Coronary Artery Disease
Coronary artery disease is a disease that develops due to partial narrowing or complete blockage of the arteries called “coronary arteries” that carry oxygen and nutrients to the heart due to various factors. The narrowing that occurs in the coronary arteries negatively affects the functioning of the heart muscle. In the event of complete blockage, the heart muscle cells begin to die rapidly. In this case, if early intervention is not made, irreversible and severe damage occurs in the heart that leads to the patient’s death. Coronary artery disease is the number 1 cause of death in our country and in the world.
What Causes Coronary Artery Disease?
The factors that cause this disease are well known today. Smoking, diabetes, excess weight, stress and atherosclerosis, which occurs due to genetic effects, are the main causes of the disease. Unfortunately, genetic effects cannot be changed, while all other risk factors can be prevented. Although genetic factors also play a role in the development of diabetes, conscious blood sugar control can prevent the development of coronary artery disease.
What are the symptoms of the disease?
The first symptom of coronary artery disease is usually chest pain. This pain initially occurs due to exertion (walking, running, climbing stairs and hills), but in the later stages of the disease it also begins to occur at rest. In the event of complete blockage of the coronary artery, a life-threatening clinical picture called heart attack (myocardial infarction) occurs. As a result of a heart attack, a certain part of the heart muscle dies. The patient may have to live the rest of his life with complaints such as shortness of breath and weakness due to the heart’s reduced pumping power.
What Should a Person with Chest Pain Do?
If chest pain is particularly associated with exertion and the person has the risk factors mentioned above, they should consult a cardiologist without delay. Only in this way, it is possible to live a long and healthy life by protecting against a possible heart attack in the future. A patient whose coronary arteries are completely normal or have very little wall irregularities as a result of angiography should definitely stay away from smoking and smoking environments in the future, and if they are advised to use medication, they should strictly comply. Patients who are not as lucky as this group and whose arteries are severely narrowed are either placed with a balloon/stent by the cardiologist or are referred directly to a cardiovascular surgeon for coronary bypass surgery.
What is Coronary Bypass Surgery and How is it Performed?
Coronary artery bypass surgery (CABG) is based on the principle of restoring normal blood flow by bypassing the narrow or blocked area of the artery by stitching a vein taken from another part of the body. There are many types of bypass surgery. The most common method is the classic method, where the rib cage is completely opened in the middle with a saw and the patient’s heart is temporarily stopped. In order for vital functions to continue, the blood in the patient’s body is directed to a special device called a heart-lung machine. During this time, the heart remains motionless and bloodless. If you want to learn more about this subject, you can watch my video of coronary artery bypass surgery, which I recorded from beginning to end.
Beating heart coronary artery bypass surgery (OPCAB) is a bypass method performed by immobilizing the areas where only the vessels will be stitched with a suction cup device (stabilizer) without stopping the heart and while it continues to pump blood to the body. It is a more difficult surgery technically than the classical method. Beating heart bypass surgery is performed on a selected group of patients who need 1 or 2 vessel bypasses and for whom the classical method would be risky (for example, those with kidney failure).
Less invasive bypass methods (minimally invasive – MIDCAB) are methods where the chest is not fully opened, but small incisions are made between the ribs and bypasses are performed while the heart is beating. It requires advanced technical skills. It is applied in very carefully selected cases, such as patients in whom full opening of the chest may be risky due to lung disease.
Where in the body are the veins used for bypass taken from?
Coronary arteries, as we mentioned before, are arteries. Therefore, the vessels that will provide the best compatibility with these vessels are again arteries. The vessel that we prefer most and use in 99% of bypass patients is the intrathoracic mammary artery called LIMA. The bypass performed with this vessel has a very high patency rate. You can watch the video I recorded during a coronary bypass surgery that shows how LIMA is removed here. Another vessel used is the saphenous vein, which is taken from the inner parts of the legs and is used in varicose vein surgery. The fact that this vessel is a vein negatively affects its patency after the bypass. However, it is the most preferred vessel by us surgeons because it is easily accessible and can be easily removed to the desired length.
What Awaits You After Bypass Surgery?
Bypass surgery is an extremely easy surgery, with a mortality rate of less than 1% and no pain afterwards. Patients usually stay in intensive care for 1-2 days and in ward rooms for 3-5 days after the surgery, have a full body bath on the 4th day and are discharged home with their prescriptions arranged at the end of the first week. Patients who go home rest for about 1 week and then apply to our polyclinic for their first check-up. Here, the wound areas are checked and some tests are performed. At the end of this check-up, i.e. the 2nd week of the surgery, our patients return to their social lives that they have been on hold for. They can go out and walk around and have visitors. They do not drive for 6 weeks after the surgery in order not to damage the sternum and avoid any movements that may damage the sternum. An important issue I would like to mention here is the issue of lying on their backs. We absolutely do not enforce the 2-month obligation to lie on our backs that many of our physician colleagues apply and we never make our patients wear a chest corset. We can only recommend these applications to our patients whose bone structure is very thin and fragile.
Remember, after bypass, we do not eliminate your coronary artery disease. We only provide blood to your heart again and contribute to a better quality and longer life. For this reason, if you continue to smoke, eat poorly, be exposed to stress, do not control your blood sugar and do not use the medications given to you regularly, you may have to come to the hospital again with the same complaints and in a worse condition after a short time.
I wish you all a healthy, long and happy life with your loved ones…