvious.

2-3 months after CABG, a VEM or Treadmill test is recommended. These tests help determine the condition of the imposed bypass grafts and blood circulation in the heart. The operation of CABG is not a panacea and does not guarantee the stop of atherosclerosis and the growth of new plaques in other arteries.

Even after coronary artery bypass grafting, all the principles for the treatment of coronary heart disease remain unchanged. CABG is carried out with only one purpose – to save the patient from angina pectoris and reduce the frequency of hospitalization due to the exacerbation of the process.

For all other criteria, such as, for example, the risk of recurrent heart attack and death within 5 years, the indicators are comparable both with coronary artery bypass grafting and with stenting or conservative treatment.

For CABG, there are no age restrictions; only the presence of a concomitant pathology limiting the conduct of abdominal surgery matters. In addition, if coronary artery bypass grafting surgery has already been performed earlier, then the risk of complications in the case of repeated CABG is much higher, and such patients are rarely taken for a second operation.

What is the operation for?

Cardiac stenting and coronary artery bypass grafting are the most modern techniques for restoring vascular patency. They are carried out in different ways, but have the same high result.

A lack of oxygen in atherosclerosis can lead to tissue necrosis and cause myocardial infarction in the future. Therefore, in the absence of the effect of drug treatment, it is recommended to install shunts on the heart. Indications for this operation include coronary artery disease, atherosclerosis, and myocardial aneurysm.

Such treatment as CABG does not pose a threat to human life and helps to reduce the mortality rate from cardiovascular pathologies by several times.

Before the operation, the patient must undergo thorough preparation and pass the necessary tests. The elimination of the risk of complications during surgery and in the postoperative period will help the exclusion of negative factors: smoking, diabetes, high blood pressure, etc.

CABG is performed on several vessels at once or only on one, depending on the individual pathology. Significantly facilitate the rehabilitation period after coronary bypass surgery will help the special breathing technique, which the patient must master before the operation.

Bypassing the vessels of the lower extremities helps restore blood circulation in the absence of the effectiveness of a standard treatment technique. Since this surgical intervention is considered the most dangerous and very difficult, the operation should be performed by a professional surgeon with modern equipment.

Rehabilitation after cardiac bypass surgery for the first days takes place in the intensive care unit so that it is possible to carry out emergency resuscitation if necessary.

The presence or absence of negative consequences depends on how long the patient will be in the hospital, and how the body will recover. Also, the healing process depends on how old the patient is and on the presence of other diseases.

Tip: smoking increases the risk of developing coronary heart disease by several times. Therefore, you can get rid of complications after installing the coronary artery bypass graft if you quit smoking once and for all.

After determining the treatment regimen by a cardiologist and a rheumatologist, the patient is hospitalized in a hospital, where all necessary preoperative studies are carried out in 2-3 days:

  • ECHO-KG (to assess the functioning of the heart muscle);
  • urine and blood tests (to study general indicators and exclude or confirm other diseases and latent inflammatory processes);
  • angiography (to visualize the circulatory system of the heart and detect the exact site of obstruction);
  • CT and MRI (in order to see a layered image of the arteries and assess how much the nearest tissues have already suffered);
  • studies of the circulatory system of shunt sampling sites (lower and upper limbs, sternum);
  • a decision is made – how many shunts, and from what places will be taken.

Additionally, other types of examinations can be prescribed. In addition, hospital staff will describe in detail how to behave immediately after surgery (breathing exercises, coughing techniques, etc.). Also, the anesthetist and the attending physician will give detailed information about the course of the upcoming coronary artery bypass grafting – how long the operation lasts, possible complications, how many shunts will be taken, etc.

On the eve of the operation, the patient can only eat liquid food, and for 6-8 hours immediately before the intervention, in general, it is forbidden to eat or drink anything.

Varieties of heart bypass surgery

Three variants of aorto-coronary bypass surgery (CABG) are conditionally distinguished:

  1. 1 – single;
  2. 2 – double;
  3. 3 – triple and so on.

