Recovery after heart surgery. Open heart surgery, stages and recovery period Heart surgery

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 very high. 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 low level 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 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 replacement, mitral valve 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 the hospital stay, patients were given classes on the following topics:

risk factors for heart disease vascular 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 learned correct technique self-measurement of blood pressure, pulse counting, weighing, training in 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 last?” And the most current issues:

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: compassion, empathy, the ability to put themselves in the patient’s place and see the world through his eyes. There is constant growth professional knowledge. Carrying out independent nursing care required nurses to study special medical literature 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.

Bibliography

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. // Home 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.

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. The leader among acquired diseases is ischemic disease, in this case, surgery is considered the most effective treatment method. 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 surgical intervention. Reveal chronic diseases, stages of the disease, assess the risks, in this case they talk about elective surgery. If needed emergency help, for example, when a blood clot breaks off or an aneurysm dissects, minimal diagnostics are performed. Anyway surgically the function of the heart is 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:

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.
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.
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. The catheter delivers contrast agent, 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:

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

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

How the operations are done

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

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

Heart valve surgery

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

The plastic surgery is performed openly or closed; during the operation, special rings or sutures are applied manually along the diameter of the valve, which restore normal lumen and narrowing of the passage. Manipulations last on average 3 hours, with open views connect the AIK. 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 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 defects interatrial septum. 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” the septum using a patch, or sutured the defective part.

Bypass surgery

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

To prevent complications or alleviate the disease, use:

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

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

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

Recovery after interventions

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

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

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

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

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

Often except surgical care prescribe medications. 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.

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 specific thoracic spine.

The participation of the ribs in breathing, their 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.

Pain persists after surgery long time, radiates into the hand. 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 outflow 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 to e-mail to the address: 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. During the reconstruction process, the following people introduced their achievements: famous manufacturers medical equipment, such as Dreger, B-Brown, Mortara, Storz, etc.

Two of the four operating rooms are equipped with OR-1 equipment, where it became possible implementation 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, both from the hospital and from the worldwide network.

And at the end of December they started working at full capacity operating rooms of the Center cardiovascular surgery under the guidance of Professor I.A. Borisov.

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

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.

Non-union of the sternum. Osteosynthesis of the sternum

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

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

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

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

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

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

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

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

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

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

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

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

Corr.: Are these clamps installed for life?

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

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

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

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

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

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

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

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

V.A.: The operation itself is part of a 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 difficult, but it does require experience and understanding, because the plates must be bent correctly and the screws that secure the plates must be correctly adjusted.

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

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

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

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

V.A.: As a rule, this becomes noticeable within a month. It's easy to diagnose. But, unfortunately, cardiac surgeons around the world often do not deal with this problem themselves. This is due to the fact that this is considered a somewhat “dirtier” job in medical terms, because cardiac surgery is an extremely clean job, the appearance of such patients in the cardiac surgery department threatens its closure. In addition, almost all cardiac surgery departments operate on the basis 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 the machine for some time after CABG. artificial ventilation lungs. 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 this is a very massive bone and it accounts for huge pressure. The skin over the sternum heals in a few weeks, but the bone itself takes at least 4-6 months. For her more fast healing, it is necessary to provide her with peace, for this they use special medical bandages. 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 an increase 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 carry out load test VEM or Treadmill, in order to assess how passable the new bypass paths are and how well the myocardium is supplied with oxygen. If there is no pain or changes in the ECG during the test, then everything is fine.

But keep in mind, this does not mean that you can now start smoking again, overeat on fatty pork and stop taking all medications. No one is immune from the growth of new plaques, and in this case the chances that you will be accepted for repeat surgery 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

Primary recovery period lasts for about a day. During this time, the patient gradually returns to normal activities.

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

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

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

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

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

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

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

If they become 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 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 it sleeping pills only as a last resort.

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

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

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

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

After heart surgery

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

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

Unlike balloon angioplasty with stent installation, the idle vessel is completely excluded from the blood circulation and no attempts are made to open it. A specific decision 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, similar operations are performed in all major cardiac centers. The latest medical equipment has made it possible to more accurately determine indications for surgery, operate on a beating heart (without a heart-lung machine), and shorten the postoperative period.

How are indications for surgery selected?

