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Bypass Surgery, Heart (Coronary Artery Bypass Graft)

Coronary artery bypass surgery is performed to fix the blockages. It helps redirect blood around a section of a blocked or partially blocked arteries in the heart to improve blood flow to the heart muscle. The procedure involves taking a healthy blood vessel from a patient's leg, arm or chest and connecting it beyond the blocked arteries in the heart.

Although coronary bypass surgery doesn't cure the heart disease that caused the blockages (coronary artery disease), it can ease symptoms, such as chest pain and shortness of breath and prevent heart attack. For some people, this procedure can improve heart function and reduce the risk of dying of heart disease.

Why Bypass Surgery is performed?

For blocked artery in heart coronary bypass surgery is the best treatment.

Surgery is considered in case of following cases:

  • There is severe chest pain caused by narrowing of several of the arteries that supply your heart muscle, leaving the muscle short of blood during even light exercise or at rest.

  • There is more than one diseased coronary artery and the heart's main pumping chamber, the left ventricle isn't functioning well.

  • If left main coronary artery is severely narrowed or blocked. This artery supplies most of the blood to the left ventricle.

  • An artery blockage for which temporarily inserting and inflating a tiny balloon to widen the artery (angioplasty) is not appropriate, if the patient had a previous angioplasty or placement of a small wire mesh tube (stent) to hold the artery open that hasn't been successful, or had stent placement, but the artery has narrowed again (restenosis).

Coronary bypass surgery might also be performed in emergency situations, such as a heart attack, if the patient is not responding to other treatments.

Coronary bypass surgery, patient need to make lifestyle changes after surgery. Medications are prescribed routinely after coronary bypass surgery to lower your blood cholesterol, reduce the risk of developing a blood clot and help your heart function as well as possible.

What are the risks of Heart Bypass Surgery?

Because coronary bypass surgery is an open-heart surgery,  might have complications during or after your procedure. Possible complications are:

Bleeding, Heart rhythm irregularities (arrhythmias), Infections of the chest wound, Memory loss or troubles with thinking clearly, which often improve within six to 12 months, Kidney problems, Stroke, Heart attack, if a blood clot breaks loose soon after surgery.

Risk of developing complications is generally low, but it depends on the health before surgery. The risk of complications is higher if the operation is done as an emergency procedure or if  other medical conditions, such as emphysema, kidney disease, diabetes or blocked arteries in the legs (peripheral artery disease).

Preparations for Heart Bypass Surgery

Doctor will give specific instructions about activity restrictions and changes in diet or medications the patient should make before surgery.

Make arrangements for after surgery. It will take about four to six weeks for the patient to recover to the point where he/she can resume driving, return to work and perform daily chores.

Before the procedure

If coronary bypass surgery isn't performed as emergency surgery, patient is likely be admitted to the hospital the morning of the surgery.

During the procedure

Coronary bypass surgery generally takes between three and six hours and requires general anesthesia. The number of bypasses you need depends on where in your heart and how severe your blockages are. General anesthesia is administered through the tube which helps in breathing.

Most coronary bypass surgeries are done through a long incision in the chest while a heart-lung machine keeps blood and oxygen flowing through your body. This is called on-pump coronary bypass surgery.

The surgeon cuts down the center of the chest, along the breastbone. He or she then spreads open the rib cage to expose the heart. After the chest is opened, the heart is temporarily stopped with medication and a heart-lung machine takes over to circulate blood to the body.

The surgeon takes a section of healthy blood vessel, often from inside the chest wall or from the lower leg, and attaches the ends above and below the blocked artery so that blood flow is redirected around the narrowed part of the diseased artery.

Other surgical techniques used for heart bypass surgery:

  • Off-pump or beating-heart surgery-This procedure allows surgery to be done on the beating heart using special equipment to stabilize the area of the heart surgeon is working on. This type of surgery is challenging because the heart is still moving. It's not an option for everyone.

  • Minimally invasive surgery- A surgeon performs coronary bypass through small incisions in the chest, often with the use of robotics and video imaging that help the surgeon operate in a small area. Variations of minimally invasive surgery might be called port-access or keyhole surgery.

After completing the graft, the surgeon will restore the heartbeat, disconnect the patient from the heart-lung machine and use wire to close chest bone. The wire will remain in the body after the bone heals.

After the procedure

Patient stay in intensive care unit for 1 or 2 days. The breathing tube will remain in the throat until patient is awake and able to breathe on his/her own.

Cardiac rehabilitation often begins in the hospital. Patient will be given a program of exercise and education designed to help you recover. It will continue with monitored programs in an outpatient setting until patient safely follows a home-based maintenance program.

Patient is discharged from the hospital within a week if there are no complications. There might be difficulty doing everyday tasks or walking a short distance. Call your doctor if you have the following symptoms at home:

  • Rapid heart rate

  • Fever

  • New or worsened pain around the chest wound

  • Reddening around the chest wound or bleeding or other discharge from the chest wound

Expected recovery period is about six to 12 weeks. In most cases, patients can return to work, begin exercising and resume sexual activity after four to six weeks.

Results

After the surgery, most people feel better and might remain symptom-free for more than 10 to 15 years. Over time, however, it is possible that other arteries or even the new graft used in the bypass will become clogged, requiring another bypass or angioplasty.

Better outcome of surgery will depend on taking medications to prevent blood clots, lower blood pressure, lower cholesterol and help control diabetes as directed, and following a healthy lifestyle:

  • Exercise regularly.

  • Follow a healthy-eating plan

  • Stop smoking.

  • Achieve and maintain a healthy weight.

  • Manage stress.

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