For a particular type of operation, the choice made is determined only by the extent of vascular damage: if only one artery does not function and only one shunt is required, then this is a single bypass, two arteries are closed – double, and three, respectively, triple heart bypass.

What is the essence of coronary artery bypass grafting?

In coronary heart disease, the main culprit of which is atherosclerosis of the coronary vessels, blocking of one or more heart arteries can occur. This process is accompanied by severe myocardial ischemia, the patient often has angina attacks and myocardial infarction may develop.

To restore blood circulation in the heart muscle, surgeons create workarounds by performing anastomosis from a vein excised from under the skin of the thigh, or the patient’s artery, taken from the forearm or inner surface of the chest.

One end of such a bypass vessel joins the aorta, and the second is sutured into the coronary artery below the site of atherosclerotic obstruction or narrowing.

If the internal thoracic artery, which is already connected to the aorta, is used for the shunt, then one of its ends is sewn to the coronary vessel. Such a heart surgery is called coronary artery bypass grafting.

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Earlier, femoral veins were used to create the anastomosis, but now surgeons often use arterial vessels, since they are more durable. According to statistics, the shunt from the venous femoral vessel does not undergo repeated blockage for 10 years in 65% of patients, and from the arterial vessel of the internal thoracic artery it functions properly in 98% of the operated patients.

When using the radial artery, the anastomosis has been working smoothly for 5 years in 83% of patients. The main goal of coronary artery bypass grafting is aimed at improving blood flow in the area of ​​myocardial ischemia.

After the operation, the heart muscle zone experiencing a lack of blood supply begins to receive an adequate amount of blood, angina attacks become less frequent or are eliminated, and the risk of developing a heart muscle infarction is significantly reduced.

As a result, coronary artery bypass grafting allows you to increase the patient’s life expectancy and reduces the risk of sudden coronary death. The main indications for coronary artery bypass grafting may be the following conditions:

  • narrowing of the coronary arteries by more than 70%;
  • narrowing of the left coronary artery by more than 50%;
  • ineffective percutaneous angioplasty.

What diseases are indicated for bypass surgery?

The list of health problems that are indications for bypass surgery includes 4 major diseases. As a rule, they are relevant for people in old age, but recently even more often occur in young people.

In particular, they may include:

With this disease, the formation of specific plaques on the walls of blood vessels. Normally, there should not be any formations there, because it is plaques that are the main obstacle to full blood flow.

If the disease is not paid attention to in a timely manner, it will end with tissue necrosis with all the ensuing consequences.

The most common disease in which specialists prescribe a bypass. Again, the main problem here is vascular blockage with cholesterol. Actually, the disease is diagnosed with a thorough examination of the blood channels for a possible narrowing.

The narrowing leads to a restriction of oxygen access to the heart, which can lead to a wide variety of negative consequences. Ischemia manifests itself in pain in the chest (more often in its left part), as well as angina pectoris.

Overweight. Recently, this operation has become a particularly common method of combating obesity. The mechanism that helps to lose weight is already described above.

The stomach is divided into larger and smaller parts, the latter connecting with the small intestine. Accordingly, the amount of food needed for satiety decreases, and the body loses weight.

Coronary disease of the brain.

The principle in this case is very similar to the heart. Brain ischemia may be limited or global. The disease leads to disruption of the organ, and in worst cases, to a stroke or to the formation of tumors of an oncological nature.

With diseases of this kind it is necessary to fight in a hospital. Before shunting, conservative therapy is carried out, which includes the use of drugs to dilate blood vessels, against thrombosis, to thin the blood, etc. Shunting is prescribed only if the disease is started.

So, if this procedure was prescribed for you, it is important to know how the further rehabilitation goes. First of all, the specialist categorically forbids you to expose the body to any loads. Of course, it will not be possible to lift weights.

It is believed that such implants can last up to 7 years, but this period can be significantly reduced due to the use of nicotine. Therefore, after shunting, the patient will have to quit smoking. In addition, further nutrition will also be significantly limited.

First of all, the restriction will affect animal fats. Depending on the disease, the doctor may prescribe this or that diet to the patient, for example:

  • diet number 12 – with blockage of blood vessels and ischemia;
  • diet No. 15 – in case of chronic circulatory failure.

