- What is Bypass surgery & when is it performed?
Heart bypass surgery, also known as coronary artery bypass surgery, is performed to replace damaged arteries in the heart muscle. The damaged arteries are repaired by taking blood vessels from another area of the body. These arteries supply oxygenated blood to the heart. The heart doesn’t work properly if these arteries are blocked, or if blood flow is restricted. This can lead to heart failure. A certain type of bypass surgery is recommended basis the number of blocked arteries.
- Single bypass: only one artery is blocked
- Double bypass: two arteries are blocked
- Triple bypass: three arteries are blocked
- Quadruple bypass: four arteries are blocked
Risk of getting a heart attack, heart failure, or another cardiac issue depends on the number of arteries blocked. Surgery may take longer or become more complex if there is blockage in more arteries.
When a material in blood (plaque) builds up on arterial walls, less blood flows to the heart muscle. The muscle is more likely to become exhausted and fails if it is not receiving enough blood. This mostly affects or damages the left ventricle, the heart’s primary pump. Doctorsgenerally recommend a heart bypass surgery when coronary arteries become so narrowed or blocked leading to a high risk of a heart attack.
This condition is known as coronary artery disease, or atherosclerosis. Doctorsgenerally recommend a bypass surgery when the blockage is too severe to manage with medication or other treatments. The operation can save your life if you are having a heart attack or are at a high risk of having one. If you have ongoing angina and shortness of breath from diseased heart arteries, elective coronary bypass surgery is highly effective at eliminating or reducing discomfort. You can get your life back with a coronary bypass surgery.
- Bypass or Angioplasty- which one should be performed?
During cardiac catheterization, images of the inside of the coronary arteries are examined by the doctor. If plaques in these arteries (coronary artery disease) are causing areas of narrowing, you may need treatment. Treatment options depend on various factors including:
- Severity and extent of coronary artery disease
- Symptoms, such as chest pain and shortness of breath
- Overall heart function
- Other medical conditions, such as peripheral artery disease, diabetes or prior stroke or heart attack
Medications and lifestyle changes may be the treatment of choice for some people.
In other cases, angioplasty or Percutaneous coronary intervention may be recommended for opening the clogged arteries. Angioplasty may especially be recommended when you experience chest discomfort (angina) due to reduced blood flow that has not responded to medication and lifestyle changes.
During angioplasty, a tiny balloon at the site of the blockage is inserted and then expanded to widen the narrowed artery. Your doctor may then implant a stent (small metal coil) in the clogged artery to keep the artery open and hence reduce the risk of it narrowing again. It is possible to even have angioplasty during cardiac catheterization, if your doctor thinks it is the most feasible treatment option for you.
In a case where arteries are narrowed or blocked in multiple areas, or the left main coronary artery is narrowed, your doctor may recommend coronary bypass surgery. Some studies and researches show coronary bypass surgery may also be an appropriate treatment if you have diabetes and have multiple blocked or narrowed arteries.
During bypass surgery, surgeons take a sample of healthy blood vessels usually from inside the chest wall or the lower leg and attach it above and below the blocked artery. This permits blood to bypass the blocked area and flow to the heart muscle.
While angioplasty is a minimally invasive scheme, of widening a coronary artery where a balloon catheter is used to widen the artery from within and a stent is placed inside the artery to keep it open. Anaesthetic is not needed (although the patient may be suggested sedation), and patients can go home same day or the next day.
The recovery time for angioplasty is quicker than heart bypass, but patients having CHG are not advised to go for angioplasty. People who have triple-vessel disease are suggested to have heart bypass, and if one has diabetes, heart bypass gives better survival outcomes. Angioplasty is usually used for people having less-severe coronary artery disease.
- What to expect before, during & after bypass surgery
Before the procedure:
- One should not take any drugs having aspirin for three days before the surgery. These drugs can cause bleeding more than usual.
- One should quit smoking. People who have a habit of smoking have more mucous in their lungs and is hard to remove after surgery.
- One needs to have someone to stay with them after getting home from the hospital.
- One can also hire a home health aide but these services can prove to be costly.
- One may require blood while in the hospital. Anyone can donate their own blood, after telling the doctor.
- One may not be allowed to eat or drink anything after midnight before the surgery. Take your normal pills with a small sip of water. If diabetic, check with the doctor about your diabetic medicines.
- One needs a chest X-ray, a urine test, and ECG of your heart and blood tests before surgery. These tests may be done at an outside facility or in the hospital the day before surgery.
- The day before surgery, one needs to scrub the abdomen and legs with a soap to kill germs.
- One needs to bring all the pills to be taken with and show them to the nurse.
- Do not bring any valuables, such as jewellery or money to the hospital.
- The doctor would explain the surgery to you and give u a consent form for signatures.
- One should meet other members of the team involved in the surgery, such as the anaesthesiologist, etc.
During the procedure:
- If one is in the hospital, day before the surgery, one would have the time to see their loved ones before the surgery.
- One is asked to remove dentures and non-permanent bridgework, hair clips, jewellery and nail polish before going in to surgery.
- In the morning of the surgery, your chest, groin and legs will be shaved.
- Nurse will start an IV in the arm to give you fluids.
