Different kinds of heart bypass surgery

There are different types of bypass surgeries and the cardiac surgeon will decide on the one depending on the numbers of arteries that are blocked.

Beating Heart CABG

Off Pump CABG

Total Arterial LIMA, RIMA, Radial

Conventional – LIMA Vein

Higher the numbers of arteries that are blocked, greater are the chances and risks of heart failure, heart attack and other kinds of cardiac problems. When blockages are found in more numbers of arteries the process of surgery becomes complex and time taking.

What is the need of a heart bypass surgery?

When plaque starts building up on the walls of the artery, the artery becomes narrow. As a result, the flow of blood to the heart becomes restricted. The muscles of the heart become exhausted when they do not receive the amount of blood needed for proper functioning. This might lead to heart failure. In this kind of situation, the left ventricle is most affected and this is the heart’s primary pump. Heart bypass surgery is recommended when the coronary arteries become excessively narrowed and blocked. The risks of heart attack increase manifold times in such occurrences. This health condition is known as atherosclerosis or coronary artery disease. When the blockage or damage is not possible to be cured by medication or other kinds of treatments, bypass surgery is the only way out.

How does the doctor determine if you need a bypass heart surgery or not?

A cardiologist and his team of doctors will identify the various symptoms and determine whether you need bypass heart surgery or not. There are some conditions in which carrying out the surgery might become complicated and hence the plan is eliminated. Some of the conditions which might cause high risk for surgery include:

Kidney diseases

Diabetes-uncontrolled

Emphysema-severe

Peripheral Arterial Disease (PAD)-Bilateral

These issues must be discussed with the doctor before finalizing on the surgery. Inform the doctor on all kinds of medicines that you take along with your family’s medical history. Surgeries, which are planned and done are usually more successful than the ones which are done in emergency situations.

What are some of the risks associated with coronary heart bypass surgery?

Like any other kind of surgery, bypass heart surgery comes with its own risks. There have been many medical and technological advancements, which have helped in improving the surgical procedure and the chances of successful surgeries have improved. Still, there are chances of risks and complications after the surgery. Success rate of CABG is 99%, under mortality < 1% is in safe hands.

Some of the possible complications, which might take place include:

• Arrhythmia
• Bleeding
• Chest pain
• Blood clots
• Low grade fever
• Infection
• Kidney failure
• Memory loss – temporary or permanent
• Stroke or heart attack

What are the preparations needed for heart bypass surgery?

When the doctor suggests that you will need a heart bypass surgery, he will give you complete instructions as what needs to be done and followed. If the surgery process is planned, you will have ample time and opportunity to make the preparations. You might need to visit the doctor for preoperative appointments, where various aspects of the surgery will be discussed. There are also some tests and investigations which the doctor will ask to do before the surgery. These tests include:

Various kinds of blood investigations

• Chest X-ray
• Electrocardiogram
• Angiogram

How is the bypass surgery performed?

Prior the surgery: Preparations for the surgery are important. The patient will be made to change in a hospital gown and get all kinds of medication, anesthesia and fluids through the IV channel. As the anesthesia starts working, the patient will go into sleep so that no pain is felt during the surgical process.

During the surgery: In the beginning, an incision is made right in the middle of the chest. The rib cage is opened and the heart is exposed. Some of the cardiac surgeons go for minimally invasive cardiac surgery as well where smaller incisions are done on the chest and specialized miniature instruments are used along with robotic procedures.

On Pump Surgery

The patient is then put on a cardiopulmonary bypass machine, which is also known as a heart-lung machine. Oxygenated blood is circulated all throughout the body with this device, while surgery on the heart is being done. While blood is pumped out from the heart for removing carbon dioxide, oxygenated blood is pumped in so that the body functions normally – all this is controlled by the cardiopulmonary bypass machine.

Off Pump Surgery

In off-pump CABG, the heart keeps on beating during the surgical process, and there is no use of the heart-lung machine. Since no machine is used, there are also no pipes attached to the heart. Special devices are used so that it is possible to mechanically stabilize the part of the heart, which is relevant and suturing can be done on kind of relatively immobile platform.

Depending on the situation and need, the surgeon might need to use cooling techniques, also known as extreme cooling, for bringing down the body temperature considerably. The various processes of the body are suspended and helps in performing surgeries that will take long time to perform. The need of oxygen by the heart is less when the body has low temperature. The cooling technique is highly effective as it reduces the risks of heart and brain damage during the surgery due to lack of oxygen.

Once the patient looks stable with all parameters running fine, the surgeon removes a healthy blood vessel from the leg or from the chest wall for replacing the damaged or blocked portion of the artery. While one end of the graft is attached above the blockage, the other is attached above. The blood now flows to the heart via this new attached graft. Once the grafting process is complete, the heart-lung machine is removed in off pump surgery. It is checked whether the bypass route is working with proper blood flow. Once it is confirmed that the alternate route is working well, the incision is stitched and bandaged. The patient is kept in Intensive Care Unit initially for monitoring.

Recovering from the bypass heart surgery

A patient recovering from a bypass heart surgery might have strange feelings after he gains consciousness. Usually there is a tube in the mouth of the patient when the patient wakes up from the surgery. There will be pain as well along with some temporary side effects like confusion, short-term memory loss and not being able to keep track of time. Vital signs are monitored continuously and hence the patient is kept in the ICU for a few days. Once the patient is stable, he is shifted to another room. The hospital stay will be for 7-8 days if all goes well. If complications arise, the stay will be extended.

At the time of discharge, the medical team will guide and instruct as to how one should take care of the patient at home. The patient should get plenty of rest and refrain from any kind of physical activity.

It will take almost 6-12 weeks for the patient to recover completely, even if there are no complications of any sort. The breastbone takes minimum that time to heal from the surgery. Refrain from physical activity, exercise or exertion of any kind during this time. Do not drive as well.

Cardiac rehabilitation is also recommended by many as a part of cardiac surgery treatment. In the process of rehabilitation, a regimen is followed where stress limits and physical activity limits are tested and monitored. The rate of heart healing is also administered.

If there is any kind of discomfort or pain or any other problem, let the doctor know about it immediately.

Medications that are needed after a bypass surgery

Various kinds of medicines are prescribed at discharge after the bypass surgery. Pain management medicines like ibuprofen or acetaminophen is given for keeping the pain to a minimum. Along with this, nitrates, beta-blockers, anti-platelet drugs, ACE inhibitors and lipid-lowering medicines are also prescribed. While some patients might need all these medicines, some might need only selected ones from the list. The doctor will understand your condition and requirements and prescribe accordingly.

Various symptoms like chest tightness, shortness of breath and high blood pressure will improve after the successful bypass surgery. Though the problem of blocked artery is solved with the surgery, one must take all kinds of preventive steps and measures for keeping future heart diseases at bay. Making healthy lifestyle changes is highly recommended. Talk to the doctor and make the required changes for maintaining a healthy heart after surgery.