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Heart Bypass Surgery – Frequently Asked Questions

What is the full form of CABG?

CABG is a medical abbreviation for “Coronary Artery Bypass Surgery”. It is a type of bypass surgery that can create new path around either severely narrowed or blocked coronary arteries to improve the blood flow to the heart. CABG is the ultimate treatment which can cure severe artery blockage.

What is heart bypass surgery?

A heart bypass surgery is also known as Coronary Artery Bypass Surgery (CABG). It is the surgical procedure which involves rerouting the blood flow to the heart by creating a new path.

When the plaque starts to accumulate in the arteries, they begin to harden, narrowed and get blocked. The blocked arteries restricts the flow of oxygen and blood to the heart, which affects its functioning and leads to heart attack. So, to restore proper blood flow to the heart, the blockage in the arteries  should be removed.

In case of severe artery blockage, which cannot be unclogged either by stenting or balloon angioplasty, CABG is suggested. To perform a heart bypass surgery, the cardiothoracic surgeon may take a healthy blood vessel from the patient’s leg, arm or chest and connect it to the other healthy arteries in the heart. So, the blood bypasses the blocked area of the artery which restores the proper blood flow and therefore heart functioning.

What are the types of CABG surgery?

CABG surgery can be performed in three different ways which are usually referred as types of CABG. The three types of CABG are:

open heart surgery

Traditional CABG:

It is the most common type of CABG and is used when at least one major artery needs to be bypassed. During the surgery, the heart is accessed by opening the chest bone. In order to allow the surgeon to operate on a still heart, medicines are given to temporarily stop the heart and a heart-lung bypass machine is used to keep the blood and oxygen moving throughout the body.

After the surgery, the proper blood flow to the heart is restored. Usually, the heart starts to beat again on its own. But in some cases, mild electric shocks are used to restart the heart.

Off-pump CABG or Beating Heart Bypass Surgery:

Unlike the Traditional method of CABG, Off-pump CABG allows the surgeon to perform the surgery while the heart is still beating. The heart is not stopped as it is done in traditional CABG, but medication may be given to slow down the heart during the surgery. This type of procedure can be an option for the patients with a single – vessel disease. During the off-pump CABG, the heart-lung machine is not used; but an advanced operating equipment is used to stabilize the portions of the heart and the blocked artery is bypassed in a highly controlled operative environment. Meanwhile, the rest of the heart continues to pump and circulates blood to the body.

Minimally Invasive Cardiac Surgery:

It is similar to the procedure of Off-pump CABG. But, instead of making a large incision (cut) to open the chest bone and access the heart; several small incisions are made on the left side of the chest between the ribs.

A minimally invasive CABG is performed rarely when compared to other types of CABG. It is mostly done in cases which need bypassing the blood vessels in front of the heart and if more than one or two coronary arteries have to be bypassed.

What are the risks and complications of a CABG surgery?

As with any heart surgery, CABG surgery also carries some risks. Though technological advancements have improved the chances of a successful surgery, there are still some risks and complications after the surgery.

Few risks and complications of CABG surgery:

  • Bleeding
  • Arrhythmia (irregular heart rhythm)
  • Blood clots
  • Chest pain
  • Infection of the chest wound
  • Kidney problems
  • Memory troubles
  • Stroke
  • Heart attack, in case of the blood clot breaks loose soon after the surgery.

What is the time for recovery after heart bypass surgery?

Since CABG is a major surgical treatment, even without any complications, it can take around 6 to 12 weeks to recover from the surgery. It is the least period of time that takes to heal the breastbone. At the time of discharge, the patient will be given with set of instructions for post-surgery care; which helps in the process of healing.

Some of the instructions include:

  1. Wound care
  2. Pain relief
  3. Activities and Driving
  4. Diet
  5. Rest and Sleep

Wound care:

The incision made by the surgeon should be kept clean and dry. After the surgery, the patient will be able to take a bath within a few days. The patient should seek doctor’s advice if any signs of infection are seen, such as oozing than usual from the wound, redness or warmth around the cut, edges pulling apart, and fever.

Pain relief:

Before leaving the hospital after surgery, the patient will be prescribed pain medication. There would be some discomfort around the incision and in the muscles which can include itching, tightness, and numbness. These are normal, but it shouldn’t bother the patient much as it did before the surgery.

If the surgeon had used leg veins as grafts to bypass, legs may hurt more than the chest. The patient may feel soreness and stiffness which will fade with time, but gentle exercises can help to deal with the discomfort.

Activities and Driving:

For the first few weeks, the activity can gradually build up such as household chores. But, the activities shouldn’t include lifting, pushing or pulling heavy things. The patient should get doctor’s advice prior starting to drive.