Operation

During the operation, you will sleep deeply and will not remember the progress of the operation. During the operation, the heart-lung device will take over the functions of your heart and lungs, which will give the surgeon the ability to perform bypass surgery of all arteries. Gradually stop cardiopulmonary bypass, if used.

To complete the operation, drainage tubes in the chest will be installed to facilitate the evacuation of fluid from the operation area. A thorough hemostasis of the postoperative wound is carried out, after which it is sutured.

The patient is disconnected from the monitors in the operating room and connected to portable monitors, then transported to the intensive care unit (intensive care unit).

The duration of the patient’s stay in the intensive care unit depends on the amount of surgery and on his individual characteristics. In general, he is in this department until his condition is completely stabilized.

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Day after surgery: postoperative period

While the patient is in intensive care, blood tests are taken, electrocardiographic and x-ray studies are performed, which can be repeated if necessary. All vital indicators of the patient are recorded.

After completing respiratory support, the patient is extubated (the breathing tube is removed) and transferred to spontaneous breathing.

Chest drainage and gastric tube remain. The patient uses special stockings that support blood circulation on his legs, wrap him in a warm blanket to maintain body temperature.

The patient maintains a lying position and continues to receive infusion therapy, analgesia, antibiotics and sedatives. The nurse constantly cares for the patient, helps him roll over in bed and perform routine manipulations, and also communicates with the patient’s family.

Day after surgery: postoperative period – 1 day

The patient can remain in the intensive care unit or he can be transferred to a special ward with telemetry, where his condition will be monitored using special equipment. After restoration of fluid balance, the Foley catheter is removed from the bladder.

Remote monitoring of cardiac activity is used, medical anesthesia and antibiotic therapy continue. The doctor prescribes diet food and instructs the patient about physical activity, the patient should begin to sit on the bed and reach for a chair, gradually increasing the number of attempts).

It is recommended that you continue to wear support stockings. Nursing staff scrubbing the patient.

Postoperative period – 2 days

On the second day after surgery, oxygen support ceases, and breathing exercises continue. The drainage tube from the chest is removed. The patient’s condition improves, but monitoring of parameters with the help of telemetry equipment continues.

The patient’s weight is recorded and the administration of solutions and medicines continues. If necessary, the patient continues to be anesthetized, and also perform all doctor’s prescriptions. The patient continues to receive diet food and his level of activity is gradually increasing.

He is allowed to carefully get up and with the help of an assistant move to the bathroom. It is recommended that you continue to wear supportive stockings, and even begin to perform simple physical exercises for your arms and legs.

The patient is advised to take short walks along the corridor. The staff constantly conducts explanatory conversations with the patient about risk factors, instructs how to process the suture and talks with the patient about the necessary activities that prepare the patient for discharge.

Postoperative period – 3 days

Monitoring of the patient’s condition stops. Weight registration continues. If necessary, continue analgesia. Perform all doctor’s appointments, breathing exercises. The patient is already allowed to take a shower and increase the number of movements from bed to chair up to 4 times, already without assistance.

It is also recommended to increase the duration of walks along the corridor and do this several times, without forgetting to wear special supportive stockings.

The patient continues to receive all the necessary information about dietary nutrition, about taking medications, about home physical activities, about the full restoration of vital activity, and about preparation for discharge.

Postoperative period – 4 days

The patient continues to perform breathing exercises several times a day. The weight of the patient is checked again. Dietary nutrition continues (restriction of fatty and salty foods), however, food becomes more diverse and portions become larger.

It is allowed to use the bathroom and move around without assistance. Assess the physical condition of the patient and give the latest instructions before discharge. If the patient has any problems or questions, then he must definitely resolve them before discharge.

Shortly after surgery, a bandage will be removed from the incision in your chest. Air will help to dry and heal the postoperative wound.

The number and length of cuts on the legs of different patients may be different, depending on how many venous shunts you planned to perform. Someone has cuts, they will only have one leg, someone has both, someone has a cut on his arm.

