What Can I Expect During Heart Bypass Surgery?

Heart bypass surgery, also known as coronary artery bypass grafting, refers to the establishment of a channel between the proximal and distal ends of coronary stenosis when one or more coronary arteries are narrowed or blocked due to atherosclerosis. To bypass the stenosis and reach the distal operation. Take more of the patient's own blood vessels, such as the saphenous vein, internal mammary artery, right gastroretinal artery, radial artery, and sub-abdominal artery. To the site of ischemia. Heart bypass surgery is recognized as the most effective method for treating coronary heart disease, which can improve myocardial blood supply, achieve the purpose of relieving symptoms of angina pectoris, improving heart function, improving quality of life, and prolonging life.

Basic Information

Chinese name

Heart bypass surgery

Anesthesia

general anesthesia

Indication

Myocardial ischemia symptoms cannot be controlled by medical treatment

Contraindications

Severe heart, brain, lung, and kidney dysfunction

1. Anesthesia method (General anesthesia.)

2. Preoperative preparation (1) Ask a detailed medical history before surgery, and pay special attention to any comorbidities, including hypertension, myocardial infarction, diabetes, stroke, liver and kidney dysfunction, and history of cardiac surgery.
(2) Do a comprehensive and thorough physical examination, paying attention to the presence of carotid murmurs, heart murmurs, lung murmurs, varicose veins of the lower limbs, and signs of peripheral vascular disease.
(3) Do coronary angiography before surgery to determine the location and extent of coronary artery stenosis.
(4) routinely do echocardiography, electrocardiogram, chest X-ray examination, liver and kidney function examination, coagulation function, blood glucose and so on.
(5) Do an ultrasound of the internal mammary artery or radial artery to understand its status as a bridge vessel for selection.
(6) Take antiplatelet, nitrate and beta-blocker drugs routinely before surgery.
(7) Prepare the skin as instructed by the doctor and inform the patient to fast at 2 o'clock and water at 24 o'clock the night before surgery.

Myocardial ischemic symptoms can not be controlled by medical treatment. include:
1. Left main disease: Surgery is the first choice for left main disease.
2. Three or more vascular diffuse lesions.
3. Patients with cardiac insufficiency: Complete revascularization is required to promote the recovery of ischemic myocardium.
4. Patients with diabetes: more than two vascular lesions, especially with anterior descending stenosis.
5. Cardiac emergency: those who have failed some interventional treatment or have acute complications, such as severe coronary artery injury, cardiac tamponade, ventricular septal perforation, etc. or acute myocardial infarction with cardiogenic shock.
6. Anti-platelet drug allergy.

1. The diameter of the distal vessel of coronary artery disease is <1mm.
2. Severe heart, brain, lung, liver, and kidney dysfunction, who cannot tolerate surgical trauma.

1. The great saphenous vein bypass operation is performed under the systemic circulation, and the thoracotomy and the great saphenous vein are removed at the same time in two groups. The operation should be light, do not damage the vein, and ligate the small branches; during the ligation, prevent the narrowing of the vein cavity due to traction. The proximal and distal ends of the removed saphenous vein must be marked. Because the great saphenous vein has a valve closure, which can block blood flow, the distal end is anastomosed with the ascending aorta, and the proximal end is anastomosed with the coronary arteries.
Note that the use of a large saphenous vein bypass is more likely to produce vascular intimal hyperplasia. In severe cases, the bridge can be blocked within 3 months. Most large saphenous vein bridges will have different degrees of blockage within 5 years after surgery.
2. Internal thoracic artery bypass surgery The long-term patency rate of internal thoracic artery bypass surgery is good, and the 10-year patency rate is> 90%. The internal thoracic artery can regulate blood flow according to the physiological needs of myocardial blood supply, and the chance of atherosclerosis is small, but the internal thoracic artery is limited in length. The left internal thoracic artery is mainly used as the left anterior descending branch bypass. The right internal thoracic artery can be anastomosed with the right coronary artery or posterior descending branch. Other blood vessels must be combined with the great saphenous vein vascular bridge.
3. Radial artery bypass surgery In recent years, due to the improvement of surgical technology and the use of calcium channel blockers to prevent vasospasm and postoperative anticoagulation therapy, the radial patency rate has been greatly improved, and the 5-year patency rate has reached 90%.

1. Assist the patient in supine position with chest height.
2. Separate the large saphenous vein and the instrument for thoracotomy to avoid contamination.
3. Prepare the defibrillator in advance and prepare for extracorporeal circulation at any time.

1. Strictly monitor heart rate, heart rate, blood pressure, and body temperature after surgery, and appropriately use nitrate drugs to effectively expand the coronary arteries of patients and improve blood supply.
2. Record and control the amount of liquid input and output to ensure water, electrolyte and acid-base balance. Appropriate use of vasodilator drugs, measurement of central venous pressure, guidance of fluid volume and speed.
3. The tracheal intubation should be removed as soon as possible to guide the patient how to cough and sputum. If the patient is unable to sputum, auxiliary sputum should be given, and turn over and back should be strengthened, and mechanical sputum suction should be given if necessary.
4. Patients with left ventricular dysfunction can be assisted by aortic balloon counterpulsation.
5. After the patient is awake, it is necessary to properly extend and extend the limbs to facilitate blood return, observe the dorsal foot artery pulsation and the limb peripheral circulation, and use elastic bandages to tighten the limbs to prevent thrombosis. Instruct patients on early bed activities.
6. Postoperative anticoagulation treatment is required for 6 months.

Every day after surgery, you should ensure that you consume the right amount of fruits and vegetables, eat more foods with high protein content (such as fish, eggs, etc.) and foods with unsaturated fatty acids, and eat less foods with high saturated fatty acids. Quit smoking and limit alcohol.