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Heart Bypass Surgery

Heart bypass surgery, also known as coronary artery bypass graft (CABG) surgery; is meant to restore or improve the flow of blood into your heart. Using blood vessels taken from another part of the body, the surgeon “bypasses” damaged or clogged up arteries of your heart and sends blood through the other blood vessels. Bypass surgeries are amongst the safest and most common surgeries performed every year; the United States alone recorded 500,000 heart bypass surgeries last year. A rising prevalence of cardiovascular diseases such as Coronary Artery Disease (CAD) or Coronary Heart disease (CHD), Myocardial Infarction (MI), hypertension and some others has led to such astronomical surgery statistics. 

When plaque (found in blood) builds up and deposits on the walls of the arteries; less blood is able to flow into your heart. This is known as atherosclerosis. The heart will become weak and eventually fail if the lack of blood flow is not corrected. Surgery can be recommended when the arteries become so narrow that almost no blood is going through and medication is not making any improvements. There are different types of bypass surgery, dependent on the number of arteries that are blocked. A “Single Bypass” will be performed in case one artery is blocked, “Double Bypass” for two blockages, “Triple” for three and “Quadruple” for four. The higher the blockage, the longer and more complicated the surgery. A team of Cardiac Surgeons will evaluate the need for and type of bypass surgery a person will require and whether one can undergo an “open heart” surgery or not.  Pre-existing health conditions like diabetes or kidney disease can also complicate bypass surgeries and need to be taken into account. A number of tests such as blood tests, X Ray scans of the chest, Electrocardiogram (ECG) and Angiogram will be used by the surgeon to get a complete picture of the patient’s overall health condition. Surgery may not be performed if any cold or flu like symptoms are present as these infections may increase.

The procedure entails a dose of fluids and medication followed up by anaesthesia to induce a long and painless sleep. The surgery begins with an incision being cut in the middle of the chest; through the incision the rib cage is moved apart to reveal the heart. There are other minimal invasive techniques that involve small cuts, miniature instruments and robotic assistance. A cardiopulmonary bypass machine may be used to supply oxygen rich blood to the heart while the surgery is being performed and some surgeries will not require such machines, called “off pump” procedures. Then comes grafting where the surgeon will remove a healthy vessel from another part of the body and bypass the blocked part of the artery, one end of the graft is placed above the blockage and the other below. This will be the new bypass, like optional roads on highway that take you to the same destination. Upon completion of the surgery, the surgeon will double check the functioning of the bypass.

Bypass surgeries are not performed by solo surgeons but by a team of specialists. For instance, a perfusion technologist operates the cardiopulmonary bypass machine while a cardiovascular surgeon performs the bypass and an anaesthesiologist will ensure proper anaesthesia is provided. Bypass surgeries last around 4-5 hours in most cases.

Post-surgery is spent in an ICU for monitoring vitals and other signs. Some pain may be felt at the points of incision or while breathing heavily or coughing. Upon being declared stable, the patient will be moved into a regular room. Recovery can take anywhere between 4- 6weeks and lifestyle changes will have to be made. 

Regular follow up with doctors and healthy lifestyle are required for maintaining good health for a long period after heart bypass surgery.

Dr. Abhay Kumar
Director
Dept of Cardio Thoracic and Vascular Surgery

 

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