- One might also receive drugs to help you relax and have a facemask to breathe oxygen.
- One will be asked to go to the washroom five to ten minutes before the surgery as during and immediately after the surgery, a small tube is inside the bladder to drain urine.
- The room for operation might be cool and you may have a blanket if you wish.
- One will receive drugs to put to sleep and to block pain so that one is not be awake during the surgery.
- The surgeon divides the breastbone and spread the ribs to get to the heart. The heart-lung machine will take over the work of your heart and lungs.
- The surgeon then removes a small length of blood vessel from your leg or chest and he will begin sewing it to your heart vessels.
- Once this is done, the surgeon will start your heart and turn off the heart-lung machine.
- Your breastbone is wired shut and the wound is closed with stitches or staples.
- One may have two or more small pacing wires on the chest. These wires will be used to help control your heart beat if needed. They will be removed before going home.
- One will have two or three tubes in your chest which will be hooked to a machine to drain the extra air and blood. These tubes will be taken out in about a day.
After the procedure:
- One is taken to the Cardiac Surgery Intensive Care Unit.
- One will have a breathing tube inside your windpipe. The nurse uses a small tube to remove mucous from the lungs and mouth to prevent any build-up in your lungs.
- This procedure can cause pain, make one cough and hard to breathe, but drugs may be given to treat these symptoms.
- On waking up, one will be weaned from the machine that is helping to breathe. Once this happens, the tube in your windpipe is taken out.
- One will have a mask on their face to give oxygen after the breathing tube is removed,.
- The facemask is taken off and will have a small tube under your nose to provide oxygen.
- When in pain, tell the nurse, who can give you drugs to ease the pain.
- One should take deep breaths and cough for 10 to 20 times per hour to prevent any fluid build-up in the lungs. (You will learn to use a small gauge, called an incentive spirometer, to see how depth of your breath and to train to breathe deeply.)
- After the surgery, one should get up as soon as you can and talk with family and friends. This might speed up your healing and helps family and friends feel less worried.
- One can walk, with help, the day after surgery.
- If vessel for the bypass surgery was taken from your leg, onhee may have some swelling in the legs.
- After a day or two, one will be moved to the Cardiac Progressive Care Unit, where one will be kept for three to five days.
- One will have an IV, oxygen and a monitor to check your heart.
- One may have a chest X-ray, blood work, or other tests, as needed.
- One may have anaemia after the surgery, which is normal but will make you feel tired.
- The dressings over your chest and leg wounds will be taken off after a day or two.
- Most stitches are inside and will dissolve over time while the staples would be taken out in about five to seven days after the surgery.
- One may also have small paper strips on your chest and legs, which will slowly peel and should be taken off after one week you get home.
- One can talk to a dietician about the kinds of food need to be eaten and avoided.
- One can slowly start walking more, begin exercises to help heal and learn what to do when you get home.
- One also needs to see the surgeon about four weeks after going home.
- One should arrange a follow-up visit with one’s own doctor.
- What are the risks involved in Bypass surgery & complications
They may include the following:
- There is a huge risk of bleeding from the graft and other sources and near about 30 percent of patients require blood transfusions after surgery. Very rarely the bleeding would be severe enough to do any additional surgery.
- Another risk is that of Heart rhythm problems where Atrial fibrillation (a condition where the upper chambers of the heart quivers rather than beating properly) is a frequent complication of coronary bypass surgery and can lead to blood clots that forms in the heart and which can travel to the other parts of the body. Some other forms of heart rhythm problems are also possible though less common.
- Also there may be chances of Blood clots, if formed, they can lead to a heart attack, stroke, or lung problems.
- Infection at the site where the chest gets opened for surgery can also happen. This complication is also rare, but can occur in only about 1 percent patients.
- Post-Pericardiotomy syndrome is a condition occurring in near about 30 percent of the patients starting from a few days to 6 months after the surgery. Common symptoms are fever and chest pain.
- Kidney failure or renal, failure is another risk that may damage the functioning of a patient’s kidneys, though often temporary.
- Many patients report difficulty in thinking after the surgery. This problem improves in about 6 months to an year. Researchers are finding its cause, though one theory says that use of the heart-lung machine dislodges tiny bits of fatty build-up in an artery that travels up to the brain.
- People can have adverse reactions to anaesthesia including difficulty in breathing while asleep.
- Death is a very rare risk but can happen after the bypass surgery caused by heart attack or stroke.
Surgical Risks of Bypass
Every surgery has risks and holds the potential for small to serious complications. Some of the possible surgical risks involved for bypass surgery include:
- Spiking high fever
- Developing a bad infection
- Bleeding from the site or some infection at the incision
- Having adverse reaction to anaesthesia
- Loss of a lot of blood
- Developing blood clot affecting the lungs
Some more risks likely to occur during bypass surgery include:
- Having a sudden heart attack or stroke
- Dying during the bypass surgery
- Infection in the chest
- Abnormalities of heart rhythm; this is called arrhythmia
- Chronic pain of breastbone towards the wound site
- Severe Pneumonia
- Difficulty in breathing
- Kidney or Renal failure
- Difficulty with cognitive function and thinking
- Chest pain with fever that may live up to six months