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After heart surgery. Open heart surgery, stages and recovery period Cardiac valve surgery

Open heart surgery is one of the methods of treating cardiovascular diseases, in which special surgical procedures are performed. The general principle boils down to the fact that there is an intervention in the human body in order to carry out the necessary measures on an open heart. In other words, this is an operation during which an opening or dissection of the human sternum area is performed, affecting the tissues of the organ itself and its vessels.

Open heart surgery

Statistics say that the most common intervention of this type among adults is an operation that creates artificial blood flow from the aorta to healthy areas of the coronary arteries - coronary artery bypass grafting.

This operation is performed to treat severe coronary heart disease, which occurs due to the development of atherosclerosis, in which the vessels supplying blood to the myocardium narrow and their elasticity decreases.

The general principle of the operation: the patient’s own biomaterial (a fragment of an artery or vein) is taken and sewn into the area between the aorta and the coronary vessel in order to bypass the area affected by atherosclerosis, in which blood circulation is impaired. After the operation is performed, the blood supply to a certain area of ​​the heart muscle is restored. This artery/vein supplies the heart with the necessary blood flow, while the artery in which the pathological process occurs is bypassed.


Coronary artery bypass grafting

Today, taking into account progress in medicine, for surgical treatment of the heart it is enough to make only small incisions in the appropriate area. Another intervention, more complex, will not be needed. Therefore, the concept of “open heart surgery” sometimes misleads people.

Reasons for prescribing open heart surgery

There are a number of indications for open heart surgery:

  • The need to replace or restore the patency of blood vessels for the correct flow of blood into the heart.
  • The need to restore defective areas in the heart (for example, valves).
  • The need to place special medical devices to maintain heart function.
  • The need for transplantation operations.

What do you need to know about coronary artery bypass surgery?

Time

According to medical data, this type of operation takes at least four and no more than six hours. In rare, especially severe cases, when the operation requires a larger volume of work (creation of several shunts), an increase in this period may be observed.

Patients spend the first night after heart surgery and all medical procedures in the intensive care unit. After three to seven days have passed (the exact number of days is determined by the patient’s well-being), the person is transferred to a regular ward.

Dangers during surgery

Despite the qualifications of doctors, no one is immune from unplanned situations. What is the danger of surgical intervention, and what risk can it carry:

  • infection of the chest due to the incision (this risk is especially high for people who are obese, have diabetes, or are undergoing repeated surgery);
  • myocardial infarction, ischemic stroke;
  • heart rhythm disturbances;
  • thromboembolism;
  • increased body temperature for a long time;
  • cardiac discomfort of any nature;
  • pain of various types in the chest area;
  • pulmonary edema;
  • short-term amnesia and other transient memory problems;
  • loss of a significant amount of blood.

These negative consequences, as statistics show, occur much more often when using an artificial blood supply.


The risk of unpleasant consequences is always present

Preparatory period

In order for the planned operation and general treatment to be successful, it is important not to miss anything significant before it begins. To do this, the patient must tell the doctor:

  • About medications that are currently used. These may include medications prescribed by another doctor, or those that the patient purchases himself, including dietary supplements, vitamins, etc. This is important information, and it should be announced before surgery.
  • About all chronic and past diseases, health problems that currently exist (runny nose, herpes on the lips, upset stomach, fever, sore throat, fluctuations in blood pressure, etc.).

The patient should be prepared for the fact that two weeks before the operation the doctor will ask him to refrain from smoking, excessive alcohol consumption, and taking vasoconstrictor medications (for example, nasal drops, ibuprofen, etc.).

On the day of the operation, the patient will be asked to use a special bactericidal soap, which significantly reduces the risk of infection during the procedure. In addition, several hours before the intervention you should not eat or drink water.

