Coronary artery bypass grafting (CABG) - a major operation aimed at ensuring the normal blood supply to the heart muscle and restoring health. israeli doctorsclinic Assutause their skills and experience for the surgery. This solves the immediate problem, but the patient waits longer rehabilitation when necessary to apply force to return to the familiar life. Recovery of each person is unique. Much depends on the co-factors of the operation, the age and condition of the patient in the postoperative period, before it is allowed to go home. CABG will take at least 6 weeks prior to the time when good health will recover.
Coronary artery bypass surgery - Overview
In ischemic heart disease coronary artery calcium deposits clog and fat molecules. Cholesterol plaques narrow the lumen of the vessels in which the blood flows to the heart. The main muscle of the body loses its supply of nutrients, oxygen and energy sources. There is ischemia, which says manifested angina, severe pain in the chest. There are cases with fatal outcome, when myocardial infarction occurs.
Surgeons spend bypass using native human veins, advantageously withdrawn from the lower extremities or the forearm. With their help, the artificially created artery bypass occluded blood vessels, which contributes to the restoration of blood supply to the heart muscle. Operation eliminates or alleviates pain in the chest, extends the life of patients even with severe coronary artery disease.
The decision to conduct surgery on the heart- coronary artery bypass grafting is accepted by the attending physician based on the patient's history, the risk of a negative scenario after the intervention. Having the documents confirming the diagnosis, it is necessary to apply to the clinic Assuta, to get a competent opinion of qualified cardiologists. If necessary, doctors send the patient to additional research and consultation, examining the results of which can form a professional opinion about the appropriateness of this transaction in a particular situation.
Surgery is recommended if the following violations:
- Stable angina - angina condition is expressed in the persistent pain in the chest, frequent and severe attacks. For these patients there are several treatment options - drug therapy with taking drugs and CABG surgery to bypass the occluded coronary artery. Coronary stent can be carried out, during which doctors use plastic catheter from the wire cells with a flexible texture, blown cylinder connected. The tube is inserted into an artery, after receipt of air expands, increasing occlusion of plaque clearance, which leads to improved blood supply to the heart. According to doctors, the procedure is less aggressive nature as compared to the bypass.
- With extensive heart disease, when there is a narrowing of the left main coronary artery and poor pumping ability of the left ventricle, people with CABG surgery have a favorable prognosis. Typically, the life expectancy of such patients is higher than in patients with a coronary stent or past drug therapy.
- Patients at risk for a heart attack in the near future - in the clinic conducted a profile test load perception. Negative changes are recorded on the tape ECG. Patients can not tolerate exercise, have a limited blood flow to the heart muscle. Measure the speed of blood flow allows echocardiography.
- Unstable angina - Patients with this diagnosis are candidates for bypass surgery.
- After myocardial infarction - coronary artery bypass grafting is performed when coronary stent does not result in the purification of the vessels from atherosclerotic plaques.
Preparation for coronary artery bypass surgery
The mood of the patient is important, compliance with the recommendations of the doctors is a must. Careful examination of health status, delivery of laboratory tests, research. The number of procedures: ultrasound, ECG, blood analysis, urine. It is mandatory performed coronary angiography - the technology determine the state of the arteries, determine the degree of narrowing of blood vessels, the blockage location. The method consists in the introduction of profile material in the vessels passing radiographic procedures. Part of the study, patients pass on their own, the other - in the hospital. The patient is taken to a clinic where develops breathing techniques that will be useful to himafter the operation to restore the lung functions.
Subtleties of the procedure of the heart coronary artery bypass grafting
For organizations bypass the blood supply to the heart muscle blood vessels are transplanted from other parts of the patient's body. Passing a narrowed section of the coronary artery, a vessel to stabilize the bloodstream. Doctors use several transplants, if there is more than one occluded coronary artery. Typically, alternative vessels are removed from the legs, arms, chest, abdomen:
- Saphenous vein is taken from the lower extremities. The main problem is the use of a stenosis, similar to the narrowing of coronary arteries. This limits the lifetime of the graft in the period of 5-7 years. Such an indicator is observed in 50% of patients. In addition, there are a number of factors that worsen the situation: smoking, hypertension, lipid disorders, diabetes. On some of them the patient is not able to work.
- The internal thoracic artery, located in the right and left side of the chest. In contrast to alternative methods artery partially removed from the point of initial location. One end of the surgeon attaches to the coronary artery.
- Arterial grafts have better survival rate in comparison with venous shunts, rare occurrence of complications. This explains the lower number of operations in the next period, reducing the risk of myocardial infarction condition, reduction of recurrent angina. The best result shows the left internal thoracic artery.
