Coronary Artery Bypass Surgery: Importance and Risk Reduction in Diabetic Patients

Author: Care Online

Image: shutterstock

“A male diabetic patient in his 50s had undergone multiple heart catheter stent treatments due to severe coronary artery stenosis, but the coronary arteries were blocked several times and he developed heart failure, so he finally decided to undergo coronary artery bypass surgery.” Shaowei, Director of the Department of Cardiovascular Surgery at Chang Gung Memorial Hospital pointed out, “The principle of coronary artery bypass surgery is to use the patient’s own blood vessels to to overcome the narrowed condition and to help the myocardium to obtain sufficient blood circulation”.

Since the patient has diabetes, the risk of postoperative wound complications (including infection) is higher, so a postoperative negative pressure wound care system is used to reduce the risk. Professor Chen Shaowei said that the postoperative negative pressure wound care system can eliminate wound fluid accumulation, reduce the risk of infection, and help wound healing. Under the care of the cardiac surgery team, the patient was in stable condition and was successfully discharged seven days after the surgery.

Today, cardiac catheterization procedures have become very advanced, but coronary artery bypass surgery still plays a very important role in the treatment of coronary heart disease. Compared to patients treated with stents covered by a cardiac catheter, patients can with diabetes and multiple coronary artery obstruction who underwent coronary artery bypass surgery effectively reduced the risk of death and significantly reduced the risk of myocardial infarction after five years of follow-up . it is recommended to prioritize coronary artery bypass surgery[1].

Coronary arteries are blood vessels that supply oxygen and nutrients to the heart muscle. When the coronary arteries are narrowed or blocked, coronary heart disease (coronary heart 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 occurs if the coronary arteries are blocked completely. -sudden and the coronary blood flow is interrupted, the myocardium suffers from hypoxia and necrosis, called myocardial infarction It is very important and the patient can die suddenly.

Coronary heart disease can be caused by several reasons: diabetes, high blood pressure, hyperlipidemia, smoking, excess weight, family history, etc. Professor Chen Shaowei said that during an angina pectoris attack, symptoms include dizziness, chest tightness, chest pain, pressure, shortness of breath, etc.

For acute myocardial infarction and when the patient’s condition is very poor, it is recommended to perform an emergency heart catheterization intervention. Dr. Chen Shaowei said that since cardiac catheterization can open blood vessels faster and is less invasive, it has a chance to save hypoxic myocardium.

For patients with stable angina pectoris, that is, patients with insufficient coronary blood flow during physical activity or emotional excitement, coronary artery bypass surgery can achieve better long-term vascular tolerance and reduce adverse events. cardiovascular in patients with severe coronary artery stenosis risk of death.

Professor Chen Shaowei said that if the three coronary arteries are blocked or the left main coronary artery is stenotic, coronary artery bypass surgery will be recommended. Including former US President Clinton and Japan’s Emperor Akihito, they all underwent coronary artery bypass surgery under the advice of the best medical teams.

The 2021 American/European Society of Cardiology Guidelines for Coronary Artery Revascularization specifically recommend that the following groups should prioritize coronary artery bypass surgery over cardiac catheter stent surgery, giving a- include: Diabetic patients with multivessel obstruction, multiple or main left coronary artery obstruction (SYNTAX score greater than 33 points), left ventricular dysfunction (systolic fraction less than 50%), multiple blood vessels together to multivessel stenosis, unsuitable for antiplatelet drugs, or patients inaccessible with the new drug-covered stent.

Injury problems that should not be ignored

Coronary artery bypass surgery is a very mature heart surgery, and thoracotomy does not mean it is a back treatment. The expert medical team will pay special attention to reducing the risk of heart failure, stroke, bleeding and other complications. Professor Chen Shaowei said that coronary artery bypass surgery for patients with coronary artery disease is complicated Therefore, except for patients with relatively simple conditions and relevant injuries, small invasive and small wounds can be used at this time, most of them still require thoracotomy and multiple surgeries. Because patients with coronary heart disease often have diabetes, wounds heal more slowly and are prone to infection, putting them at higher risk of wound complications.

“If wound complications occur, it can progress to sepsis and even cause death. ” Professor Chen Shaowei said, “Especially if the sternum is infected, the mortality rate will be very high.”

To reduce injury complications, a multifaceted approach is required. Professor Chen Shaowei said that 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 care system postoperative wounds with negative pressure.

Wound complications are often related to the accumulation of fluid in the wound, because tissue fluid continues to leak after the wound is sutured, and the tissue fluid that collects in the wound can breed bacteria, gradually leading to to suppuration, cellulitis, and even bacteremia. Professor Chen Shaowei said that the postoperative negative pressure wound care system is to cover the wound with a special dressing after punching it, and then attach it to a small suction-capable host to apply pressure keep negative in the wound.

The postoperative negative pressure wound care system can effectively remove wound fluid, reduce the risk of infection, and help keep the skin dry and avoid skin infiltration near the wound. Professor Chen Shaowei said that maintaining negative pressure can also help bring the sutured wound closer, reduce side tension, increase blood flow near the wound, promote the growth of granulation tissue, and thus increasing the chance of wound healing. After the surgery is completed, the postoperative negative pressure wound care system can continuously protect the wound for 5 to 7 days, reducing the frequency of dressing changes and discomfort.

People with diabetes, obesity, old age, chronic kidney disease, and long-term steroid use are all at high risk for injury complications.

Organize notes into main points

If the coronary arteries are narrowed and the coronary blood flow cannot meet the needs of the myocardium, angina pectoris occurs if the coronary arteries are suddenly blocked and coronary blood flow is is broken, the myocardium becomes hypoxic and necrotic, so-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 surgery is recommended.

Compared with cardiac catheter-eluted stent treatment, patients with diabetes and multiple coronary artery obstruction who undergo coronary artery bypass surgery can effectively reduce their risk of death and to significantly reduce the risk of myocardial infarction after long-term follow-up is recommended for prioritization.

Because patients with coronary heart disease often have diabetes, wounds heal more slowly and are prone to infection, putting them at higher risk of wound complications. Therefore, keeping blood sugar under constant control and using a negative pressure wound care regimen can help reduce the risk of wound infections.

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(This article is reprinted with permission from “Care Online”, the original text is published here)

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