INTRODUCTION OF BYPASS SURGERY
What Is Heart Bypass Surgery?
Heart bypass surgery, also known as coronary artery bypass surgery, aims to replace damaged arteries in the heart. A surgeon uses blood vessels from another area of the body to repair the damaged arteries.
This surgery is used when the coronary arteries become blocked or damaged. The coronary arteries supply the heart’s muscles with oxygenated blood. If they are blocked or the flow of blood is restricted, the heart can’t function properly. This can lead to heart failure. According to the Centers for Disease Control (CDC), doctors perform 395,000 such surgeries in the United States each year.
INDICATION OF BYPASS SURGERY
Why Do I Need It?
Bypass surgery treats symptoms of coronary heart disease. That happens when a waxy substance called plaque builds up inside the arteries in your heart and blocks blood and oxygen from reaching it. You may feel things like:
- Chest pain, which is known as angina
- Irregular heartbeat
- Shortness of breath
Coronary heart disease can lead to a heart attack. It can cause a blood clot to form and cut off blood flow. Bypass surgery can give your ticker a big health boost.
Number of arteries bypassed
The terms single bypass, double bypass, triple bypass, quadruple bypass and quintuple bypass refer to the number of coronary arteries bypassed in the procedure. In other words, a double bypass means two coronary arteries are bypassed (e.g., the left anterior descending (LAD) coronary artery and right coronary artery (RCA)); a triple bypass means three vessels are bypassed (e.g., LAD, RCA and left circumflex artery (LCX)); a quadruple bypass means four vessels are bypassed (e.g., LAD, RCA, LCX and first diagonal artery of the LAD) while quintuple means five. Left main coronary artery obstruction requires two bypasses, one to the LAD and one to the LCX. Bypass of more than four coronary arteries is uncommon.
Bypass surgery can provide relief of angina when the location of partial obstructions precludes improving blood flow with stents.
There is no survival benefit with bypass surgery vs. medical therapy in stable angina patients.
Bypass surgery does not prevent future myocardial infarctions.
Age per se is not a factor in determining risk vs benefit of CABG.
TYPES OF BYPASS SURGERY
TRANSMYOCARDIAL LASER REVASCULARIZATION
Transmyocardial (tranz-mi-o-KAR-de-al) laser revascularization (re-VAS-kyu-lar-ih-ZA-shun), or TMR, is surgery used to treat angina.
TMR is most often used when no other treatments work. For example, if you’ve already had one CABG procedure and can’t have another one, TMR might be an option. For some people, TMR is combined with CABG.
If TMR is done alone, the procedure may be performed through a small opening in the chest.
During TMR, a surgeon uses lasers to make small channels through the heart muscle and into the heart’s lower left chamber (the left ventricle).
It isn’t fully known how TMR relieves angina. The surgery may help the heart grow tiny new blood vessels. Oxygen-rich blood may flow through these vessels into the heart muscle, which could relieve angina.
CORONARY ARTERY BYPASS GRAFTING
Coronary artery bypass grafting (CABG) is the most common type of heart surgery. CABG improves blood flow to the heart. Surgeons use CABG to treat people who have severe coronary heart disease (CHD).
CHD is a disease in which a waxy substance called plaque (plak) builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart.
Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause chest pain or discomfort called angina (an-JI-nuh or AN-juh-nuh).
If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. This is the most common cause of a heart attack. Over time, ruptured plaque also hardens and narrows the coronary arteries.
During CABG, a healthy artery or vein from the body is connected, or grafted, to the blocked coronary artery. The grafted artery or vein bypasses (that is, goes around) the blocked portion of the coronary artery. This creates a new path for oxygen-rich blood to flow to the heart muscle.
Surgeons can bypass multiple blocked coronary arteries during one surgery.
OFF-PUMP CORONARY ARTERY BYPASS GRAFTING
This type of CABG is similar to traditional CABG because the chest bone is opened to access the heart. However, the heart isn’t stopped, and a heart-lung bypass machine isn’t used. Off-pump CABG sometimes is called beating heart bypass grafting.
MINIMALLY INVASIVE DIRECT CORONARY ARTERY BYPASS GRAFTING
This type of surgery differs from traditional CABG because the chest bone isn’t opened to reach the heart. Instead, several small cuts are made on the left side of the chest between the ribs. This type of surgery mainly is used to bypass blood vessels at the front of the heart.
Minimally invasive bypass grafting is a fairly new procedure. It isn’t right for everyone, especially if more than one or two coronary arteries need to be bypassed.
TRADITIONAL CORONARY ARTERY BYPASS GRAFTING
Traditional CABG is used when at least one major artery needs to be bypassed. During the surgery, the chest bone is opened to access the heart.
Medicines are given to stop the heart; a heart-lung bypass machine keeps blood and oxygen moving throughout the body during surgery. This allows the surgeon to operate on a still heart.
After surgery, blood flow to the heart is restored. Usually, the heart starts beating again on its own. Sometimes mild electric shocks are used to restart the heart.
