Coronary Bypass Surgery

CORONARY BYPASS SURGERY

Overview

The human heart is a fascinating organ. Pumping away with mechanical precision, starting from the moment life starts and going on till the last breath, it ensures the life-saving oxygen reaches every organ of the body and that the carbon-dioxide enriched blood reaches the lungs properly. This rhythm is what forms the basis of life. Now imagine, if this critical supply of blood gets disrupted!

There can be a number of reasons for the blood flow to get disrupted, like when the arteries supplying blood get blocked. These blockages in the initial stages can be removed by lifestyle changes, medicines or other procedures. But, if the blockage is too high, the doctor may decide to go for bypass surgery. If left unattended it may lead to stopping of flow of blood to the heart and subsequently to heart failure and possibly death.

Symptoms

The coronary artery blockages happen due to the deposit of calcium, cholesterol or fat in the arteries known as plaque. If the plaque deposit is less, the doctor will advise lifestyle changes and an active lifestyle to reduce the fat deposits. It’s only when the deposit is beyond a certain critical limit, that the doctor advises heart bypass surgery. There can be other factors that the doctor will consider before suggesting this procedure like
  • Medical history of diseases like diabetes
  • The severity of blockages and their location
  • Age and age related ailments
  • Lifestyle including activity, smoking and drinking habits, diet etc.

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Procedure of Coronary Bypass Surgery

Once the doctor has determined that you need Coronary Artery Bypass Surgery, they will familiarize you with the procedure and also guide you in your preparation for the surgery. The bypass surgery is done by grafting (attaching) new blood vessels, taken from other parts of the body, to create an alternate route (bypass) for the blood to flow to the heart.

The Coronary Artery Bypass Surgery (CABG) is done as an open heart bypass surgery, meaning the surgeon opens up your chest to reach your heart. The complexity and duration of the surgery increases with the number of arteries that need to be grafted. The procedure is named as per the number of arteries that need to be bypassed, i.e. 

  • 2 arteries to be bypassed - double bypass surgery
  • 3 arteries to be bypassed - triple bypass surgery
  • 4 arteries to be bypassed - quadruple bypass surgery
  • 5 arteries to be bypassed - quintuple bypass surgery

Before the procedure, the doctor will reduce your medicine intake. You will be advised to bathe with a special antiseptic soap prior to your surgery. Also, you should not eat or drink anything since midnight the previous day.

In the Operation theatre, before starting the cardiac bypass surgery, the doctors will monitor your heart rate and other vital parameters by means of ECG and other tests. Then, you will be administered general anaesthesia, which will make you sleep and not feel the pain during the procedure.

Once the anaesthesia has taken effect, the doctor will start the bypass surgery procedure by making an incision in your chest through the breastbone to reach the heart. The team of doctors will administer medicine to stop your heart and attach it to a heart lung machine, which ensures the blood flow is through the machine and not the heart.

After this the cardiac surgeon will take a graft (generally taken from the left part of your chest or leg) and attach one end above and the other below the blockage. The blood flow is then restarted to the heart to see if the blood is flowing properly through the graft. This bypass surgery procedure is called “On Pump” procedure. 

In some modern day procedures, the heart lung pump is not used and minimal invasions are made on the left side of the chest. This is also referred to as “Off-Pump” procedure. On completion of the procedure, the breastbone is stitched together with special wire that is left inside and the incision is then closed.

Recovery process

The patient is allowed to slowly recover from the anaesthesia after the heart bypass surgery procedure and hence may take 4-6 hours to wake up after the procedure. Tubes are attached to remove any fluid build-up and catheter is attached to the bladder to remove urine. The patient is kept under medical supervision in an ICU and may need to stay there for up to a week.

It is extremely important to follow the post-operative regimen prescribed by your doctor as complete recovery from a bypass surgery can take anywhere between six to twelve weeks. You may need up to six months to come back to your previous activity level.

Special care needs to be taken of the incision site during recovery to avoid infections. Side effects of the bypass surgery also include:-

  • Tiredness
  • Depression
  • Loss of appetite
  • Itching at incision site

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