The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation COURAGE trial showed that adding angioplasty to state-of-the-art medical therapy was no better than medical therapy alone at preventing future heart attacks and extending life. The other big thing to think about is how you'll manage taking clopidogrel Plavix and aspirin every day for at least a year after getting a drug-eluting stent.
These drugs are essential for preventing the sudden, and often deadly, formation of a clot on the stent. But they can be hard on the stomach or cause gastrointestinal bleeding, especially for people who also need to take a nonsteroidal anti-inflammatory drug like ibuprofen for joint pain. Moreover, some doctors don't want their patients to stop taking this combination long enough to have a hip or heart valve replaced, a gallbladder removed, or other surgery.
Before agreeing to have angioplasty with a drug-eluting stent, make sure your doctor has a strategy for protecting the stent if you end up needing surgery down the road.
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In most cases, a small metal coil called a stent is placed in the clogged artery to help keep the artery open and reduce the risk of it narrowing again. Angioplasty may be done during your cardiac catheterization if your doctor thinks it's the best treatment option for you. If your arteries are narrowed or blocked in several areas, or if you have a blockage in one of the larger main arteries, coronary bypass surgery may be necessary.
During bypass surgery, a section of healthy blood vessel — often taken from inside the chest wall or the lower leg — is attached above and below the blocked artery. This lets blood flow around the blocked area to the heart muscle. There is a problem with information submitted for this request. Sign up for free, and stay up-to-date on research advancements, health tips and current health topics, like COVID, plus expert advice on managing your health.
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Tell your doctor about all medicines prescription and over-the-counter , vitamins, herbs, and supplements that you are taking. Tell your doctor if you have a history of bleeding disorders or if you are taking any blood-thinning medicines, aspirin, or other medicines that affect blood clotting.
You may be told to stop some of these medicines before the procedure. Your doctor may do blood tests before the procedure to find out how long it takes your blood to clot. If you smoke, quit smoking as soon as possible. This will improve your chances for a successful recovery from surgery and benefit your overall health. Coronary artery bypass graft surgery CABG requires a stay in a hospital.
Procedure may vary depending on your condition and your doctor's practices. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
Once you are sedated put into a deep sleep , a breathing tube will be put into your throat and you will be connected to a ventilator, which will breathe for you during the surgery. A healthcare professional will insert an intravenous IV line in your arm or hand. Other catheters will be put in your neck and wrist to monitor your heart and blood pressure, as well as to take blood samples.
Once all the tubes and monitors are in place, your doctor will make incisions cuts in one or both of your legs or one of your wrists to access the blood vessel s to be used for the grafts. He or she will remove the vessel s and close those incision s.
The doctor will cut the sternum breastbone in half lengthwise. He or she will separate the halves of the breastbone and spread them apart to expose your heart.
To sew the grafts onto the very small coronary arteries, your doctor will need to stop your heart temporarily. Tubes will be put into the heart so that your blood can be pumped through your body by a heart-lung bypass machine. Once the blood has been diverted into the bypass machine for pumping, your doctor will stop the heart by injecting it with a cold solution.
When the heart has been stopped, the doctor will do the bypass graft procedure by sewing one end of a section of vein over a tiny opening made in the aorta, and the other end over a tiny opening made in the coronary artery just below the blockage.
If your doctor uses the internal mammary artery inside your chest as a bypass graft, the lower end of the artery will be cut from inside the chest and sewn over an opening made in the coronary artery below the blockage. You may need more than one bypass graft done, depending on how many blockages you have and where they are located.
After all the grafts have been completed, the doctor will closely check them as blood runs through them to make sure they are working. Once the bypass grafts have been checked, the doctor will let the blood circulating through the bypass machine back into your heart and he or she will remove the tubes to the machine. Your heart may restart on its own, or a mild electric shock may be used to restart it. Your doctor may put temporary wires for pacing into your heart.
These wires can be attached to a pacemaker and your heart can be paced, if needed, during the initial recovery period.
Once your doctor has opened the chest, he or she will stabilize the area around the artery to be bypassed with a special instrument. The heart-lung bypass machine and the person who runs it may be kept on stand-by just in case the procedure need to be completed on bypass.
The doctor will do the bypass graft procedure by sewing one end of a section of vein over a tiny opening made in the aorta, and the other end over a tiny opening made in the coronary artery just below the blockage.
You may have more than one bypass graft done, depending on how many blockages you have and where they are located. Before the chest is closed, the doctor will closely examine the grafts to make sure they are working. Your doctor will sew the sternum together with small wires like those sometimes used to repair a broken bone.
He or she will insert tubes into your chest to drain blood and other fluids from around the heart. Your doctor will put a tube through your mouth or nose into your stomach to drain stomach fluids. After the surgery, you will be taken to the intensive care unit ICU to be closely monitored. Machines will constantly display your electrocardiogram ECG tracing, blood pressure, other pressure readings, breathing rate, and your oxygen level.
Coronary artery bypass surgery CABG requires an in-hospital stay of at least several days. You will most likely have a tube in your throat to help with breathing through a ventilator breathing machine until you are stable enough to breathe on your own. As you continue to wake up from the anesthesia and start to breathe on your own, your doctor can adjust the breathing machine to allow you to take over more of the breathing.
When you are awake enough to breathe completely on your own and you are able to cough, your doctor will remove the breathing tube. After the breathing tube is out, a nurse will help you cough and take deep breaths every couple of hours.
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