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

The success of other methods is unlikely if:

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

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

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

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

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

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

Group II includes patients in need of very probable prevention acute heart attack(without surgery the prognosis is unfavorable), but difficult to treat medicines. 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 high risk infarction 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;
availability severe symptoms decompensated heart failure with congestion.

What is the additional bypass vessel made of?

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

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

The radial artery and saphenous vein can be removed:

openly through skin incisions;
using endoscopic technology.

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

What is the preparation for the operation?

Upcoming CABG requires thorough examination patient. Standard tests include:

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

Special studies are carried out in the preoperative period in the hospital. A coronary angiography (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 complete relaxation of the patient, so it is used general anesthesia. The patient will only feel the prick of the intravenous needle as the IV is inserted.

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

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

Specialized centers use equipment for monitoring and control of:

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

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

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

How is the operation performed?

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

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

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

It is technically difficult to 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 mechanical damage blood cellular elements;
reducing the duration of the intervention;
decrease possible complications, caused by equipment;
faster postoperative recovery.

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

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

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

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

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

How does the postoperative period proceed?

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

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

Exercise therapy ( physical therapy) it is recommended to start 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. Deep breaths straighten the lung tissue and protect 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 unloading due to 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 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?

Most frequent complications coronary artery bypass grafting are considered:

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.

How to properly spend the postoperative period, what to be prepared for and what to be wary of.

Heart surgery is a chance for successful continuation of normal full life. The realization of this chance largely depends on a properly conducted postoperative period. It will not be easy for the patient and his family at first, but if everything is done correctly, the result will exceed all expectations. Main principle- do not make sudden movements: all “pre-operative” activity will have to be restored calmly and slowly.

Emotions

Almost everyone experiences mood swings after open heart surgery. Joyful excitement after recovery from anesthesia is often replaced by depressive irritation. Memory weakens, concentration decreases, and absent-mindedness appears. Neither the patient nor his relatives need to worry about this. These symptoms usually go away within a month after surgery.

Home!

Usually you are discharged from the hospital 7-14 days after surgery. The patient must remember that even if everything went well, for full recovery After the operation he will need from 2-3 months to a year. You need to start taking care of yourself right outside the hospital. There are many cases where the patient had to be returned by ambulance within 3-6 hours after discharge. If the journey home takes more than an hour, you must stop and get out of the car. Otherwise possible serious problems with blood circulation of blood vessels.

At home, we must try to build relationships in such a way that the postoperative period is as smooth as possible for both the patient and his family members. Family members should treat the patient with understanding and make efforts for his recovery, but this does not mean that their entire life from this period should be subordinated only to him. neither the patient nor his relatives need it.

It is imperative that the patient is constantly monitored by the attending physician after discharge - a family doctor, internist or cardiologist.

What (not) is

Immediately after surgery, your appetite is most likely not very good, and healing physical and mental wounds requires good nutrition. Therefore, it is possible that for 2-4 weeks doctors will not set food restrictions at all. However, within a month, serious dietary restrictions will begin - on fats, cholesterol, sugar, salt, and calories. It is advisable to eat food with a high amount of easily digestible carbohydrates (vegetables, fruits, sprouted grains) and fiber. To combat anemia, you will most likely have to eat foods with high content iron: spinach, raisins, apples, moderately lean red meat.

Diet for the rest of your life:

Lots of vegetables and fruits
Porridge, possibly with bran, or muesli and cereal for breakfast
Sea fish as a main course at least 2 times a week
Fermented yogurt or juice instead of ice cream
Only dietary dressings, olive oil and mayonnaise for salads
Herbal and vegetable spices instead of salt
Reduce weight to normal, but not quickly. 1-2 kilograms lost per month is ideal
Move!
Check your sugar and cholesterol regularly
Smile at life!

Postoperative sutures

There will definitely be discomfort at the incision site after the operation and will only go away with time. When the stitches are overgrown, pain-relieving ointments and moisturizing lotions can be used to relieve discomfort. It is best if the patient consults his surgeon before using any ointments. If you are concerned about the cosmetic consequences of the operation, then it is advisable to see a plastic surgeon immediately after removing the stitches.

