CABG may be performed in select individuals with ST-segment elevation myocardial infarction (STEMI). Possible surgical candidates include patients with diabetes and cardiovascular disease involving three different coronary arteries. The procedure requires emergent reperfusion therapy.
Although not a cure, CABG is considered palliative treatment for patients with cardiovascular disease (CAD). The surgery improves patient outcomes based on quality and quantity of life. However, older patients have an increased risk of postoperative complications and mortality.
Patients experiencing uncontrolled angina not responsive to medical therapy may be candidates for CABG. The procedure decreases pain by allowing oxygen to adequately perfuse the heart through revascularization of the coronary arteries.
The internal mammary artery is the preferred artery for CABG. The artery is left attached to the subclavian artery and dissected from the chest wall. The artery is then connected with sutures to the coronary artery distal to the blockage. The patency rate of using internal mammary artery grafts after 10 years is greater than 90%.
The saphenous leg vein may also be used during CABG. Sections of the saphenous vein are attached to the ascending aorta and the coronary artery distal to the blockage. However, this vein is more likely to develop intimal hyperplasia and lead to future stenosis and graft occlusions. The patency rate of using saphenous vein grafts after 10 years is between 50-60%
Transient limb edema may occur 4-6 weeks after CABG procedures involving the saphenous vein. Ankle swelling in the operative leg is common and may be minimized by wearing elastic support stockings and elevating legs while sitting.
The postoperative CABG patient should be closely monitored for any complications. This includes monitoring for signs of bleeding by assessing the patient's chest tube drainage and incision sites. Hemodynamic values and fluid status should be assessed in patients bleeding postoperatively after CABG surgery.
Venous thromboembolism prophylaxis should be initiated in patients after CABG surgery. Prophylactic measures include encouraging early ambulation and use of sequential compression devices.
Encourage the patient to use an incentive spirometer while recovering from CABG surgery. An incentive spirometer helps prevent postoperative respiratory complications by keeping the airway open and preventing fluid or mucus from building up in the lungs. Coughing and deep breathing exercises will also help prevent respiratory complications. To minimize pain, instruct the patient to splint the incision.
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