Heart bypass surgery, also known as coronary artery bypass grafting (CABG) or simply bypass surgery, is a life-saving procedure for individuals grappling with coronary artery disease. The surgery involves taking a healthy blood vessel from the leg or chest area. Then the vessel is connected below the blocked heart artery to create a new pathway that improves blood and oxygen flow to the heart muscle. In this blog, we present an overview of heart bypass surgery and discuss the common indications, risk factors, and recovery time.
What Are the Common Indications for Coronary Artery Bypass Grafting?
Coronary artery bypass surgery is a treatment for coronary artery disease. It serves to reinstate blood flow around an obstructed heart artery, especially in critical situations such as a heart attack. Depending on the causes and symptoms, CABG is advised by cardiac surgeons for various conditions:
- Presence of a blockage in the left main heart artery, a vital supplier of blood to the heart muscle.
- Significantly narrowed main heart artery.
- Pronounced chest pain resulting from the constriction of multiple heart arteries, restricting blood flow even during mild exercise or at rest.
- Multiple diseased heart arteries are coupled with diminished functionality in the lower left heart chamber.
- Blocked heart artery that has remained blocked after an unsuccessful coronary angioplasty.
- Narrowing arteries after previous unsuccessful attempts at angioplasty post-stent placement.
What You Can Expect?
Before the Procedure
For patients undergoing scheduled coronary artery bypass (CABG) operations, admission to the hospital typically begins on the morning of the procedure. In the days and hours leading up to the surgery, they undergo a series of heart tests and blood tests to ensure everything is alright. Cardiac surgeons will also discuss and switch up any medicines and supplements that you may be on.
During the Procedure
Before entering the operating room, the patient is administered an intravenous (IV) line in the forearm or hand, accompanied by a sedative to induce relaxation.
Upon entering the operating room, the patient can anticipate the following procedures:
- Anaesthetics: Delivery of a combination of medicines through the IV and a face mask, inducing a pain-free, sleep-like state known as general anaesthesia, for the entire duration of the procedure.
- Breathing machine: Insertion of a breathing tube into the mouth, connecting it to a ventilator. This machine assists with breathing during and immediately after surgery.
- Heart-lung machine: For the on-pump coronary surgery, where the heart is stopped for the surgery, a heart-lung machine will be used to ensure the continuous flow of blood and oxygen in the body.
The duration of coronary artery bypass surgery typically ranges from 3 to 6 hours, contingent on the number of blocked arteries.
In open surgery, the surgeon commonly makes a longitudinal incision along the breastbone, spreading the rib cage to access the heart. This is when the heart is temporarily halted with medications and the heart-lung machine is activated. During the procedure, a segment of healthy blood vessels is removed from the chest wall, arm, or lower leg. This forms the graft for damaged blood vessels. The surgeon attaches the graft’s ends below the obstructed heart artery and the aorta, establishing a new pathway for blood circulation. Multiple grafts may be employed during the same surgery if you have multiple blockages.
Post-surgery, healthcare providers restore the patient’s heartbeat in the operating room and stop the heart-lung machine. The surgeon uses wire to close the chest bone, and the wire remains in the body after the bone heals.
Apart from the on-pump surgery, there are other types of CABG surgery:
- Off-pump or beating-heart surgery: This technique operates on the beating heart without a heart-lung machine. It is challenging due to the heart’s continual movement and may not be suitable for everyone.
- Minimally invasive surgery: Conducted through small chest incisions, this approach involves the use of a laparoscope and video imaging for precision. It may be referred to as port access or keyhole surgery.
- Robotic surgery: In this minimally invasive surgery, robotic arms are used to conduct a laparoscopic procedure under the control of the cardiac surgeon.
After the Procedure
Following coronary artery bypass surgery, a dedicated team of healthcare professionals ensures your postoperative well-being, prioritising your comfort. Upon waking, patients may experience soreness and confusion, with the following expectations:
- Breathing tube: The breathing tube remains in the throat until patients regain the ability to breathe independently.
