Bypass Surgery

Navigate your way to a Healthy Heart

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What is a bypass surgery?

Imagine traveling by road and getting stuck in a traffic jam. To

'bypass' the jam, you take another route and join the same road

back again. That's exactly what takes place in a CABG (Coronary

Artery Bypass Graft surgery) or commonly known as bypass

surgery.

Coronary Artery Bypass Grafting (CABG) is a surgical procedure

done to create a 'bypass' around the blocked part of a coronary

artery (blood vessels that supply blood to the heart) to restore

blood supply to the heart muscle. The bypass is made with the

help of blood vessels (known as grafts taken from the other parts

of the body (leg, hand, chest wall, etc.)

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Why and when is a bypass done?

When one or more of the coronary arteries becomes partially or

totally blocked, the heart does not get adequate blood supply.

This is called an ischemic heart disease or Coronary Artery

Disease (CAD). It can cause heart pain (angina) or a heart

attack (myocardial infarction).

CABG is one of the treatment options for ischemic heart

disease. Bypass surgery is advised for:

1. Disease of the left main coronary artery

2. Significant, multiple blockages in all three main vessels

of the heart

3. Failure of angioplasty

4. When the efficiency of the left ventricle is reduced to less

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How is the surgery done?

Before the surgery

Once the patient has been diagnosed with a triple vessel disease

and has been advised to undergo a bypass surgery he has to plan

accordingly.For a bypass surgery a stay in the hospital of

approximately 10 days is expected with a recovery time of a month

after the surgery to get back to the normal routine.

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The pre-operative investigations include the following:

• Blood tests: includes CBC, Serological tests, blood grouping,

blood sugars,

• Urine tests: creatinine, electrolytes

• Chest x-ray

• Ultra sonography

• Carotid and radial Doppler studies

• 2D Echo

• CT angiography of the internal mammary arteries

• Sputum and nasal swabs to check for any active infections

in the body

• Lung function tests

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Preparing the patient:

• On the day of surgery the patient is given medicines to

reduce anxiety and then rolled into the Operation Theatre

(OT)

• Electrodes connected to ECG monitor are attached to the

patient’s back to monitor the heart’s activity during the

operation

• Intravenous lines are then inserted into the veins of the

wrist or arm for administration of medicines and salt

solutions

• One IV line is threaded up the vein all the way to the vena

cava ( the biggest vessel that carries impure blood from all

the parts of the body to the heart) to allow administration of

medication directly to the heart.

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Surgery:

 

• For the surgery, first the chest is cut open at the mid line of

the breast bone ( sternum) and the sternum is separated.

• Then the internal mammary artery to be used for the surgery

is separated from the chest wall gently.

• Then the surgeon will work on the patients limbs to remove

the vein or the artery.

• After this the grafting of the conduits is done.

• After several hours of grafting the chest closure is done in

layers.

• The patient is then shifted to the ICU

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However, in a beating heart surgery the heart lung machine is

not used and the surgery is performed on a beating heart. This

method is know as an Off-Pump Coronary Artery Bypass

surgery (OPCAB) or beating heart surgery.

It allows the bypass to be created while the heart is still beating

by using a device known as 'octopus'. The advantage is a

quicker recovery, fewer complications and better long term

outcome, especially in elderly patients and in patients with

problems like kidney failure, previous brain strokes, etc. Asian

Heart Institute is one of the few centers in the world that

specializes in this type of surgery, performing nearly 100% of

its bypass surgeries on a beating heart with a very significant

percentage using total arterial grafting.

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Redo bypass surgery

A second or redo bypass surgery is needed if blockages

develop after the first surgery. It is complex and risky because

after surgery, the heart and lungs stick to the breast bone. A

beating heart surgery using arterial grafts reduces the risk of a

redo bypass surgery. At Asian Heart Institute redo bypass

surgery is also performed 'Off-Pump', thereby suggesting the

competence of the team.

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Frequently Asked Questions After Bypass Surgery

1. When can I drive on my own?

It is wise to wait for 2 months after surgery, before driving on your

own. This is the amount of time it takes for the healing of your

sternum (breast bone), which was cut open during surgery. Any

chance injury, can cause damage if driving is started too early.

Please consult with your surgical team before undertaking any

activity after a bypass.

2. Can I travel by car?

Yes. You may travel by car as soon as you are discharged. However,

for the first few weeks, it is advisable to restrict your travel to less

than two hours. If the drive is going to be longer, then take a break

every two hours and walk around for a few minutes.

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3. Should I speak less?

There is no reason for you to 'speak less' after surgery.

However, during the first few days of your recovery, you

might feel short of breath while speaking for a long period of

time. If so, your body is telling you to rest, and your may

keep silent for some time.

4. Will eating curd or watermelon affect the

stitches and slow down the healing of the breast bone?

No. Eating curd or watermelon has no effect on your stitches

and healing process.

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5. When can I start climbing the staircase?

If there is an elevator, there is no need to climb stairs just for the

sake of exercising. If you do not have an elevator and have to take

the staircase, you can do so as soon as you are discharged. While

climbing, pace yourself. Take a minute's rest after climbing 10-12

steps during the first week after discharge. As your walking

capacity increases, there is no restriction on climbing steps, as

long as you do not run out of breath.

6. When can I go back to work?

It is advisable to wait for at least 2 months after surgery before

returning to work. However, depending on the condition of your

heart, you may be able to start light work after a month. Please

consult with your doctor before returning back to work.

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7. What about the blockages in the arteries, will they remain?

The blockages which are present is the arteries remain as they were.

The 'graft' which provides the 'new blood supply' is connected below

your old blockages, thereby providing adequate blood to the heart

muscle.

8. After my surgery, why do I still feel pain in my chest?

To perform your surgery, your chest-bone was cut open and stitched

together after surgery. It is quite normal to feel some pain or altered

sensations in your chest region for a few months after surgery.

However, this pain will be different from the pain of 'angina' which

you might have experienced before surgery.

 

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The AHI Advantage

The latest trend in healthcare is to have lesser invasive

surgeries, i.e. surgeries which involve minimal cuts & ensure

that patient has a faster recovery. Keyhole or Minimally Invasive

Surgery (MIS) is a modern innovative surgical technique that

reduces the patient's post-surgery distress & allows them to

return back to their normal life in just a couple of days. In

Minimally Invasive Surgery (MIS) is a modern innovative surgical

technique that reduces the patient's post-surgery distress &

allows them to return back to their normal life in just a couple of

days.

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Recovery/ Prognosis:

Recovery from the surgery takes time. The patient who has

received a CABG can expect considerable relief from symptoms

and in many cases, increase life span. It should be remembered

however that the graft vessels are subject to fatty blockage at

any increased rate, so care must still be taken to reduce the risk

factors that cause the original blockage.

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You can do many things to reduce the risk factors like:• Not smoking• Regular exercising• Control of vitals like Blood Pressure, sugar levels, cholesterol levels etc• Rectification of other clinical conditions if any

Related Tags: Best cardiac arrest treatment | Hospitals for cardiac arrest treatment | Best cardiologist for angioplasty

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THANK YOU….

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