CONVENTIONAL HEART BYPASS SURGERY
Conventional heart bypass surgery is often referred to as “open-heart surgery.” Your surgeon will make an 8- to 10-inch incision in your chest and separate your sternum to perform the bypass. A section of vein will be taken from your leg, chest, or groin area to form a graft near the diseased artery. The graft is the new route through which blood will flow to your heart, bypassing the damaged sections of blood vessels.
You may be put on a heart-lung machine, which is a device that keeps you alive while your heart is temporarily stopped to perform the surgery. Your doctor may alternatively choose to perform an off-pump procedure while your heart is still beating. This type of open-heart surgery is ideal for people whose health would make the use of a heart-lung machine risky. The surgery can take as long as six hours to complete, and your surgeon may repair more than one artery.
ANESTHESIA OF BYPASS SURGERY
Prior to Bypass surgery, you’ll change into a hospital gown and be given an IV. Through this IV, you’ll receive medication, fluids, and anesthesia. When the anesthesia begins working, you’ll fall into a deep, painless sleep.
PROCEDURE OF BYPASS SURGERY
What the Procedure Does
Special tubing with an attached deflated balloon is threaded up to the coronary arteries. The balloon is inflated to widen blocked areas where blood flow to the heart muscle has been reduced or cutoff. Often combined with implantation of a stent to help prop the artery open and decrease the chance of another blockage. Considered less invasive because the body is not cut open.Lasts from 30 minutes to several hours. Often requires an overnight hospital stay.
PREOPERATIVE PROCEDURE OF BYPASS SURGERY
Patient education is an important element of care for people having a range of investigations and treatments. The potentially beneficial effect on outcomes has been explored. In particular research, and meta-analyses of the studies, have demonstrated the positive effect of pre-operative education on post-operative outcomes in patients having a variety of surgical procedures. However, application of the findings to defined groups of specialist patients may be difficult. This paper seeks to establish whether pre-operative education benefits patients following coronary artery bypass surgery and to identify the outcomes affected. A broad search strategy revealed 10 studies which examined pre-operative education and measured post-operative outcomes. Data were extracted which revealed there is limited evidence to suggest that pre-operative education benefits patient’s recovery from coronary artery bypass surgery. However, this finding should be considered with caution as this body of research suffered from weak design and there was limited available data.
POSTOPERATIVE PROCEDURE OF BYPASS SURGERY
What Happens After Surgery?
You’ll wake up in an intensive care unit (ICU). You’ll have a tube in your mouth to help you breathe. You won’t be able to talk and will feel uncomfortable. Nurses will be there to help you. They’ll remove the tube after a few hours, when you can breathe on your own.
You’ll also be hooked up to machines that monitor your vital signs, like your heart rate and blood pressure, around the clock. You’ll stay in the ICU for a few days before being moved to a hospital room. You’ll stay there for about 3 to 5 days before you go home.
The recovery period is an excellent time to review your lifestyle choices and create a healthy living plan to help keep your heart functioning as well as possible. Some things to consider during this time include:
- quitting smoking
- finding an outlet for relieving stress
- learning about heart-healthy nutrition
- beginning a daily exercise plan when you’re able
COMPLICATIONS OF BYPASS SURGERY
What Are the Risks of Heart Bypass Surgery?
As with any “open heart” surgery, heart bypass surgery does carry significant risks. However, recent technology advancements have helped improve the procedure, making the likelihood of success much higher.
There are some possible complications that can arise after surgery, including:
- blood clots
- chest pain
- kidney failure
- low-grade fever
- temporary or permanent memory loss
- heart attack or stroke
An arrhythmia (ah-RITH-me-ah) is a problem with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm.
Many arrhythmias are harmless, but some can be serious or even life threatening. If the heart rate is abnormal, the heart may not be able to pump enough blood to the body. Lack of blood flow can damage the brain, heart, and other organs.
Medicine usually is the first line of treatment for arrhythmias. If medicine doesn’t work well, your doctor may recommend surgery. For example, surgery may be used to implant a pacemaker or an implantable cardioverter defibrillator (ICD).
A pacemaker is a small device that’s placed under the skin of your chest or abdomen. Wires connect the pacemaker to your heart chambers. The device uses low-energy electrical pulses to control your heart rhythm. Most pacemakers have a sensor that starts the device only if your heart rhythm is abnormal.
An ICD is another small device that’s placed under the skin of your chest or abdomen. This device also is connected to your heart with wires. An ICD checks your heartbeat for dangerous arrhythmias. If the device senses one, it sends an electric shock to your heart to restore a normal heart rhythm.
Another arrhythmia treatment is called maze surgery. For this surgery, the surgeon makes new paths for the heart’s electrical signals to travel through. This type of surgery is used to treat atrial fibrillation, the most common type of serious arrhythmia.
Simpler, less invasive procedures also are used to treat atrial fibrillation. These procedures use high heat or intense cold to prevent abnormal electrical signals from moving through the heart.