If the postoperative sutures heal normally, 2 weeks after the operation you can take a shower (not a bath, especially not a jacuzzi!). But at the same time: no expensive shampoos and contrasting changes in water temperature. Wash with plain soap and get wet (do not wipe, but blot with a clean towel). It is best for the first “water procedures” after the operation to be accompanied by someone close to you: you never know what can happen….

You should call your surgeon immediately if you experience the following symptoms:

temperature above 38°C
severe swelling and redness of the sutures, discharge of fluid from them
severe pain at the surgery site

Movement

From the first day after the hospital, you can try to calmly walk 100-500 meters on a flat surface. You need to stop - stop! You should go for a walk when it is convenient and when the weather permits. But not immediately after eating! By the end of the first month after the operation, you can slowly walk 1-2 kilometers.

At the end of the first week of staying at home, you can independently and slowly walk 1-2 flights up and down the stairs. Start wearing light items - up to 3-5 kilograms. If everything went ok with the stairs, you can gradually (!) start thinking O

Light housework won't hurt: dusting, setting the table, washing dishes, or helping family members cook.

After one and a half to two months, the sutures should heal completely, and then most likely cardiologists will conduct a functional stress test, based on the results of which it will be possible to judge the acceptable rate of increase in motor and psychological activity. Gradually, you can begin to lift and move heavier things, swim, play tennis, and do light (physically) work in the garden and/or office. A repeat test is usually performed 3-4 months after surgery.

Medicines

The most important thing here is the complete lack of independence. Medicines are always at hand and are taken only as prescribed by a doctor, and are not canceled without his prescription. Particular attention should be paid to drugs to prevent the formation of blood clots, for example aspirin and medications to normalize blood pressure. Don’t forget about medications and dietary supplements that reduce bad cholesterol levels.

What awaits you after heart surgery? What loads are permissible and when? How will the return to normal life? What should you pay attention to in the hospital and at home? When can I return to full health? sex life, when will you be able to wash your car yourself? What and when can you eat and drink? What medications should I take?

All answers are in this article.

After heart surgery, you may feel like you've been given another chance—a new lease on life. You may think that you will be able to make the most of your “new life” and make the most of the results of the operation. If you have had coronary artery bypass surgery, it is important to consider lifestyle changes, such as losing 5 kilograms or starting regular exercise. This should be taken seriously and you should talk to your doctor about your risk factors. There are books about health and cardiovascular diseases, they should be guides to your new life. The days ahead will not always be easy. But you must move forward steadily towards recuperation and recovery.

In the hospital

In the inpatient department, your activity will increase every day. In addition to sitting on a chair, walking around the ward and in the hall will be added. Deep breathing to clear the lungs and exercises for the arms and legs should continue.

Your doctor may recommend wearing elastic stockings or bandages. They help blood return from the legs to the heart, thereby reducing swelling of the legs and feet. If for coronary artery bypass grafting was used femoral vein, slight swelling of the legs during the recovery period is quite normal. Raising your leg, especially when you are sitting, helps lymphatic and venous blood flow and reduces swelling. When lying down, you should take off your elastic stockings 2-3 times for 20-30 minutes.
If you get tired easily, taking frequent breaks from activity is part of recovery. Feel free to remind your family and friends to keep visits short.
Muscle pain and brief pain or itching in the wound area may occur. Laughter or blowing your nose can cause short-term but noticeable discomfort. Rest assured - your sternum is sewn very securely. Pressing a pillow to your chest can help reduce this discomfort; use it when you cough. Don't hesitate to ask for painkillers when you need them.

You may sweat at night, even though your temperature will be normal. These night sweats are normal for up to two weeks after surgery.
Possible pericarditis - inflammation of the pericardial sac. You may feel pain in your chest, shoulders, or neck. Typically, your doctor will prescribe you aspirin or indomethacin for treatment.

In some patients it is impaired heartbeat. If this happens, you will have to take medication for a while until the rhythm is restored.

Patients after open heart surgery often experience mood swings. You may be in a joyful mood immediately after surgery, but become sad and irritable during the recovery period. A sad mood and outbursts of irritability cause anxiety in patients and loved ones. If emotions become a problem for you, talk to your nurse or doctor about it. It has been established that mood swings are a normal reaction, even if they continue for several weeks after discharge. Sometimes patients complain of changes in mental activity - it is harder for them to concentrate, their memory weakens, and their attention is distracted. Don't worry - these are temporary changes and should disappear within a couple of weeks.

