2024-04-28 03:18:19
Author: Online Care
Image: Shutterstock
“A diabetic patient in his 50s had undergone several cardiac catheter stent treatments due to severe coronary stenosis, but the coronary arteries were repeatedly blocked and he developed heart failure, so he finally decided to undergo coronary artery bypass grafting, Professor Linkou Chen.” Shaowei, director of the Department of Cardiovascular Surgery at Chang Gung Memorial Hospital, pointed out: “The principle of coronary artery bypass grafting is to use the patient’s own blood vessels to bypass the narrowed position and help the myocardium obtain circulation. sufficient blood. »
Since the patient is diabetic, the risk of postoperative wound complications (including infection) is higher, therefore a negative pressure postoperative wound care system is used to reduce the risk. Professor Chen Shaowei said that the postoperative negative pressure wound care system can eliminate fluid accumulation in the wound, reduce the risk of infection and promote wound healing. Under the care of the cardiac surgery team, the patient was in stable condition and was successfully discharged seven days after surgery.
Today, cardiac catheterization procedures have become quite advanced, but coronary artery bypass grafting still plays a very important role in the treatment of coronary heart disease. Compared with patients treated with stents covered with a cardiac catheter, patients with diabetes and multiple coronary artery obstructions who have undergone coronary artery bypass grafting can effectively reduce the risk of death and significantly reduce the risk of myocardial infarction after five years of follow-up. it is recommended to favor coronary artery bypass grafting[1]。
Coronary arteries are blood vessels that supply oxygen and nutrients to the heart muscle. When the coronary arteries are narrowed or blocked, coronary artery disease (coronary artery disease) occurs. Professor Chen Shaowei explained that if the coronary arteries are narrowed and the coronary blood flow cannot meet the needs of the myocardium, angina will occur; If the coronary arteries are suddenly blocked and coronary blood flow is interrupted, the myocardium will suffer from hypoxia and necrosis, called myocardial infarction. It is very critical and the patient can die suddenly.
Coronary heart disease can be caused by many reasons. Risk factors include: diabetes, high blood pressure, hyperlipidemia, smoking, being overweight, family history, etc. Professor Chen Shaowei said that during an attack of angina, the symptoms include dizziness, chest tightness, chest pain, pressure, shortness of breath, etc. The pain may extend to the jaw, shoulders, etc.
In cases of acute myocardial infarction and when the patient’s condition is very poor, it is recommended to carry out an emergency cardiac catheterization procedure. Dr. Chen Shaowei said that because cardiac catheterization can open blood vessels more quickly and is less invasive, it has the possibility of saving hypoxic myocardium.
For patients with stable angina, that is, patients with insufficient coronary blood flow during physical activity or emotional excitement, coronary artery bypass grafting can achieve better long-term vascular patency and reduce adverse cardiovascular events in patients with severe coronary stenosis. the risk of death.
Professor Chen Shaowei said that if all three coronary arteries are blocked or the left main coronary artery is stenotic, coronary artery bypass grafting will be recommended. Among them, former US President Clinton and Japanese Emperor Akihito, all underwent coronary artery bypass grafting under the guidance of top medical teams.
The 2021 American/European Heart Association Guidelines for Coronary Artery Revascularization specifically recommend that the following groups prioritize coronary artery bypass grafting surgery over cardiac catheter stenting surgery, including: : Diabetic patients with multiple vessel obstructions, complex main or left main coronary artery obstruction (SYNTAX score greater than 33 points), left ventricular dysfunction (systolic fraction less than 50%), multiple blood vessels associated with multivessel stenosis, unsuitable to antiplatelet drugs or patients unaffordable with the new drug-coated stent.
Wound complications not to be ignored
Coronary artery bypass grafting is a very mature cardiac surgery, and thoracotomy does not mean it is retrograde treatment. It provides the best results for patients suffering from complex and serious illnesses. The experienced medical team will pay special attention to minimizing the risk of heart failure, stroke, bleeding and other complications. Professor Chen Shaowei said that coronary artery bypass grafting is for patients with complex coronary artery disease. Therefore, except for patients with relatively simple conditions and suitable lesions, minimally invasive and small wounds can be used. several surgical procedures. Blood vessels are removed from the wound, so postoperative wound care is very important. Because patients with coronary heart disease often have diabetes, the wounds heal more slowly and are prone to infections, putting them at higher risk for complications.
“If complications occur, they may progress to sepsis and even lead to death,” said Professor Chen Shaowei, “especially if the sternum is infected, the mortality rate will be relatively high.”
To reduce wound complications, a multi-pronged approach is necessary. Professor Chen Shaowei said the risk of wound complications can be reduced by stabilizing blood sugar control, using prophylactic antibiotics, cleaning the surgical site before surgery, and using a wound care system through postoperative negative pressure.
The occurrence of wound complications is often related to the accumulation of fluid in the wound, because tissue fluid continues to flow after the wound is sutured, and tissue fluid accumulated in the wound can breed bacteria, leading gradually to suppuration, cellulitis and even bacteremia. Professor Chen Shaowei said that the postoperative negative pressure wound care system involves covering the wound with a special dressing after suturing it, and then connecting it to a small host capable of suction to maintain negative pressure in the wound.
The postoperative negative pressure wound care system can effectively remove fluid from the wound, reduce the risk of infection, help keep the skin dry, and prevent skin infiltration near the wound. Professor Chen Shaowei said that maintaining negative pressure can also help bring the sutured wound together, reduce lateral tension, increase blood flow near the wound, stimulate the growth of granulation tissue, thereby increasing the chances of the wound healing. After adhesion is completed, the postoperative negative pressure wound care system can continuously protect the wound for 5-7 days, reducing the frequency of dressing changes and discomfort.
People with diabetes, overweight, older adults, chronic kidney disease, and long-term steroid use are all at high risk for wound complications. Before having surgery, you can discuss with your doctor how to take preventative measures to reduce the risk of wound infection. .
Organize notes into key points
If the coronary arteries are narrowed and coronary blood flow cannot meet the needs of the myocardium, angina will occur; If the coronary arteries are suddenly blocked and coronary blood flow is interrupted, the myocardium will become hypoxic and necrotic, which is called myocardial infarction, and the patient may die suddenly.
If all three coronary arteries or the left main coronary artery are severely narrowed, coronary artery bypass grafting is recommended.
Compared with cardiac catheter-covered stent treatment, patients with diabetes and multiple coronary artery obstructions who undergo coronary artery bypass grafting can effectively reduce the risk of death and significantly reduce the risk of heart attack of the myocardium after long-term follow-up. It is recommended to give priority to coronary artery bypass grafting.
Because patients with coronary heart disease often have diabetes, the wounds heal more slowly and are prone to infections, putting them at higher risk for complications. Therefore, keeping blood sugar levels under stable control and using a negative pressure wound care system can help reduce the risk of wound infection.
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(This article is reproduced with permission from “Care Online”, the original text is published here)
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