Today, as we all know, a heart attack occurs as a result of the blockage of the coronary vessels that nourish the heart. With coronary angiography, the coronary artery with 70% or more stenosis is detected and the intervention is planned. This intervention is in the form of stent placement or coronary bypass surgery. Generally, if there are extensive lesions in more than one coronary artery, surgery is recommended.
The coronary artery anatomy consists of three main arteries originating from the left and right exit and divided into two on the left and their side branches. Atherosclerotic (cholesterol plaques) lesions can sometimes completely occlude the coronary artery, as a result, if this develops over many years, collateral (side branches) form from other branches to the area it feeds and may not show symptoms or have mild chest pain. It is detected incidentally on coronary angiography. Therefore, myocardial infarction (heart attack) may not always occur. Whether there is a crisis or not, intervention is required for the lesion in the stenosis in the artery.
Diabetes, hypercholesterolemia, smoking, obesity (obesity), sedentary life (inactivity) and genetic structure increase the risk of coronary artery disease. The fact that these patients have coronary angiography control prevents the risk of heart attack. In other words, detecting the heart nutrition without impairment (myocardial infarction) reduces the risk of the surgery and provides more benefit from the surgery.
Antiaggregant (blood thinners) treatment is discontinued in the preparation of patients for surgery, but if there is a risk of heart attack, that is, if the lesion in the occluded artery is critical, the treatment with subcutaneous blood thinners is continued. The carotid ultrasound is taken and breathing exercises are started. Currently, coronary bypass operations can be performed in the minimally invasive and / or working heart, depending on the number, location and diameter of the vessels with stenosis or occlusion.
Minimally invasive (small incision with little damage) methods are preferred considering the physical structure of the patient, such as armpit, sub-breast, partial sternotomy (partial breastbone incision). The aim is to create a new vein graft that will provide blood flow from the main artery beyond the occlusion in the artery. The vein taken from the legs is usually used as the graft and it is very important that the vein is not damaged, pulled or stretched while it is being removed, because the tissue in the internal structure of the vein is very sensitive and if damaged, it can cause blockage in a short time. For this reason, endoscopic saphenous removal, which is the preferred reason for the patients not to have a large incision in the leg, may not be very accurate. Since this vein is just under the skin, there is no complication as a result of its closure and the scar tissue becomes vague in a short time. On the other hand, the intra-thoracic artery LIMA (left internal mammarian artery) is preferred especially for the anterior facial coronary arteries (LAD, Diagonal arteries) of the heart. The patent retention rate is high as a result of good anastomosis, but it is not correct to think that the leg vein made is also blocked because its diameter and flow are not very good.
Early mobilization (standing up and movement) and early return to daily life are of great importance after coronary bypass surgeries. For this reason, the patient, who is discharged after 5-6 days of hospitalization, should not interfere with daily exercises such as walking, but should not overdo it when tired. You should avoid foods rich in cholesterol and should not smoke. Diabetic patients should follow blood sugar control well and ensure its stabilization. It is important that they do not interfere with their annual and monthly controls. Let’s not forget that early diagnosis is more important than all.