Carrying out the operation

When open heart surgery is performed, the following steps are performed sequentially:

  • The patient is placed on the operating table.
  • He is given general anesthesia.
  • When the anesthesia begins to take effect and the patient falls asleep, the doctor opens the chest. To do this, he makes an incision in the appropriate area (usually it is no more than 25 centimeters in length).
  • The doctor cuts the sternum, partially or completely. This allows access to the heart and aorta.
  • Once access is secured, the patient's heart is stopped and connected to a heart-lung machine. This allows the surgeon to calmly perform all manipulations. Today, technologies are used that in some cases make it possible to perform this operation without stopping the heartbeat, and the number of complications is lower. than with traditional intervention.
  • The doctor creates a shunt to bypass the damaged section of the artery.
  • The cut part of the chest is secured with a special material, most often a special wire, but in some cases plates are used. These plates are often used for elderly people or for people who have undergone frequent surgical operations.
  • After the surgery is performed, the incision is sutured.

Postoperative period

After the operation is completed and the patient awakens, he will find two or three tubes in his chest. The role of these tubes is to drain excess fluid from the area around the heart (drainage) into a special vessel. In addition, an intravenous tube is installed to supply therapeutic and nutritional solutions to the body and a catheter is installed in the bladder to remove urine. In addition to tubes, devices are connected to the patient to monitor heart function.

The patient should not worry; if questions or discomfort arise, he can always contact medical professionals who will be assigned to monitor him and promptly respond if necessary.


The duration of the recovery period depends not only on physiology, but also on the person himself

Every patient should understand that rehabilitation after surgery is not a quick process. After six weeks of treatment, some improvements can be observed, and only after six months will all the benefits of the operation become visible.

But each patient is able to speed up this rehabilitation process, while avoiding new heart ailments, which reduces the risk of repeat surgery. To do this, it is recommended to take the following measures:

  • follow the diet and special diet prescribed by your doctor;
  • limit salty, fatty, sweet foods);
  • devote time to physical therapy, walks in the fresh air;
  • stop frequent drinking of alcohol;
  • monitor blood cholesterol levels;
  • monitor blood pressure.

If these measures are followed, the postoperative period will pass quickly and without complications. But you should not rely on general recommendations; the advice of your attending physician, who has studied your medical history in detail and is able to draw up an action plan and diet during the recovery period, is much more valuable.

Cardiac surgery is a branch of medicine devoted to the surgical treatment of the heart. In case of pathologies of the cardiovascular 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 disease, a late visit 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. Chronic diseases and stages of the disease are identified, risks are assessed, in which case they talk about planned surgery. If emergency assistance is needed, for example, in case of a blood clot or aneurysm dissection, minimal diagnostics are performed. In any case, the function of the heart is surgically restored, its parts are rehabilitated, 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, the AIC may not be connected, but only the desired zone of the heart can be stopped, for example, during coronary artery bypass grafting. 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 moves a thin catheter through the blood vessels and gets to the 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. A planned intervention is prescribed when the pathology does not pose a particular danger, but it cannot be postponed.
  2. Emergency - these 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 are surgeries 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, local anesthesia is sufficient, for example during 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, or due to concomitant heart diseases. To eliminate this problem, open surgery is also needed, often with artificial cardiac arrest.

During the manipulations, the surgeon can “patch up” the septum with a patch, or suture 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 of the 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; at 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, computed tomography, and x-ray studies are prescribed. 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 of permanent medications and other medications can give a negative result. Even regular painkillers need to be discussed with. To keep fit and restore health faster, it is recommended to spend more time in the fresh air and 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.

Diseases of the cardiovascular system are rightly called one of the most pressing problems of our time. Around the world, up to 20 million people die from them every year. These diseases cause fear because they creep up unnoticed. Few people will go to an appointment with a cardiologist until signs of malaise clearly manifest themselves. Cardiac surgery, which comes to the rescue when conservative treatment becomes ineffective, saves the lives of thousands of patients every year. These operations are becoming more and more complex and high-tech, doctors are starting to treat cases that until relatively recently were considered hopeless. Despite the increase in the severity of cardiac surgery patients over the past 15-20 years, mortality in cardiac surgery has decreased significantly, and today is about 1-2% in uncomplicated cases. According to publications in medical journals in 1965, the mortality rate was about 15%. However, the complication rate still remains high. Modern medicine has learned to treat well many complications that until recently were fatal. But we have not yet learned how to prevent their appearance. The frequency of their occurrence still remains at a very high level. Finding ways to prevent postoperative complications in cardiac surgery is the foundation on which patient safety should be based before, during and after surgery.