At first, you will be washed with antiseptic solutions, and dressings. Somewhere on the 8th-9th day, with successful healing, the sutures will be removed, and the safety electrode will also be removed.

Later, it will be possible to gently wash the cut area with soap and water. You may have a tendency to swelling of the ankle joints or you may feel a burning sensation in the place where the vein sections were taken.

This burning sensation will be felt when you stand or at night. Gradually, with the restoration of blood circulation at the venous sites, these symptoms will disappear.

You will be asked to wear elastic supportive stockings or bandages, this will improve blood circulation in the legs and reduce swelling. However, we should not forget that a full fusion of the sternum will be achieved in a few months, so you will need to discuss with your doctor the timing of an adequate load on the shoulder girdle.

Patients usually spend 14-16 days in a clinic after surgery bypass surgery. But the timing of your stay may vary. As a rule, this is associated with the prevention of concomitant diseases, since this operation will require the patient to expend great efforts of the whole organism – this can provoke an exacerbation of chronic diseases.

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Gradually, you will notice an improvement in general condition and a surge of strength. Quite often, patients feel fear and confusion at discharge. Sometimes this happens because they are afraid to leave the hospital, where they felt safe under the supervision of experienced doctors. They think that returning home carries a risk.

You must remember that the doctor will not write you out of the clinic until he is sure that your condition is stabilizing and that further recovery should take place at home.

A nurse or social worker can help you solve all your discharge problems. Typically, discharge from the hospital takes place around noon.

After operation

From the above it follows that CABG surgery is the main step towards the patient’s return to normal life. CABG surgery is aimed at treating coronary artery disease and relieving the patient of pain.

However, it cannot completely relieve the patient of atherosclerosis. The main task of the operation is to change the patient’s life and improve his condition, minimizing the effect of atherosclerosis on the coronary vessels.

As you know, many factors directly affect the formation of atherosclerotic plaques. And the cause of atherosclerotic changes in the coronary arteries is a combination of several risk factors.

Gender, age, heredity are predisposing factors that can not be changed, but other factors can be changed, controlled and even prevented:

  • High blood pressure;
  • Smoking;
  • High cholesterol;
  • Overweight;
  • Diabetes;
  • Low physical activity;
  • stress;

With the help of doctors, you can assess your health and try to get rid of bad habits, gradually moving to a healthy lifestyle.

Results of coronary artery bypass grafting

Creating in the process of shunting a new section of the vessel changes the quality of life of the patient. Life after heart bypass grafting involves the normalization of blood flow that feeds the myocardium, which is a consequence of shunting, has a number of positive effects:

  • Angina attacks disappear.
  • The risk of myocardial infarction is reduced.
  • Disability is restored.
  • The patient’s well-being improves markedly.
  • A safe level of physical activity is increasing.
  • Of the medicines, only a preventive minimum is required.
  • Life expectancy is increasing, and the risk of sudden death is reduced.

In other words, after CABG, the life of a healthy person becomes practically accessible for a sick patient. Patients who underwent coronary artery bypass grafting leave the most positive reviews – for the most part they talk about returning after shunting to a full life.

Statistics show that up to 70% of patients get rid of almost all disorders after surgery, and the condition of a third of patients improves markedly. In 85% of the operated, there is no new blockage of blood vessels.

Any patient thinking about this operation, no doubt, is interested in the question of how much they live after heart bypass surgery. There is no standard answer to this question, and no honest doctor can guarantee a specific period.

The prognosis is influenced by many factors: from the general condition of the patient, age, to his lifestyle and the presence of bad habits. To this we can add only that the average shunt service life is approximately 10 years, but in young patients it can last longer, after which a second operation will be required.

After CABG, you should forget about smoking. If the patient continues this addiction, then the risk of a return of coronary heart disease will multiply. Therefore, the patient after this operation should not have compromises regarding smoking.

Consequences and complications

Heart bypass surgery, or rather coronary arteries, is a very common procedure for patients suffering from coronary heart disease. It is the only method to improve a person’s quality of life when drugs do not help, and the disease progresses.

