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Heart Bypass Surgery
Relevant information about Heart Bypass Surgery.
Coronary/Heart Bypass is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease. Arteries or veins from elsewhere in the patient's body are grafted to the coronary arteries to bypass atherosclerotic narrowings and improve the blood supply to the coronary circulation supplying the myocardium (heart muscle). It's sometimes called CABG ("cabbage"). The surgery was first performed during the 1967, as a creation of the brilliant argentine doctor René Favaloro (1923-2000). The surgery reroutes, or "bypasses," blood around clogged arteries to improve blood flow and oxygen to the heart. It’s the most commonly performed "open heart" operation in the United States.
The arteries that bring blood to the heart muscle (coronary arteries) can become clogged by plaque (a buildup of fat, cholesterol and other substances). This situation can lead to chest pain (angina pectoris) or a heart attack (myocardial infarction). The CABG is needed specifically in three medical cases. 1: an obstruction on the stem of the left coronary artery. 2. A proximal obstruction of two or three epicardial arteries. 3. A proximal obstruction of the anterior descending -is impossible to make a coronary angioplasty over this-.
A coronary artery disease is possible if the patient has suggestive symptoms, multiple risk factors, and/or a strong family history of coronary artery disease. Risk factors include male sex, high blood cholesterol, diabetes mellitus, high blood pressure (hypertension), and cigarette smoking. If the patient has some of these risk factors, he/she should consult with their cardiologist for a thorough examination. It is the only way to prevent such complex surgery.
- How is the surgery performed
CABG is a procedure performed exclusively by cardiothoracic surgeons. Surgeons take a segment of a healthy blood vessel from another part of the body and make a detour around the blocked part of the coronary artery. The traditional technique involves an incision down the front of the chest through the breastbone or sternum.
The surgery can be done with the patient’s heart stopped, using a special mixture of chemicals called cardioplegia. After the bypasses have been performed the patient is taken off of the machine and their own heart takes over once again. During the past several years, more surgeons have started performing off-pump coronary artery bypass surgery (OPCAB). In this procedure, the heart continues beating while the bypass graft is sewn in place. So, the possibilities are: on pump surgery or off pump surgery. Each procedure has its peculiarities. The pros of On Pump are: surgeon can operate quicker because the heart is still, very little blood makes surgery faster, appropriate for unstable patients. The pros of Off Pump are: the heart is moving, slower surgery, less blood loss and fewer transfusions, decreased risk of stroke, decreased length of hospital stay, less expensive.
There are several types of bypass grafts used for Heart Bypass Surgery. The surgeon decides which graft(s) to use, based on the location of the blockage, the amount of blockage, and the size of the patient's coronary arteries. The surgeon makes a small opening just below the blockage in the diseased coronary artery. If a saphenous (leg) or radial (arm) vein is used, one end is connected to the coronary artery and the other to the aorta. If a mammary artery is used, one end is connected to the coronary artery while the other remains attached to the aorta. The graft is sewn into the opening, redirecting the blood flow around this blockage. Surgery ends when all affected coronary arteries are treated.
A patient may undergo one, two, three or more bypass grafts, depending on how many coronary arteries are blocked. During the last years, there have been many developments to improve the procedures and the future patient’s welfare. One technique to improve patient outcomes involves the use of multiple arterial grafts - doing all bypasses with arteries like the internal thoracic artery - and not using the saphenous vein.
CABG is a complex surgery, so complications can always be present. For this reason, the procedure will be the last choice made by the cardiologist. Previously, the cardiologist used up all the previous instances like prescription drugs or balloon angioplasty. The magnitude of the risks varies according to each patient's specific health conditions. Potential complications of CABG include bleeding or infection, stroke (which is primarily related to age and history of previous strokes), kidney failure (related in large measure to the kidney function before the surgery), and heart attack during or after the surgery.
- How is the post-surgery process
After the surgery, the patient is moved to a hospital bed in the cardiac surgical intensive care unit. Heart rate and blood pressure monitoring devices continuously monitor the patient for 12 to 24 hours. After successful CABG, a patient's anginal chest pain should be gone, although they will likely experience some incisional chest discomfort. Surprisingly, however, even the incision does not bother most people much after the first 48 to 72 hours. Some patients find that their energy level actually improves after surgery. In fact, some patients state that they had not realized how much they had been slowing down prior to surgery.
Patients usually stay in the hospital from four to six days and sometimes longer. Tests are done to evaluate the patient’s health, also monitoring the conditions of the post surgery. After leaving the hospital, the patient is enrolled in a physician-supervised program of cardiac rehabilitation. A minority of patients will need to repeat the surgery, usually 10 or more years after their original operation. Patients undergoing coronary artery bypass surgery will have to avoid certain things for eight to 12 weeks to reduce the risk of opening the incision. These are called sternal precautions. Some examples of sternal precautions are: avoid the use of arms in excess, avoid lifting things that weigh more than 5 kg, avoid overhead activities with their hands.
In addition to the relief of the symptoms, research shows that the expected survival (life-span) for specific subgroups of patients improves after CABG. However, some rules of lifestyle are necessary to feel this relief. Patients must improve behaviors in some routines. Patients are often advised to eat foods low in cholesterol and saturated fat and to avoid Trans fat while increasing daily physical activity to help regain strength. Doctors recommend return to a normal lifestyle, which includes home routines -light housework, going out, visiting friends, climbing stairs-. This is necessary to stabilize the patient's health.
The objective of return to normal life includes work. However, the physician must define when it is advisable to return to work activities. It is not a decision of the patient. The doctor is the one who decides. The decision is usually based on the type of work and level of physical exertion required. In the long run a patient can expect to return to their preoperative condition or better. The long term results of CABG are excellent.
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