Thesis on "Technical Instructions for Coronary Artery Bypass Graph"

Thesis 5 pages (1986 words) Sources: 2 Style: APA

[EXCERPT] . . . .

Technical Instructions for Coronary Artery Bypass Graph Surgery

Key Points and Definitions

Because more and more people are living longer, there has been a corresponding increase in age-related heart conditions as well as those that result from the cumulative effects of various environmental factors over the long-term. Besides older people, many others of all age groups are experiencing heart-related problems based on an increasingly sedentary lifestyle that has contributed to the prevalence of obesity in the United States to the point where many authorities are describing the problem in terms of it being an epidemic. For these and other reasons, the number of people who are needing coronary artery bypass graph (CABG) surgery has also increased in recent years so it is important to provide this growing group of patients with the timely information they need to understand what the procedure involves and what they should expect before, during and following the surgery.

While statistics differ somewhat across the country, coronary heart disease remains a profound physical illness as well as one of the primary causes of death across the board in Western society today; as a result, many people are considering a CABG, which the patient should recognize is "a major surgical treatment" (Ben-Zur, Rappaport, Ammar & Uretzky, 2000, p. 201). The procedure is becoming increasingly commonplace, with just over a third of a million CABGs being performed in the United States each year; moreover, healthcare practitioners continue to improve their methods and success rates (Ben-Zur, 2000). While any surgical procedure, especially those involving general anesthesia, carry certain risks, the research to date suggests that the CABG is worth the risk for most people: "This operation prolongs the life of patients in cases of triple-vessel disease. It also improves patients' quality of life thus providing them with the opportunity for successful rehabilitation" (Ben-Zur et al., 2000, p. 201). The chances of patients enjoyed positive clinical outcomes can be improved when they understand what is involved and what they can expect over the course of the procedure. What many patients may not realize, though, is just how much and for how long general anesthesia can affect them, even under the best of circumstances and these issues are discussed further below.

Surgical Outcomes of the CABG Procedure

The growing body of evidence concerning the surgical outcomes of a CABG has largely been based on various preoperative, perioperative, and immediate postoperative factors of patients undergoing this procedure; however, until recently, there were few efforts to understand the quality of life of these patients postoperatively with regard to their perception of the procedure and unique personal characteristics. The limited number of studies that have explored this aspect of the CABG patient rehabilitation process have resulted in mixed findings, but they have also identified new themes and continuum of care issues that should be taken into account by CABG patients as well as their healthcare providers following the procedure that can help promote successful clinical outcomes over the long-term (Kos-Munson et al., 1988). What is known today is that the better informed people are concerning what is involved in a given surgical procedure and how they will react to it following its completion, the better they will be able to cope with any resulting regrets or grief, as well as the physical pain that will be involved.

For example, more recently, Ben-Zur et al. found that during the first few weeks immediately following CABG surgery, some people experienced elevated levels of high anxiety or depression; over longer periods of time (e.g., about one year after the surgery), most patients have managed to recover in terms of their moods as well as experiencing improvements in the overall quality of life (Ben-Zur et al., 2000). Although everyone's case is unique, Ben-Zur et al. add that different outcomes typically relate to a number of factors, including the severity of the patient's condition as well as individual personality and coping characteristics, with those possessing better resiliency skills recovering faster psychosocially and more completely physically than those without these skills (Ben-Zur et al., 2000).

Based on the results of this and comparable studies, the purpose of a study by Peterson, Charleson, Williams-Russo and Krieger (2002) was to examine the incidence of depression among patients who were not depressed prior to their CABG procedures, as well as the long-term outcomes and expectations of patients who did and did not experience increased symptoms of depression following their CABG surgery. Based on their analysis of the CABG patients for the 6-month period after their surgery as well as a follow-up review at 36 months, Peterson et al. found that CABG patients who experienced increased depression at the 6-month point following their surgery were more likely to experience new cardiac morbidity / mortality between 6 and 36 months after the CABG procedure (Peterson et al., 2002). Based on their findings, Peterson and his associates concluded that among patients who have undergone CABG, the patients with greater comorbid burden together with elevated depressive symptoms represent the highest risk group for subsequent morbidity and mortality.

How the CABG Works

Although more expansive and exhaustive presentations are readily available everywhere online, some useful guidance is provided by the U.S. Department of Health and Human Services (DHHS) which reports that, "Coronary artery bypass grafting (CABG) is a type of surgery that improves blood flow to the heart. It's used for people who have severe coronary heart disease (CHD), also called coronary artery disease" (What is coronary artery bypass grafting, 2010, para. 1). Coronary heart disease results when there is an accumulation of plaque within the coronary arteries and some way of circumventing these clogged routes must be found, which is where the term "bypass" originates in the CABG. According to the DHHS, "During CABG, a healthy artery or vein from the body is connected, or grafted, to the blocked coronary artery. The grafted artery or vein bypasses (that is, goes around) the blocked portion of the coronary artery. This creates a new passage, and oxygen-rich blood is routed around the blockage to the heart muscle" (What is coronary artery bypass grafting, 2010, para. 2).

A typical CABG procedure is illustrated in Figure 1 below, with the requisite vein usually being harvested from the patient's chest or leg.

Figure 1. Typical sites for CABG bypass graphs

Source: http://intensivecare.hsnet.nsw.gov.au/five/images/coronary_artery_bypass.jpg

As can clearly be seen in Figure 1 above, the CABG will likely be regarded as a highly invasive procedure from the perspective of the patient and it is important for the healthcare team to provide CABG patients with the information they need to understand what is involved and with the opportunity to have their questions fully answered. Moreover, because the CABG procedure does not address the other healthcare issues that may have contributed to the need for the CABG procedure in the first place, it will be important to provide CABG patients with the long-term follow-up care they will need to help them resume their normal lives as much as possible as quickly as possible while treating the behavioral, dietary and other lifestyle factors such as smoking, drinking and substance abuse that may be comorbid with the CABG patient's overall healthcare status. In this regard, some useful guidelines for CABG patients concerning what takes place and what they can expect before, during and after their procedure is provided at Appendix A.

Finally, the results of a recent study by researchers at the Stanford University School of Medicine published in the Annals of Internal Medicine ("CABG and PCI each have strengths, weaknesses," Ann Intern Med. 2007), patients who elected the CABG procedure were more likely to experience angina relief than those who received the percutaneous coronary intervention (PCI); in addition, CABG patients were also more likely to avoid having to undergo subsequent revascularization procedures compared to the PCI (CABG and PCI each have strengths, weaknesses, 2007). Nevertheless, the procedure is not without its risk and patients considering this alternative should ensure that they understand what is involved, what they should expect before, during and after the procedure. Indeed, ensuring that CABG patients manage their post-operative condition to avoid depressive episodes and harmful behaviors was shown to be an essential part of the rehabilitation process.

Summary

People who are considering a coronary artery bypass graft surgical procedure should recognize that it is major surgery which carries certain concomitant risks, including death. For the overwhelming majority of patients who survive the experience, though, their chances of regaining their psychosocial skills and an improved quality of life will be enhanced if they know what to expect and what is involved at the technical level so that there will be on surprises and the patient can become mentally prepared for what is to come so that what happens afterwards can be dealt with in an effective fashion. Because patients need between 6 months and a full year -- or more -- to completely recover from a CABG, they must recognize that the recovery and rehabilitation process takes time and to avoid becoming frustrated and… READ MORE

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