Coronary heart disease causes arteriosclerosis of blood vessels. Plaques do not allow the vessels to function normally, and the heart is saturated with nutrients. Shunting is aimed at eliminating this situation. During this operation, a second path is created for the passage of blood to bypass the “sick” vessel.

To do this, use the vein of the patient himself, which, most often, is taken from the thigh (saphenous vein of the thigh). Such an operation will protect a person from the risk of future heart attacks.

The operation requires careful preparation of the patient for several days. You should stop taking blood thinners (aspirin, ibuprofen, and so on) and tell your doctor in detail about past illnesses and allergic reactions to medications.

Usually, a month after the operation, a person returns to his usual life (with some limitations) But, like any operation, heart bypass surgery can lead to very unpleasant consequences (complications).

  • Specific are complications associated with the heart and blood vessels.
  • Nonspecific are complications characteristic of any operation, including heart bypass surgery.

Among the specific complications of the operation, the following are distinguished:

  1. The development of heart attacks in a number of patients and, as a consequence, an increase in the likelihood of deaths associated with them.
  2. Pericarditis – damage to the serous membrane of the heart by the inflammatory process.
  3. Acute congestive heart failure.
  4. Various cardiac arrhythmias (atrial fibrillation, blockade, and so on).
  5. Phlebitis is the development of inflammation in the venous wall.
  6. Pleurisy of an infectious or traumatic nature.
  7. Narrowing the lumen of a shunt.
  8. Strokes.
  9. The development of the so-called postpericardial syndrome.

Its development is associated with damage during heart surgery. Patients complain, at the same time, about the appearance of pain and heat in the chest. The duration of the syndrome can be significant and reach six months.

Nonspecific complications

Since heart bypass surgery is very complicated and involves finding the patient for some time on the ventilator, lung complications are not uncommon. They begin to develop stagnant phenomena.

After the operation, working with your breath is very important. Breathing exercises or a simple exercise – inflating balloons, great help the lungs to straighten out and improve their blood supply.

And then, congestive postoperative pneumonia will not be scary.

Lots of blood loss during surgery can lead to anemia.

To prevent its occurrence, in the postoperative period, nutrition should be meat (beef, liver, and so on). The meat is saturated with iron and vitamin B12, which is necessary to restore hemoglobin levels.

  • Blood thickening with the formation of clots and their entry into the pulmonary arteries (pulmonary embolism).
  • Infectious complications. It may be a urinary tract or lung infection. For example, pleurisy, pyelonephritis.
  • Postoperative wound infection. People with obesity and diabetes are especially prone to this complication.
  • Ligature fistulas, the appearance of which is associated with inflammation of the wound after surgery, which can be caused either by infection or rejection of suture material.
  • Diastasis of the sternum.
  • Renal failure.
  • Pulmonary insufficiency.
  • Deterioration of memory and thinking.
  • The failure of the seams.
  • The formation of a keloid scar.
  • In order to reduce the risk of complications to a minimum, it is necessary to identify patients with a burdened history and use all possible preventive measures in relation to them.

    After the operation, it is very important to correctly monitor the patient and follow the rational diet by the patient himself after heart bypass surgery, and then conduct rehabilitation measures. The latter is quite well understood in life after shunting.

    Rehabilitation

    The operation solves the problems created by coronary heart disease. However, the causes of the disease remain, the condition of the walls of the vessels of the patient and the rate of atherogenic fats in the blood do not change. As a result of this state of affairs, there is a risk of a decrease in the clearance in other parts of the coronary arteries, which will lead to the return of old symptoms.

    Rehabilitation is aimed at preventing negative scenarios and returning the operated patient to a full life.

    More specific rehabilitation tasks:

    1. Creating conditions to reduce the likelihood of complications.
    2. Myocardial adaptation to a change in the nature of blood circulation.
    3. Stimulation of recovery processes in damaged tissue areas.
    4. Fixing the results of the operation.
    5. Reducing the intensity of the development of atherosclerosis, coronary heart disease, hypertension.
    6. Adaptation of the patient to the external environment. Psychological help. The development of new social and domestic skills.
    7. Recovery of physical strength.