Diet:

Healthy diet help in the process of healing. The patient will be advised to have or avoid specific things post surgery. After the surgery, the appetite may get suppressed and not feel like eating. Smaller meals should be taken often instead of large ones. Consult the doctor, if the appetite doesn’t return within a few weeks.

Rest and Sleep:

After surgery, most of the people have trouble falling asleep. But, the normal sleeping pattern gets back within a few months. Getting adequate rest and taking a lot of naps during the day helps in healing. If pain troubles falling asleep, take the medication before going to bed. Also, arrange the pillows to stay in a comfortable position. Try to avoid caffeine and sodas in the evening time which can interfere with falling asleep. Consult the doctor, if lack of sleep affects mood and behaviour.

What are the indications for CABG surgery?

The indications for CABG depend on various factors such as symptoms of an individual and severity of the disease. Some of the indications for CABG include:

  • Left main artery disease
  • Triple vessel disease (narrowing of three coronary arteries)
  • Abnormal left ventricular function
  • Failed PTCA (Percutaneous Transluminal Coronary Angioplasty: A minimally invasive procedure to unclog the blocked coronary arteries)
  • Myocardial Infarction
  • Severe arrhythmias (irregular heart rhythms)
  • Blockage of grafts from previous CABG

What is the heart bypass surgery success rate?

CABG is considered to be a routine surgery in the past few decades. With technological advancements over time, the chances of successful surgery have improved a lot minimizing the post-surgical risks and complications. At present, the mean success rate of CABG is approximately 98%. The risk increases as the severity of the heart muscle damage and blockage of the arteries.

What is the difference between open heart surgery and bypass surgery?

 

Open Heart Surgery

Bypass Surgery

Definition

In a open heart surgery, the chest bone is opened to access the heart and perform the surgery. The term ‘open’ refers to the chest, but not to the heart. The surgery can be performed on the muscles, valves or arteries of the heart.

A heart bypass surgery or CABG involves the replacement of damaged arteries with a healthy blood vessel taken from another part of the body, to restore the blood flow to the heart.

Used for

  • Heart Valve Replacement
  • CABG
  • Congenital and other heart problems

Rerouting the blood flow to the heart by creating a new path in case of severe coronary artery diseases.

Types

  • On-pump surgery: Uses a heart-lung machine to temporarily take over the heart’s functioning and the surgery is performed on a still heart.
  • Beating heart or off-pump: Uses medication or device to slow down the heart rate and operated on an active beating heart.
  • Robot-assisted surgery: The surgeon uses a special computer to operate the robotic arms that perform the surgery.
  • Femoral – Popliteal Bypass: A healthy blood vessel is taken from another part of the body and used for grafting.
  • Aorto – Bifemoral Bypass: An artificial graft is used to create a new path and restore the blood flow to the heart.

Suggested in cases of

  • Ischemic heart disease
  • Congenital heart diseases
  • Heart or lung transplantation
  • Heart valve disease
  • Coarctation of the aorta
  • Tetralogy of Fallot
  • Procedures on aorta
  • Atherosclerosis (hardening of the arteries)
  • Diabetic foot or gangrene
  • Mesenteric ischemia (injury of the small intestine due to lack of proper blood supply)
  • Leg ulcers
  • Pulmonary embolism
  • Renovascular conditions
  • Carotid Artery Disease

Risks

  • Stroke
  • Systemic inflammatory response
  • Air or fat embolism
  • Excessive bleeding
  • Allergic reaction to anesthesia
  • Heart attack
  • Arrhythmias (abnormal heart rhythm)
  • Kidney or lung problems
  • Bleeding
  • Arrhythmia (irregular heart rhythm)
  • Blood clots
  • Chest pain
  • Infection of the chest wound
  • Kidney problems
  • Memory troubles
  • Stroke
  • Heart attack, in case of the blood clot breaks loose soon after the surgery.

Citations:

  1. Early Outcome After Off-Pump Versus On-Pump Coronary Bypass Surgery: http://circ.ahajournals.org/content/104/15/1761.short
  2. Effect of Partial Ileal Bypass Surgery on Mortality and Morbidity from Coronary Heart Disease in Patients with Hypercholesterolemia — Report of the Program on the Surgical Control of the Hyperlipidemias (POSCH): http://www.nejm.org/doi/full/10.1056/nejm199010043231404
  3. Additional spirometry criteria predict postoperative complications after coronary artery bypass grafting (CABG) independently of concomitant chronic obstructive pulmonary disease: http://pamw.pl/sites/default/files/PAMW-09-2009_Lizak.pdf