An important problem in the prevention of postoperative complications, including the prevention of infection in the surgical area, is the low level of knowledge of our patients.

The main causes of postoperative complications and/or readmission of patients undergoing reconstructive cardiac surgery are often due to behavioral factors:

· Violation of drug therapy.

· Incorrect wearing of postoperative bandages.

· Violation of the physical activity regime.

· Lack of self-control.

· Non-compliance with diet.

Taking into account the relevance of this problem, a study was conducted in the cardiac surgery departments of the Samara Cardiac Dispensary to determine the level of awareness of cardiac surgery patients about the prevention of postoperative complications. The order to conduct the study was approved by the Ethics Committee of the State Budgetary Healthcare Institution

"Samara Regional Clinical Cardiology Dispensary" and the board of the Samara regional public organization of nurses.

The object of the study was a group of men and women 50-65 years old, numbering 125 people, who were treated in the 4th and 11th cardiac surgery departments of the Samara Regional Clinical Cardiological Dispensary in the period from 01.08.2015 to 30.09.2015 who underwent open heart surgery (coronary artery bypass grafting , aortic, mitral valve replacement and others).

The effectiveness of the activities was assessed through conversations and questionnaires conducted with patients before and after the training.

The results of the initial survey revealed:

ü 26% of respondents know that violation of drug therapy and physical activity regimen are risk factors for postoperative complications,

ü 35% of patients are aware that smoking and alcohol are risk factors for CHF,

ü to the question: “Do you know about the principles of nutrition in the postoperative period?” - 18% answered “yes”,

ü 11% are aware of the main symptoms of complications in the early postoperative period,

ü “Do you know about self-care in the early postoperative period?” - only 10% answered positively,

ü 100% of respondents are afraid of the upcoming operation and the future,

ü 80% of cardiac surgery patients do not have healthy sleep.

The results of the survey show that patients' awareness of the prevention of postoperative complications is low. Patients' quality of life is sharply reduced. Only 15 out of 125 people knew about the use of elements of self-help and self-care before training.

During their hospital stay, patients were given classes on the following topics:

· risk factors for cardiovascular diseases;

· general information about open heart surgery;

risk factors for postoperative complications;

· symptoms of complications and principles of self-control;

· diet in the early and late postoperative period;

principles of self-care:

· physical activity;

Practical classes were conducted where patients were taught the correct technique for independently measuring blood pressure, counting pulse, weighing, learning how to properly wear a bandage and the technique of applying an elastic bandage in the area of ​​a postoperative wound on the leg.

All patients received educational materials on self-control and a “After Heart Surgery” leaflet. It contains information about frequently asked questions:

ü “How will the preparation for the operation proceed?”

ü “What will happen to me on the day of the operation?”

ü “How long will the operation take?” And the most pressing questions:

ü “What will the suture be like and will it get infected after the bandage is removed?”

ü “When and how to put on a bandage?”

ü “When should I start bandaging my leg with an elastic bandage and how long should I wear it?”

ü and other useful information.

After repeated questioning, the level of patients' knowledge about the prevention of postoperative complications increased significantly. 84% of patients acquired self-help skills and 100% learned elements of self-care. After completing the training course, patients began to understand that responsibility for the effectiveness of the prescribed treatment largely depends on themselves.

The introduction of nursing research into practice has made it possible to increase the status of nursing staff and responsibility for the work performed. Maintaining nursing documentation allows you to systematize information obtained during the examination of patients. With the daily registration of nursing records, nurses learn to better and more deeply understand patients, collecting information about their life history and illness. In the process of working in new conditions, nurses develop new qualities: sympathy, empathy, the ability to put themselves in the patient’s place and see the world through his eyes. There is a constant increase in professional knowledge. Carrying out independent nursing care required nurses to study special medical literature on care. Nursing standards have been developed to allow for more effective implementation of nursing interventions. The quality of care has increased, which has ensured the prestige of working in the departments.

References

1. Glushchenko T.E. Features of clinical-functional and clinical-social indicators of adaptation of patients before and after coronary artery bypass surgery depending on the level of personal anxiety // Siberian Medical Journal. – 2007. – Volume 22, No. 4. – P. 82–86.