    Rehabilitation program after CABG from day 2

    The patient performs exercise therapy in a sparing mode, the emphasis is mainly on breathing exercises. Of the methods of general exposure, bioresonance therapy and aerotherapy are used. Local exposure methods include inhalation through a nebulizer (mucolytics, bronchodilators, furacilin, etc.) 2 times a day.

    To monitor the safety and effectiveness of patient rehabilitation, mandatory research methods are used – an electrocardiogram (ECG), blood pressure (BP), and heart rate (HR) daily.

    Also, troponin, creatine phosphokinase (CPK), transaminases, prothrombin, activated thromboplastin time (APTT), bleeding and blood coagulation time are controlled, a clinical blood test, general urinalysis are performed.

    Of the additional methods, Holter monitoring, echocardiography (Echocardiography), determination of blood biochemical analysis parameters are used. The course lasts 7-10 days with a further transition to the next stage of rehabilitation treatment.

    Rehabilitation program after CABG from day 7-10

    The patient continues to exercise therapy in gentle mode. Intravenous laser therapy or intravenous ozone therapy, bioresonance therapy, aerophytotherapy can be added to general exposure methods.

    Of the local exposure methods, there are:

    • peripheral classical therapeutic massage,
    • massage in the electric field of the cervical-collar region,
    • low-intensity laser radiation on the region of the heart and postoperative scars,
    • peripheral magnetic therapy (on the calf muscles),
    • ultratonophoresis (lidase, pantovegin).

    Mandatory and additional methods for monitoring the safety and effectiveness of patient rehabilitation are the same as after the second day of rehabilitation after CABG. The duration of the course is 10-15 days before moving to the next stage of rehabilitation treatment.

    Rehabilitation program after CABG from day 21

    Exercise therapy or cardio training on power and cycling simulators in the mode of dosed stepwise increasing physical loads. The question of the choice of simulators and load should be decided individually, depending on the condition of postoperative sutures and scars.

    For trained patients, patients with low exercise tolerance, it is recommended to start a course with exercise therapy in a gentle mode.

    The methods of general exposure are expanded: interval hypoxic workouts, complex halotherapy, dry carbonic baths (for hands, or alternating every other day for hands and feet), bioresonance therapy, aeroionotherapy, aerophytotherapy are added to the above.

    Of the methods of local exposure, you can choose the classic therapeutic back massage using a gentle method, massage in the electrostatic field of the front surface of the chest, low-intensity laser radiation on the heart region, low-frequency electromagnetic field on the cervical-collar region, drug electrophoresis (magnesium sulfate, panangin, anaprilin, but -shpa, papaverine) on the cervical collar region, electrotherapy (SMT).

    Mandatory and additional methods for monitoring the condition of patients remain the same. The course lasts 20–40 days.

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    Rehabilitation program after CABG after 1-2 months

    They continue to perform physical therapy or cardio training on power and cyclic simulators in the mode of dosed stepwise increasing physical loads. For trained patients, patients with low exercise tolerance, it is recommended to start a course with exercise therapy in a gentle mode. Hydrokinesitherapy can be used.

    Aerophytotherapy, carbon dioxide baths according to A.S. are added to the general exposure methods. Zalmanov, alternating every other day with dry carbonic baths, four-chamber vortex contrast baths every other day with potassium-sodium-magnesium or iodine-bromine baths.

    The choice of methods of local exposure has been expanded: classic therapeutic back massage in a gentle mode, massage in the electrostatic field of the cervical-collar zone, low-intensity laser radiation on the heart region, magnetotherapy, transcerebral electroanalgesia, ultratonophoresis (lidase, pantovegin, heparin).

    Mandatory methods for monitoring safety and effectiveness are the same studies as in the previous rehabilitation phase. The course lasts 15-30 days.

    Psychological rehabilitation of patients after CABG is extremely necessary, since due to an extensive chest injury, which serves as a source of pain, postoperative brain hypoxia in almost all patients after CABG, functional disorders of the nervous system are detected.

    These patients are irritated, often fixed on a pain syndrome, anxious, do not sleep well, complain of headaches, dizziness.