At home. What to expect?

You are usually discharged from the hospital on the 10-12th day after surgery. If you live more than an hour's drive from the hospital, take breaks every hour while traveling and get out of the car to stretch your legs. Prolonged sitting impairs blood circulation.

Although your recovery in the hospital was probably fairly rapid, your recovery at home will be slower. It usually takes 2-3 months to fully return to normal activity. The first few weeks at home can be challenging for your family too. Your loved ones are not used to the fact that you are “sick”; they have become impatient, and your mood may fluctuate. Everyone needs to try to make this period go as smoothly as possible. It will be much easier to cope with the situation if you and your family can openly, without reproaches or showdowns, talk about all your needs, and join forces to overcome critical moments.

Meetings with a doctor

It is necessary that you be observed by your regular attending physician (general practitioner or cardiologist). Perhaps the surgeon will also want to meet with you after discharge after one or two weeks. Your doctor will prescribe a diet and medications permissible loads. If you have any questions regarding the healing of post-surgical wounds, please contact your surgeon. Before you leave, find out where to go if you have any possible situations. See your doctor immediately after discharge.

Diet

Because you may initially experience loss of appetite, and good nutrition is important while wounds heal, you may be sent home on an ad libitum diet. After 1-2 months, you will most likely be advised to eat a diet low in fat, cholesterol, sugar or salt. If you are overweight, calories will be limited. A good diet for most heart diseases limits cholesterol, animal fats and foods high in sugar. It is advisable to eat foods high in carbohydrates (vegetables, fruits, sprouted grains), fiber and healthy vegetable oil.

Anemia

Anemia (anemia) common condition after any surgical intervention. It can be eliminated, at least partially, by eating foods rich in iron, such as spinach, raisins, or lean red meat (the latter in moderate amount). Your doctor may recommend taking iron tablets. This medicine can sometimes irritate your stomach, so it's best to take it with food. Please note that this may turn the stool dark and cause constipation. Eat more fresh vegetables and fruits and you will avoid constipation. But if constipation becomes persistent, ask your doctor to help with medications.

Wound and muscle pain

Discomfort due to pain in the postoperative wound and muscles may persist for some time. Sometimes pain-relieving ointments help if you massage the muscles with them. The ointment should not be applied to healing wounds. If you feel clicking movements of the sternum, notify your surgeon. Itching in the area of a healing wound is caused by hair regrowth. If your doctor allows it, a moisturizing lotion will help in this situation.

Contact your doctor if you notice following symptoms infections:

temperature above 38°C (or less, but lasting more than a week),

wetting or discharge of fluid from postoperative wounds, persistent or new appearance of swelling, redness in the area of the postoperative wound.

Shower

If the wounds are healing, there are no open spots or getting wet, you can decide to shower 1-2 weeks after the operation. Use plain warm soapy water to clean the wounds. Avoid bubble baths that are very hot and very cold water. When you wash for the first time, it is advisable to sit on a chair while showering. Using a gentle touch (not wiping, but blotting), dry surgical wounds with a soft towel. For a couple of weeks, try to have someone nearby when you bathe or shower.

General guidelines for home practice

Gradually increase your activity every day, week and month. Listen to what your body is saying; rest if you are tired or have shortness of breath or feel chest pain. Discuss the instructions with your doctor and consider any comments or changes made.

If prescribed, continue to wear elastic stockings, but remove them at night.

Schedule rest periods throughout the day and get a good night's sleep.

If you are having trouble sleeping, it may be due to your inability to get comfortable in bed. Taking a painkiller pill at night will help you rest.

Continue training your arms.

Shower if the wounds are healing normally and there are no weeping or open areas on the wound. Avoid very cold and very hot water.

First week at home

Walk on level ground 2-3 times a day. Start at the same time and distance as you did during your last days in the hospital. Increase your distance and time, even if you have to stop for a short rest a couple of times. You can do 150-300 meters.

Take these walks at the best time convenient time day (this also depends on the weather), but always before eating.