2. Ivanov S.V. Mental disorders associated with open-heart surgery // Psychiatry and psychopharmacotherapy named after. Gannushkina. – 2005. – No. 3. – P. 35–37.

3. Moiseeva T.F. Experience in managing nursing staff at the Omsk Regional Clinical Hospital: improving the professional level of nursing staff. // Chief nurse. - 2012 - No. 6. - P. 26-27.

4. Niebauer J. Cardiac rehabilitation. Practical guide. – M., 2012. – 328 p.

5. Sopina Z.E., Fomushkina I.A. Quality management of nursing care. CRM system for business. GEOTAR-Media, 2011. – 178 p.

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 is a long process associated with the characteristics of the 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. The muscles that have weakened during the postoperative period cannot support the spine, so the bandage effectively relieves 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 appearance of severe pain.

The pain after surgery persists for a long time and radiates to the arm. The bandage, along with painkillers, massage relaxation techniques and light exercises, 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 hospital stay or sanatorium treatment, a 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 fever;
  • 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?

Our institution occupies one of the leading positions in the implantation of PERCEVAL S seamless aortic valve prostheses in the Russian Federation.

1 vacancy is open - Doctor, with a valid certificate in the specialty "Anesthesiology-Resuscitation".

With any work experience, with Moscow registration, age up to 40 years.

1 vacancy is open - Nurse, with a valid certificate in the specialty (if possible), to work in a cardiac surgery operating room.

Work experience is not required, with Moscow registration, age up to 40 years.

Send your resume by email to: or by phone

In the fall of 2012, commissioning work in the reconstructed operating block of the hospital was finally completed.

Equipped with the latest technology, the operating unit has rightfully become the most high-tech department in our country. In the process of reconstruction, such well-known manufacturers of medical equipment as Draeger, BeeBrown, Mortara, Storz, etc. introduced their achievements.

Two of the four operating rooms are equipped with OR-1 equipment, where it has become possible to perform a full range of open, endoscopic and hybrid operations on the thoracic and abdominal organs. It has also become possible to broadcast the progress of operations (from different fields of view) and receive instant interactive consultations from any specialists in the hospital, and from the World Wide Web.

And at the end of December, the operating rooms of the Center for Cardiovascular Surgery under the leadership of Professor I.A. Borisov began working at full capacity.

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

How long does it take to grow together and what does it feel like? This section is specially for beginners who have not figured out the structure of the forum - write here all the questions that you don’t know where to place - someone will definitely answer. Question from a newbie

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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 result 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 exercise 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 it is cured of the 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, osteoporosis, and also in the presence of lung diseases, since in this case the cough and As a result, the chest stretches more strongly in the postoperative period. The greater the load, the greater the likelihood that the seam with which we tightened will not withstand.

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. According to 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. Simpler plates are often 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 government assistance, so the solution here is either to look for the opportunity to purchase the plate through the budget, or to buy the 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 complicated, 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 on 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, and the appearance of such patients in the cardiac surgery department threatens its closure. In addition, almost all cardiac surgery departments operate on the basis of 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 a ventilator for some time after CABG. After restoration of independent 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 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, 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.

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.

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 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.

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 consumption 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.

You will need to contact a cardiologist to obtain permission to drive a car, since after the operation your reactions will be slowed down 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 along the way.
  • 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 on the use of the most effective method in treatment is made 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, such 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 who are resistant to drug therapy or who have a significant ischemic area of ​​the myocardium:

  • with angina pectoris of functional classes III–IV;
  • with unstable angina;
  • with acute ischemia occurring 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 heart failure with ischemic changes (accompanies angina pectoris in elderly people).

Group II includes patients who need very likely prevention of acute infarction (without surgery the prognosis is unfavorable), but are difficult to treat with drugs. 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 extensive 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, one should take into account the probable risk of death, 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;
  • the presence of severe symptoms of 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;
  • urine test;
  • 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 (an X-ray of the vascular pattern of the heart after the administration of a contrast agent) is required.

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 the patient to be completely relaxed, so general anesthesia is used. 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 physician 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 perform 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;
  • reduction of possible complications caused by the 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 next few 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 of the 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 at the sites where the saphenous vein is taken. 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 porridge, 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 blood 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 surgery 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.