    Physical rehabilitation

    The rehabilitation program is considered successful if the patient managed to return to the lifestyle that healthy people lead. Physical rehabilitation in patients undergoing CABG is essential from the first days of the postoperative period, when along with drug therapy, patients are prescribed gymnastics and massage.

    On the first day after surgery, the patient sits down, on the second day he is allowed to carefully get up near the bed, perform simple exercises for arms and legs. On the third day, the number of independent movements from bed to chair increases up to 4 times.

    Accompanied walks along the corridor are recommended. On the fourth day, the patient continues to perform breathing exercises, light physical exercises for arms and legs, it is allowed to use the bathroom.

    In the following days, patients gradually increase physical activity mainly due to dosed walking along the corridor and by 10-14 days they can pass up to 100 meters. The best time for walking is from 11 to 13 hours and from 17 to 19 hours.

    When dosed walking, it is necessary to maintain a self-monitoring diary, where the pulse is recorded at rest, after exercise and after rest after 3-5 minutes in compliance with the established methodology. The pace of walking is determined by the well-being of the patient and the performance of the heart.

    First, a slow pace is mastered – 60–70 m / min. with a gradual increase in distance, then the average pace – 80–90 m / min., also gradually increasing the distance; and then fast – 100–110 m / min.

    Of no small importance at all stages is attached to the dosed climbs of the stairs. The pace of walking up the stairs is slow, not faster than 60 steps per minute. Downhill is equivalent to a 30% climb. As with any training load, patients keep a diary of self-control.

    Therapeutic diet – the basic rules

    When compiling a meal chart for those who underwent heart bypass surgery, it is necessary to focus on the fact that the use of products containing harmful cholesterol and fats in large volumes is strictly not allowed. This is due to the fact that their excess in the body, as well as carbohydrates, adversely affects the health of blood vessels, clogging them.

    As a result, the question of the return of the disease raises sharply. But even despite such caution, throughout his life a person who has undergone such operations will need to carefully monitor his weight so that he stays at approximately the same mark.

    Therefore, in this case, the life credo should be this: “moderation is above all!”.

    Important! Those who undergo such operations are required to monitor the amount of sugar and sodium chloride consumed. The former is best replaced by stevia, and the latter by a marine analogue, which, due to its high iodine content, is even beneficial for the heart.

    Products that should be excluded after heart bypass grafting:

    • fatty meat (pork, lamb, beef, ducklings, goose, fat);
    • sausages – sausages, ham, sausages, shred;
    • cheese of hard varieties;
    • homemade dairy products (cream, sour cream, butter);
    • oily fish with a high cholesterol content (halibut, catfish, stellate stellate, herring, sturgeon and saury);
    • premium wheat flour pasta;
    • any semi-finished products;
    • alcoholic beverages;
    • sparkling water;
    • fried potatoes.

    For the health of blood vessels, it is strongly recommended to exclude sweets and pastries from your diet, or limit their use as much as possible.

    Nutritionists say that if you eat no more than 30 g of food containing carbohydrates at a time, it will not cause harm to health. This portion of glucose is quickly consumed by the body.

    How to replace fats:

    • low fat cottage cheese (0%);
    • milk 1,5%;
    • diet cheeses;
    • tofu;
    • Soy meat;
    • white chicken;
    • rabbit carcass;
    • turkey;
    • veal;
    • cereals, with the exception of rice and semolina.

    Special attention should be paid to the benefits of fish oil for the heart. If it is regularly used as a food supplement to main dishes, then it will turn out well to protect the vessels from cholesterol. This is possible due to the content of omega acids in the product.

    In light of this, in addition to fish oil, nutritionists recommend eating 2-3 g of sardines, herring or salmon to maintain heart function 7-100 times in 200 days. This fish belongs to moderately fatty varieties.

    What else can I eat after heart bypass surgery: margarine, mayonnaise and butter are not included in the group of permitted products for operated patients. The same applies to sunflower oil.

    Nutritionists advise replacing it with olive, obtained by cold pressing. It does not contain polyunsaturated fatty acids harmful to the heart. Allowed, but only in limited quantities, the use of beef and / or chicken liver, as well as kidneys.