Choose a quiet, non-tiring activity: draw, read, play cards or do crossword puzzles. Active mental activity is beneficial for you. Try walking up and down the stairs, but don't do it frequently.

Travel with someone for a short distance in a car.

Second week at home

Lift and carry light objects (less than 5 kg) for short distances. Distribute the weight evenly on both hands.

Gradually return to sexual activity.

Do light housework such as dusting, setting the table, washing dishes, or helping with cooking while sitting.

Increase your walking to 600-700 meters.

Third week at home

Do household chores and yard work, but avoid strain and long periods of bending or working with your arms raised.

Start walking longer distances - up to 800-900 meters.

Accompany others on short shopping trips by car.

Fourth week at home

Gradually increase your walks to 1 km per day.

Lift items up to 7 kg. Load both hands equally.

If your doctor allows, start driving for short distances yourself.

Do daily activities such as sweeping, briefly vacuuming, washing the car, cooking.

Fifth - eighth week at home

At the end of the sixth week, the sternum should have healed. Continue to continually increase your activity. Your doctor will order a stress test approximately six to eight weeks after surgery. This test will establish adaptation to stress and will serve as a basis for determining the extent of the increase in activity. If there are no contraindications and your doctor agrees, you can:

Continue to increase your walking distance and speed.

Lift things up to 10 kg. Load both hands equally.

Play tennis, swim. Tackle the lawn, weed, and shovel in the garden.

Move furniture (light objects), drive a car over longer distances.

Return to work (part-time) if it does not involve heavy physical labor.

At the end of the second month, you will probably be able to do everything you did before the operation.

If you were working before surgery but have not returned yet, now is the time to do so. Of course, it all depends on your physical condition and type of work. If the work is sedentary, you can return to it faster than heavy physical work. A second stress test may be performed three months after surgery.

Sex after surgery

Patients often wonder how the surgery will affect sexual relations and are reassured to learn that most people gradually return to their previous sexual activity. It is recommended to start small - hugs, kisses, touches. Transition to a full-fledged sex life only when you stop being afraid of physical discomfort.

Sexual intercourse is possible 2-3 weeks after surgery, when you are able to walk 300 meters at an average speed or climb one floor of stairs without chest pain, shortness of breath or weakness. The heart rate and energy expenditure during these activities are comparable to the energy expenditure during sexual intercourse. Certain positions (such as on your side) may be more comfortable at first (until the wounds and sternum are completely healed). It is important to rest well and be in a comfortable position. For sexual activity, it is recommended to avoid the following situations:

Being overly tired or excited;

Have sex after drinking more than 50-100 grams of strong alcoholic drink;

Overload with food during the last 2 hours before the act;

Stop if chest pain occurs. Some shortness of breath is normal during sexual intercourse.

Taking medications

Many patients after surgery need drug treatment. Take medications only as prescribed by your doctor and never stop taking them without consulting your doctor. If you forget to take a pill today, don't take two at once tomorrow. It is worth keeping a medication schedule and marking each dose on it. You should know the following about each of the prescribed medications: name of the drug, purpose of action, dose, when and how to take it, possible side effects.
Keep each medicine in its container and out of the reach of children. Do not share medications with other people because they may be harmful to them. It is recommended that you carry a list of your medications with you in your wallet at all times. This will come in handy if you go to a new doctor, get injured in an accident, or pass out outside your home.

Medicines to prevent blood clots (blood clots)

Antiplatelet agents

These bad cholesterol-lowering pills can reduce triglycerides and increase good cholesterol. Should be taken after dinner.

Eat fruits and vegetables more often. Try to always have them at hand (in the car, at your desk).

Eat lettuce, tomatoes, cucumbers and other vegetables with every meal.

Try adding one new vegetable or fruit each week.

For breakfast, eat porridge with bran (for example, oatmeal) or dry breakfast (muesli, cereal).

At least twice a week, eat sea fish for lunch.

Use vegetable oil, preferably olive.

Instead of ice cream, eat frozen kefir yogurt or juice.

For salads, use diet dressings and diet mayonnaise.

Instead of salt, use garlic, herbal or vegetable spices.

Watch your weight. If yours is high, try to reduce it, but no more than 500-700 grams per week.

More movement!

Monitor your cholesterol levels.

Only positive emotions!