CABG
What is heart bypass surgery?
Arteries carry blood from the heart to the rest of the body, and
coronary arteries supply blood to the heart muscles. When the coronary
artery gets blocked, a new channel is created to bypass the blockage,
which is called bypass graft surgery. It uses a working blood vessel
from another part of the body -- the graft -- to channel blood around
the blocked area.
Why is cardiac bypass surgery needed?
When plaque buildup
narrows an artery to about 70% of its normal size, the artery is
essentially blocked. A blockage can cause a decrease in the supply of
blood and oxygen to the heart and over time can lead to debilitating
chest pain or a heart attack.
Less severe blockage can be relieved by angioplasty and stenting. But
severe blockage usually requires bypass surgery. Also, if angioplasty
proves unsuccessful, or the position of the blockage is too difficult
to access by angioplasty, or there are severe blockages in multiple
major vessels, coronary artery bypass graft (CABG) surgery is needed.
What is a graft?
A graft is a blood vessel that is
created to bypass a blocked artery. It is usually taken from the
internal mammary artery in the chest, the saphenous veins from the leg,
or in rare instances from the radial artery in the arm. The graft is
attached above and below the area in the artery where there is a
blockage, so that the blood can use the new, unblocked path to flow
freely to the heart.
How is bypass surgery done?
Doctors take a graft from
another part of the body and then attach one end of the graft to the
aorta and the other end to the coronary artery below the blockage.
The traditional operation calls for a six- to eight-inch cut down the
center of the breastbone so the surgeon can get directly at the heart.
During the operation, the body is connected to a heart-lung bypass
machine that keeps the blood flowing. The heart is stopped while the
doctor operates. Then the surgeon uses special wires to close the
chest.
Is the heart stopped during the surgery?
In some cases,
the blood circulation and breathing functions will be carried out by a
heart-lung machine during surgery, also known as cardiopulmonary
bypass. However, more coronary artery bypass surgeries are being done
while the heart is still beating (called the off-pump technique).
How long does it take to recover?
After surgery, the patient goes to an intensive care unit for a day or
two of close monitoring. Then the patient is transferred to the nursing
unit for five to six days.
Once a person who has had bypass surgery leaves the hospital, home
recovery means progressively increasing activity over the next two to
four weeks.
Most patients are fully functional in six to eight weeks, although some
people may take longer. But four to six weeks of progressive
recuperation at home is needed. The patient is not bed-bound but not
leaving home.
How long does the surgery take?
The length of the surgery varies with each patient. However, it
generally takes 4-6 hours from the time you enter the operating room.
What precautions do I need to take when I go back home?
Try to ease into the activities you enjoyed before your surgery. Do
everything in moderation-not too much or too little. If you feel tired,
rest.
It is important to walk every day. Begin walking for 5 minutes about
3-5 times a day, and gradually increase the distance so you're walking
for 20 minutes.
- Do not lift anything heavy.
- Do not drive, until the surgeon advises (usually in 4-6 weeks).
- Do not engage in forceful movements
What is minimally invasive bypass surgery?
Minimally
invasive coronary artery bypass surgery (MIDCAB) involves a
significantly smaller incision - only three inches - instead of a six-
to eight-inch incision.
An artery that supplies blood to chest muscles is grafted to the left
anterior descending artery (an important artery located close to the
chest wall). The heart continues to beat during the surgery, instead of
being attached to a heart-lung machine. Surgeons can also use a
slightly different approach by making small incisions in your chest and
viewing the surgery on video monitors. For this procedure, called
port-access coronary bypass surgery, the heart is attached to a
heart-lung machine.
What are the risks associated with cardiac Bypass?
As
with any surgical procedure, there are risks of infection and heavy
bleeding. There also are risks associated with anesthesia. These can
include adverse reactions to medication and breathing problems.
Postoperative pneumonia and wound infection also are common
complications arising from open-heart surgery.
The current success rate for bypass surgery is 96 to 98 percent. which
means that between 2 and 4 percent of the patients have complications.
Would I require rehabilitation after the surgery?
You will be put on a specialized postoperative rehabilitation and
prevention program, which usually includes supervised exercise, dietary
and lifestyle changes. You should be careful to protect the area around
the leg or arm from which the vein was harvested. This may take a few
months to return to normal.
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