Coronary artery Bypass grafting ( CABG)- 2021

Coronary artery Bypass grafting ( CABG)- 2021
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Coronary artery Bypass grafting

It is a surgical revascularization procedure to restore the coronary blood flow through new grafts . It is a type of open heart surgery.

Coronary artery bypass grafting is the surgical procedure performed to improve the circulation to the heart muscle in patient with severe  coronary artery disease.

In this procedure a healthy  Artery or vein from another part of body is connected or graft to the blocked coronary artery.

The grafted artery or vein bypass the blocked portion of the coronary artery carrying oxygenated blood to the heart muscle.

One or more coronary Artery can be by passed during a single opertion.

Mainly used grafts are internal thoracic artery or sephanous vein.

 

Aim of CABG

 Restore the blood flow to the heart.

Releave chest pain and ischemia

Lower the risk of heart attack

Improve the life Quality of patient

 

Indication

Ischemic heart disease (IHD)

Stable angina pectoris with S -T segment displacement of more than 2 mm during stage I and stage II of treadmill stress test.

Unstable angina with episodes at test

Atherosclerosis of coronary arteries

Coronary thrombosis or embolism

Myocardial infarction

Congestive cardiac failure

The patient with stenosis of left coronary artery.

Patient with failure of conservative or medical treatment.

 

Incision

Median sternotomy or sternal splint.

 

Before the surgery

IV line is started

Oral or IV sedative are given

General anesthesia

Endotracheal tube is inserted.

Urinary cather is placed

 

Procedure

An incision us made over the sternum and a chest is opened via median sternotomy.

After reaching to the heart

Heart lung machine is connected to the circulatory system throught the procedure.

Heart lung machine temporarily perform the function of heart and lung during the surgery.

It allow the heart to be stopped.

For the sephanous vein graft.

One end is connected to the aorta and other end to the narrowed coronary artery just beyond the blockage.

For internal thoracic Artery graft

One end -subclavian

Other end -As  for sephanous

Once the graft is placed the surgeon will use on electrical signals to restore the heart beat.

Once the heart start beating normally the heart lung machine will be disconnected.

Chest tube are placed in the mediastinum to drain the blood around heart and lungs.

The sternum is wired together & the incision is sutured.

 

Recently developed types of CABG surgery

-Off pump by pass surgery

-Minimally invasive by pass surgery off pump by pass surgery is also called as beating heart by pass grafting.

-Heart machine is not used.

 

After surgery

Patient is transferred into ICU

Heart monitor

Pacing wire to control heart rate temporarily

Chest tube drainage will remain placed to drain the blood.

Breathing tube will be removed once the patient can breath by its own.

 

Contra-indication for CABG

Aneurysms

Valvular disease

Congenital disease

Disease of blood

 

Vessel used for grafts

Saphenous vein

Radial artery

Internal mammary artery

 

Post opertaive physiotherapy management

No physiotheraphy is given on the day of surgery.

 

1. Day I (Treatment In ICU) (1st session)

– Analgesic are given before physiotherapy management.

– Review of case sheet and vital signs drainage tubes.

– The patient should be medically stable

– Treatment session  is for 20-30 min

– Comfortable positioning like half lying with small pad or pillow under the knee.

– In case of CABG the affected leg is supported on the pillows.

– Passive or active ankle/ toe movement,  movement should not be vigorous

– Diaphragmatic breathing exercises.

 

i. Patient is not not ventilator

– Ask the patient to take slow deep inspiration through nose and expiration through mouth and do not use accessory muscles.

– Bilateral shoulder movements active or passively shoulder abduction upto 60-70

– Removal of lung  secretions by manual percission or vibration maneuver to looser the secretions.

– Coughing or huffing technique with incisional support to remove airway secretions.

– If patient is on ventilator suctioning is done.

 

2. Day one (second session)

– Continue  quadriturn position with pillows support.

– Keep knee in mild flexion to relieve strain from abdomen.

– Deep breathing exercise both unilaterally and Bilaterally are done with inspiration hold for a few seconds.

– Removal of secretion by percussion or vibration manual maneuvers.

– IPPB is given if necessary.

 

3. Day II.

– Analgesic are administered and check for vital signs auscultation of lungs.

– Continue with 1st day of treatment with gradual increase in shoulder movement.

– Teach the patient to get up and sit from half lying position using a rope ladder support.

– Ventilatory support and drainage tubes are removed.

– Changing of position from side lying, sitting

– Bed mobility exercises.

 

4. Day III

– If the patients is medically stable he js shifted from ICU  to surgical unit.

– Continue with exercise program for 1st two days.

– Postural correction in sitting and standing using a mirror

– Deep breathing exercises.

– Incentive spirometry training to improve the inspiratory capacity.

– Shoulder girdle and bracing exercises.

– Gentle trunk mobility exercise like flexion, side flexion,  rotation exercises.

– Shoulder drill exercise

– Walking  can be gradually increased with arms swinging.

– Ask the patient to clasp the hand behind the back to prevent the shoulder protraction and maintain retraction of shoulder girdle.

– If venous graft is used from legs then apply crepe bandage with elastic stockings.

– Butterfly exercise can be done.

 

5 days IV

– Deep breathing  exercises with breath control for few seconds.

– Pursed lip breathing

– Active cycle  of  breathing techniques (ACBT)

– Gradual increase in walking

 

6. Day V

– Most of the exercises are continued except for ankle toe movements.

– Staircase climbing corridor walking

– Advise the patient home exercise program before discharge.

– Continue with exercise and posture

– Gradual increase in walking upto 1-2 miles /day

– Avoid driving for at least 6 weeks

– Avoid sexual relation for 4 weeks.

– Avoid long distance travelling or lifting heavy weights.


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