Heart surgery have long known is a coronary artery bypass surgery with the surgical procedure performed to relieve symptoms of chest pain and reduce the risk of death caused deari a heart attack. Performed by moving the arteries or veins from elsewhere in the patient's heart to bypass (bypass) the blood vessels that have refinements to improve coronary blood vessels that supply oxygen to the heart muscles. This operation is usually performed on the heart is stopped while using the Cardiopulmonary machine called Off Pump. Heart disease in adults who require surgery in general is largely due to a process Atherosclerosis of coronary arteries, the arteries responsible for blood circulation of the heart muscles.
Atherosclerosis is a vascular disorder characterized by thickening, loss of elasticity and calcification in the walls of blood vessels that causes decreased blood flow to the heart muscles. Flow blockage of blood vessels is mainly caused by cholesterol build up.
Atherosclerosis blockage due process can be accelerated by the smoking habit, high blood pressure, increased cholesterol and diabetes (diabetes).
Someone will be higher risk for Atherosclerosis occurs when she was aged between 45 to 55 years, or found a family with a history of heart disease.
If the blockage has exceeded 50-70% of the blood vessel opening, the coronary blood flow becomes insufficient to supply the heart muscle with oxygen at the time of patient activity.
At the time the patient will experience symptoms of pain called angina, or chest. However, 25% of the patients sometimes do not feel the chest pain called Silent Angina (chest pain that is hidden). This is dangerous because the patient may experience a heart attack go unnoticed.
According to the AHA (American Heart Association) as many as 427,000 coronary heart surgery performed in the United States in 2004, making this operation a major operation most often committed. For the diagnosis of coronary heart disease may take several investigations such as electrocardiogram (ECG), Stress Test, Exercise Treadmill known, echocardiography, cardiac catheterization Scanning and CT Angiography.
Coronary Heart Disease Treatment
Beberapar treatment for coronary heart disease, including provision of drugs, intervention with catheterization procedures (Balloon & stents) and coronary bypass surgery. Techniques of operations by surgeons from Argentina, DR. Rene Favaloro at Cleveland Clinic (USA) in the late 1960s. When compared with the provision of drugs alone, the action catheterization or bypass surgery is more effective. Bypass surgery techniques but better than the catheterization in patients with blockage of blood vessels that much.
However, with the development of cardiovascular medicine technology by using more recent results were not under the operation.
ACC (American College of Cardiology) / AHA (American Heart Association) Guideline of 2004 provides guidelines for bypass surgery indications as follows:
- Coronary heart disease is the base of the left coronary artery.
- Coronary heart disease is about three kororner blood vessels (three vessels)
- Coronary disease are numerous and widespread (diffuse) are not suitable for treatment with catheterization.
ACC / AHA Guideline Bypass in 2005, adding that bypass surgery is the treatment chosen for patients with high risk such as patients with impaired ventricular function or with diabetes.
What the Heart Surgery?
Because the heart within the chest cavity the heart surgeon will cut the skin on the chest area and cutting the breastbone (median sternotomy). During the bypass surgery procedure is the patient's heartbeat stopped for a moment or operations performed in beating heart is still hanging with the patient's condition. During opearsi paused heartbeat and heart function as a blood pumping machine was taken over by the heart-lung bypass. This machine will replace the function of the heart and lung function during the surgical procedure.
For blood flow to the heart of the previously used konduit disrupted blood vessels that come from the Internal Mamary right and left artery, vein Saphena Magna, radial artery, or of the right artery Gastroepiploica.
Bypass operations include sewing konduit connect with coronary artery beyond the area experiencing ayng narrowing or large arteries of the aorta, except, Mamaria Internal Gastroepiploica Artery and arteries that the other end is already connected from the beginning. This surgical procedure lasted for more than 3 hours. However long the operation depends on how much that will be bypassed. That means that the number of bypass is performed depending of the number of existing blockage in coronary arteries.
After surgery, patients will be treated specially in the room of Cardiac Intensive Care Unit (CICU). If there is no problem, in general, long treatment in CICU is up to 2 days. One day later the patient will be transferred to the regular ward for treatment and rehabilitation of injuries.
Treatment After Coronary Heart Surgery
Wound healing will take 7-14 price, while the sternum will connect again after 6 weeks. Patients should avoid sudden movements like getting up from his seat or bed, raised her hand to avoid exceeding the limit of the head.
Vein taken from the leg will cause the blood flow through the legs back to the heart will cause the foot to be swollen: Patients disaranakan to use stocking socks to reduce swelling. The swelling will be reduced or hilan after 6-8 weeks. Patients can return light activity within one week after surgery, driving a vehicle after 4 weeks and patients can return to work after 6 weeks.
In addition patients are also advised to make lifestyle changes, such as getting used to:
Exercise regularly, avoid eating fatty foods, stop smoking, control blood pressure and blood sugar levels and control blood cholesterol levels.
Bypass Surgery Risk
Overall success rate of bypass surgery is 97%. This number depends on the patient's condition and disease before surgery. The success of the operation will greatly depend on several factors. Risks will increase when the elderly patients (aged 70 years and over), decreased heart function, blockage at the base of the left coronary artery, no diabetes, have chronic lung disease, and there is chronic kidney disease.
Possible Complications
Some complications may occur after heart bypass surgery such as post perfusion syndrome, neurocognitive disorders as related to a heart lung bypass machine. Sternum bone is not united, cardiac infarction due to embolization or lack of blood flow, graft obstruction, renal dysfunction, stroke, wound infection or germs in the body, a thrombus in the veins. Compilation can generally be overcome.
The length of Graft Open
Blood vessels used as bypass graft is called. Graft can be damaged and clogged in a matter of months or years after bypass surgery.
Graft is said to remain open as well if the blockage is still more than 70% diameter.
Patensi (open and functioning) of the graft depends on several factors, including type of graft used, the size of the coronary arteries and the skill of surgeon. Average patensi best obtained when using the internal bypass surgery Artery Mamary still attached to the subclavian artery. Blood vessels smallest average is patensinya radial artery and internal Mamary artery that is not attached to the subclavian artery. This is the same if the origin is Saphena Vena Magna
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