    As an alternative, they can be considered boiled meat of rabbit, turkey and veal. In order for rehabilitation after surgery to go smoothly, it is important to adhere to the following rules:

    • calorie consumption during exercise should not be more than their overabundance;
    • It is strongly not recommended to drink alcohol in any form;
    • watch the intake of sodium (one of the components of sodium chloride). It is supposed per day that this figure does not exceed 2 grams;
    • it is highly undesirable to drink sugary drinks – coffee, soda, fruit drinks, juices, etc .;
    • if the diet includes transgenic fatty foods, then their percentage of total consumption should not exceed one unit;
    • emphasis on the menu should be made on fresh vegetables and fruits that have not been cooked;
    • cooking dishes based on fish or fish oil, but not more than 5 times in 30 days, is encouraged;
    • for dairy products of all types, the fat content threshold should be no more than 1%;
    • the norm of cholesterol per day is no more than 200 mg;
    • fats should account for 6% of the total calories eaten.

    Adhering to the above recommendations of nutritionists, you will not need to worry about all kinds of complications after surgery. The diet will help normalize the patient’s condition and direct his life back on track.

    Dietary foods that are good for the heart:

    • Rye flour pancakes with salmon or salmon wrapped inside;
    • Vegetable soup with barley groats and black crackers;
    • Canned corn with baked tuna or cod in the form of salad;
    • Yushka with fresh carrots and lentils;
    • Pea mash;
    • Oatmeal on the water;
    • Oranges and grapefruits;
    • Oven-baked apples with avocado;
    • Pine nuts with herbs and lettuce;
    • Rye cakes with avocado cream sauce;
    • Lean sardines;
    • Oatmeal pancakes with low-fat sour cream;
    • Fish stewed in tomato;
    • Egg omelet with dill;
    • Beets with walnuts and sesame oil;
    • Zucchini caviar without frying.

    Sample menu for the day:

    • boiled chicken egg;
    • green tea (1 cup);
    • slice of rye loaf;
    • slice of tofu cheese.
    • baked green apple;
    • a glass of kefir.
    • vegetable soup with lentils;
    • 25 g of rye bread;
    • barley groats with vegetables;
    • 50 g of stewed low-fat fish.
    • salad with spinach and peas;
    • steamed chicken chop;
    • a glass of tomato juice without salt;
    • a piece of bread.

    Important! The main purpose of the diet after surgery is to prevent the ingestion of a large amount of fat.

    Duration of the shunt: Each medical institution has its own data on this subject. As a result, data from Israeli cardiac surgeons indicate that the shunt can remain operational for more than a decade. However, venous substitutes serve much less.

    The term “shunt” refers to the part of the vein used as an alternative branch for the blood flow, allowing blood to flow around the affected and clogged artery.

    At a certain moment, deformation of the vessel walls occurs, individual sections expand, in these areas an clot of atherosclerotic plaques forms. An arterial shunt allows you to bend around these clusters.

    Is it possible to perform cardiac catheterization after shunting? Yes, that’s perfectly acceptable. In this case, restoration of blood supply occurs, even if the patient’s coronary disorders are quite complex.

    In this case, the bypass procedure is performed in such a way that the coronary artery does not hurt. Special centers provide balloon angioplasty services for the remaining arteries or shunts.

    Does the pain in the heart after the operation mean that it was unsuccessful

    If the patient feels pain in the heart after recovering from the operation or in the later stages of recovery, he should consult a cardiac surgeon to assess the likelihood of a clogged shunt.

    If the suspicion of the presence of this problem is confirmed, then urgent measures will be required, or the patient will soon feel the first symptoms of angina pectoris.

    Should I take medications for a long time after bypass surgery?

    Surgery for heart bypass surgery is such an event in which there is no cure for concomitant diseases.

    Taking medications is required. They will stabilize blood pressure, observe a certain indicator of glucose in the bloodstream, regulate cholesterol, triglyceride.

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    Svetlana Borszavich

    General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
    Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
    The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
    The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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