- The radial artery is taken from the forearm. The results are equivalent to the use of the internal thoracic artery. After removal of the radial artery observed minor changes - the forearm numbness, tingling in the tissues without altering motor functions.
- Gastroepiploic artery - the use of the graft is practiced in rare cases, although the results are encouraging operations.
Operation is performed under general anesthesia, the patient is in a state of deep sleep. On average surgery takes between 3 to 6 hours. Studying coronary artery bypass grafting, the process operation is as follows:
- Operating doctor performs an incision in the chest, opening the sternum and providing access to the heart muscle. In medicine, a procedure called a sternotomy.
- Organization workaround for blood flow requires a temporary cardiac arrest with the help of chemicals and exposure to cold (hypothermia).
- The blood circulation is supported by cardiopulmonary bypass. This allows the body to supply oxygen and nutrients.
- The end of the graft attached to the aorta, the other - to the coronary artery to bypass the affected area.
In surgical practice used heart bypass surgery performed on new methods and technologies. This reduces the risk of complications after surgery. There are three types of operations:
- Since cardiac arrest and cardiopulmonary bypass equipment using (method described above).
- Coronary artery bypass grafting on the beating heart without the apparatus of artificial circulation. The operation must only be performed by experienced doctors, whose skill is compared with a jeweler's work in surgery. Procedure lasts less time than in the first case. The patient recovers faster.
- Minimally invasive method or mini CABG with the device IR or without the use of equipment. A small incision of the chest due to the lower blood loss, reducing the risk of infectious complications. The patient is discharged from hospital soon, rehabilitation takes place without complications. Technology takes a lot of popularity, but is not used in all cases of operations.
These methods include the risk of complicationsafter surgery. The sophisticated technology of management of patients, modern equipment, experience Assuta hospital surgeons give high rates of favorable outcomes. In addition to the skill of experts on the impact of the forecast are the individual characteristics of the patient, medical history and other factors.
After surgery, the patient is 1-2 days in the intensive care unit. At this time, the family members of the patient's visit to the hospital, support morally and psychologically. At this time, doctors and nurses provide control parameters of the cardiovascular system, measured rhythm of the heart muscle and blood circulation rate, fixed blood pressure, body temperature, breathing characteristics. With the recovery control is being phased out. Stages of recovery are as follows:
- Fixed airway tube is removed after the patient waking up and returning to it's ability to breathe independently. Several hours a person feels disoriented in space, his condition is unstable.
- Placed for collection and measurement of urine in the bladder catheter is removed after the patient stands up and moves independently.
- Intravenous system drugs into the organism is removed.
- Drain for outflow of fluid in the chest under favorable terms is removed after 1-3 days.
- Severe pain from the injuries of the chest there is the first 72 hours, then the discomfort decreases. To eliminate the pain the patient appointed specialized drugs.
Medical practice shows that the majority of people who have had surgery on the heart - coronary artery bypass grafting, the next day can sit in a chair. In the next 1-2 days start to walk around the room and outside the room. it is worth noting from the extra niceties:
- Poor appetite, a few weeks after surgery. This is normal and to be expected. Talk to your doctor about further action, the rationaldietand nutrition is sufficient. The cardiologist will explain which foods are recommended and which should be deleted.
- Corollary poor appetite, decreased physical activity, medication - constipation. When the manifestation of difficulties in going to the toilet should consult a doctor who will prescribe laxatives permitted after surgery.
- Swelling of the legs, from which the graft is removed, decreasing the use of compression underwear and downs of damaged limb blood flow.
- Sleep disorders occur when the patient is in a hospital setting. Despite the staffing of Chambers Assuta Hospital, writing out and return home normalize sleep that allows the patient to recover more actively to produce a good rest.
- In 20-40% of patients have unstable emotional state, depressive mood. Noted a negative state easily on the grounds of prolonged sadness, lack of interest in third-party cases and events, feelings of worthlessness and uselessness that feels sick. Depressive mood hamper speedy recovery, increase the risk of heart problems in the future. If depression lasts more than two weeks, it makes sense to turn to a professional psychologist. Help and support loved ones are no less important. Talk heart to heart, memories of pleasant moments, faith in the future will help to overcome the barrier and return the patient to the meaning of life.
Practice shows that the majority of patients recover in the hospital for 4-5 days, but sometimes hospitalization lasts longer due to difficulties with the restoration related to the individual characteristics of the patient. Absence of complications and early recovery state of health makes it possible to return to work after 4-6 weeks after surgery. This applies to people working in the intellectual sphere. Physical rough work requires a longer rehabilitation. Full recovery operable intervention is 2-3 months. If you can not provide patient care in the home, it is recommended nursing care, which is covered with a doctor in a separate order.