- Lack of movement: A catheter will be placed to help pass urine until you are ready and comfortable to use the restroom by yourself. There will also be tubes connected to your chest to drain out any excess fluids.
- Hospital stay: Anticipate spending 1 to 2 days in a hospital intensive care unit. The overall duration of your hospital stay is contingent on your recovery progress and the presence of any complications. Some individuals undergoing coronary artery bypass surgery may be discharged within a week.
- Monitoring heart rhythm and breathing: Your healthcare team closely observes you for any postoperative complications. Machines record your breathing and heart rhythm, and frequent temperature checks are conducted.
- Medications: Intravenous medications are administered to alleviate pain and prevent complications, such as blood clots. If you weren’t already taking a daily aspirin, your healthcare provider might recommend it for long-term use under specific medical guidelines. It’s crucial to discuss aspirin therapy with your healthcare provider.
- Cardiac rehabilitation: Commonly referred to as cardiac rehab, this supervised programme integrates education, counselling, and exercise to enhance heart health post-surgery. Encouragement to initiate movement and walking begins in the hospital and continues at a medical centre upon returning home, progressing to a safe home programme.
As part of your recovery, it is essential to remain vigilant for potential complications both at the hospital and at home. Promptly contact your healthcare provider if you experience:
- Fever.
- Rapid heart rate.
- New or exacerbated chest wound pain.
- Changes in skin colour around the chest wound.
- Bleeding or discharge from the chest wound.
What Is the Recovery Time?
Individuals undergoing CABG typically require several weeks for a complete recovery from the procedure. Throughout this period, their healthcare provider will advise against engaging in strenuous activities or situations that could exert excessive stress on the heart and incisions.
The healthcare provider serves as the most reliable source for estimating the recovery duration and outlining expectations. They will guide the individual on when to gradually reintroduce regular activities, such as returning to work, resuming exercise, and reinstating driving privileges.
Risks of CABG
Coronary artery bypass surgery carries inherent risks, like all surgical procedures. Potential complications include:
- Bleeding
- Fatality.
- A heart attack, resulting from a post-surgery blood clot.
- Infection at the chest wound site.
- Prolonged reliance on a breathing machine.
- Occurrence of irregular heart rhythms (arrhythmias).
- Kidney issues.
- Temporary memory loss or cognitive difficulties.
- Stroke.
The likelihood of complications is notably higher in emergency procedures. Individual risk factors also contribute to the potential for complications, with certain medical conditions amplifying these risks, including:
- Peripheral artery disease.
- Chronic obstructive pulmonary disease (COPD).
- Diabetes.
- Kidney disease.
To mitigate risks, medications controlling bleeding, blood pressure, and infection prevention are typically administered before surgery. For individuals with diabetes, blood sugar management during the surgical process may also be addressed through medication.
Your cardiac surgeon will explain and discuss all the potential risks, costs, and benefits of heart bypass surgery before deciding the suitability of the procedure for your unique circumstances.
Conclusion
Heart bypass surgery, or coronary artery bypass grafting (CABG), is a transformative surgery that significantly improves patients’ well-being and quality of life. It also reduces the risk of heart attacks. While heart bypass surgery is a major procedure, it is completely natural to feel concerned or anxious about it. Engaging in a conversation with your cardiac surgeon is crucial, as they can provide you with essential information and resources, aiding in a better understanding of the procedure. Furthermore, they can offer guidance on proactive measures to minimise complications and ensure the best possible outcomes.
Disclaimer:
This article has been written for information purposes only, and is not a substitute for professional medical advice by a qualified doctor or other health care professional. The author is not responsible or liable, directly or indirectly, for any form of damages whatsoever resulting from the use (or misuse) of information contained in or implied by the information in this article. Always consult a qualified healthcare provider for accurate diagnosis, personalised treatment, and recommendations tailored to your individual health needs.