Advantages and disadvantages of the minimally invasive technique
With the minimally invasive technique, a distinction must first be made between two procedures: There is the Minimally Invasive Direct Coronary Artery Bypass (MIDCAB), in which the sternum does not have to be opened. In the Off Pump Coronary Artery Bypass (OPCAB), the sternum is opened. The advantages of both minimally invasive techniques are the significantly lower operative stress, which promises faster and better recovery after the operation.
A disadvantage is the higher technical demands on the surgeon. With the MIDCAP technique, another major advantage is that the sternum does not have to be cut through. This additionally reduces the stress caused by the operation.
The major disadvantage is that only the front of the heart can be reached with this surgical technique, which is why only some of the affected persons can be treated with this procedure. The OPCAB technique, on the other hand, allows access to both the front and the back of the heart, but is nevertheless not as stressful for the body as conventional surgery. However, the greatest danger with this technique is that it can impair the pumping capacity of the heart during the operation. In principle, both minimally invasive surgical techniques can be performed without the heart-lung machine.
How long does one stay in hospital after a bypass operation?
The stay in hospital for a bypass operation is normally about three weeks. Inpatient admission to the hospital usually takes place one day before the operation. Immediately after the operation, affected persons are monitored in detail in the intensive care unit for two to three days.
The monitoring of the heart rate and the heart rhythm is of particular importance. Provided that no problems occur in this early phase after the operation, further monitoring takes place in the normal cardiological ward. The stay there is usually about three weeks, but can be extended if necessary, for example in case of complications or complicated concomitant diseases.
In most cases, rehabilitation follows directly after the hospital stay. This rehabilitation takes place in a special clinic, usually lasts about 3 weeks, during which rehabilitation procedures take place five to six hours a day, five to six days a week. Due to the large amount of time required and the daily treatment, rehabilitation almost always takes place on an inpatient basis. In exceptional cases, however, affected persons can already stay at home overnight again, but they have to come to the rehabilitation clinic every day for their therapies.
Rehabilitation after bypass surgery
In most cases, rehabilitation is immediately followed by a stay in hospital after a bypass operation in the form of follow-up treatment (AHB). Due to the long and open operation, affected patients are exposed to a great deal of stress, which still needs to be treated in detail in the following period. As a rule, the heart disease and the operation are not only a great physical burden.
Also the psyche is mostly affected and is therefore also taken into account in a rehabilitation. Normally the rehabilitation is carried out over 3 weeks in an inpatient setting. However, outpatient rehabilitation is also possible in principle, provided that affected persons are able to come to the rehabilitation clinic independently on 5-6 days per week.
The programme consists of extensive physical training, which includes physiotherapy and occupational therapy, fitness training and various gymnastic exercises. Great importance is also attached to the education of the patients. Thus, after a rehab, everyone should have a detailed knowledge of healthy nutrition, overweight and its prevention as well as of the various medications used.
Depending on the need, independent care and, if necessary, return to work should also be provided after rehabilitation, so that these socio-medical factors also play a major role. The psychological component of rehabilitation is mainly concerned with relaxation techniques, but is also intended to address the management of anxiety, depression and pain after the operation. The various rehabilitation programmes are usually carried out in both group and individual training sessions.