Long-term prognosis after CABG
There are several factors that affect the long-term prognosis. Of great importance is the choice of the graft, which provides a workaround in the supply of the heart muscle.Statisticsshows favorable figures. In 95% of patients with multiple restriction arteries, angina disappears completely or mitigates symptoms immediately after surgery. In 85% of the people it is missing at least three years, 75% - 5 years. Causes of recurrence are narrowing of the graft vessel used in bypassing the arteries, or the progression of disease. Arterial grafts after 10 years remain open in 90% of patients. If you want to re-clogging of revascularization procedure.
What's new in cardiology coronary bypass?
Of interest is an endoscopic method for removal of transplants. Doctors are of excellent quality vessels for bypass without causing unnecessary injury to the patient. The result - a distinct cosmetic effect and comfort of the patient in the recovery period. After the procedure, the wound quickly tightened, reduced pain compared with traditional methods of intake decreases the risk of complications.
Home Care after CABG
With a favorable condition of the patient after the surgery the patient is discharged home after 5 days. If there are complications apply adequate therapy that eliminates the negative symptoms to a full stabilization. If the patient underwent coronary artery bypass grafting in Israel Assuta hospital, doctors explain in detail how to organize the recovery period of the patient and his family members. It prepared a comprehensive rehabilitation plan, designated control points and show your doctor. If necessary, subsequently adjusted doses of medications. Patients receiving a schedule of drugs whose action is directed to increasing life expectancy, the prevention of relapse. Among them:
- Antiplatelet agents - prevent the formation of a blood clot drugs. Among the most common - aspirin, appointed for a fixed term for the physician's discretion, and clopidogrel, which designed the course for a year or more.
- Beta-blockers - slowing the heart rate funds. A beneficial effect on the pressure drop, reducing the demand of the heart muscle of oxygen. Medication is prescribed to people with high blood pressure, heart failure or heart attack risk.
- Nitrates - short or long-acting. The drug dilates the coronary vessels, facilitating blood flow to the heart, relieve the discomfort of pain.
- ACE inhibitor - for high-pressure treatment.
- Hypolipidemic therapy - to reduce lipid operable after the intervention.
At the discretion of the doctor appointed by the other drugs, much depends on the medical history of the patient, the patient's treatment protocol. Attention is paid to the treatment of wounds and injuries. Up to 8 weeks after surgery, doctors recommend to give up active exercise. If the recovery period after CABG in Israel has sharply risen body temperature over 38 degrees, the pain progresses, there is a quickening of the heart rate, severe reddening of the skin and signs of festering wounds, should seek immediate medical attention.
Coronary artery bypass surgery in Israel
Leading clinics in the country for the bypass is considered to Assuta, which employs surgeons from around the world. Doctors conduct daily operations, saving thousands of lives and giving patients hope for a long life. The hi-tech equipment of a hospital contributes to the favorable outcome of the procedures. The professionalism of the medical staff provides a careful monitoring of the patient, sparing the operation and fast recovery period. CABG wondering where best to do the procedure and how much it will cost the surgery, give us a call. We will give prompt answers to your questions, help you to sort out with the date and time of the transaction.
Coronary artery bypass grafting - the price of life-saving
Coronary artery bypass grafting on the value determined in accordance with the cost of diagnostic procedures and treatments:
- Diagnostics - study package to determine the severity of the condition. Prediction on the outcome of medical manipulation is the cost of each procedure, which was subsequently summarized. Conducting stress echocardiography, detailed blood tests, ECG, consult an experienced cardiologist and surgeon, coronary cost an average of US $ 9,000-10,000. Stage surveys lasts 4 days, painted procedures in the individual patient's chart.
- The cost of CABG surgery is 37,000 dollars. Here included weekly stay in the clinic during the rehabilitation period, daily determination in intensive care, monitoring neurophysiological reactions during transplantation and vascular introduction, postoperative monitoring of the patient.
If you are interested, how much coronary artery bypass surgery, contact our specialists. We will talk about the nuances of the procedure, denoted by the existing rules of registration in the clinic. If desired, you can choose the doctor who will perform CABG. In the state hospital are such famous surgeons like Ehud Ra'anana, to which there is considered to be a big success. We want to make your health has always been strong, and life expectancy. Use the chance to be treated in one of the leading centers of Israel, the results of which are able to turn the vision of medicine and provided under the care clinics.