Bypass Surgery

Coronary artery bypass surgery or coronary artery bypass graft ( CABG ) is a surgical procedure used to replace an obstructed artery in the heart in order to restore blood flow. A bypass is performed by taking a healthy blood vessel form another area of the body (usually the leg, arm or chest), and connecting it to the arteries in the heart in such a way that the blood bypasses the blocked artery. It is used in the treatment of atherosclerosis, a condition of the arteries wherein the walls of an artery thicken and narrow due to accumulation of white blood cells resulting in a plaque build-up.

Symptoms

The following symptoms can indicate a blockage in the heart and the need for surgery:

• Chest pain
• Irregular heartbeat
• Shortness of breath
• Weakness
• Coughing
• Dizziness
• Palpitations
• Anxiety can indicate a blockage in the coronary arteries
• A coronary bypass may also be performed post a heart attack if the patient does not respond well to other treatments 

Diagnosis

Atherosclerosis can be diagnosed with the help of the following tests:-

• Physical exam- during the physical exam, the doctor might look for weak pulse, an aneurysm and low blood pressure. Slow wound healing due to restricted blood flow can also be a sign of blockage. The doctor may also listen to the heart through a stethoscope. A ‘whooshing’ sound indicated blockage in the artery.
• Ultrasound- would show the presence of a blockage
• CT scan- a CT scan would help in determining the arteries that have narrowed
• Electrocardiogram (EKG)- an EKG measures the electrical activity in the heart. It would help in looking for restricted blood flow
• Magnetic resonance angiography- would help in seeing the large arteries in the body

Treatment

The patient will be given an anesthetic before the procedure. A long incision (8-10 inches) is made in the centre of the chest, along the breastbone. The surgeon then separates the rib cage or breastbone in order to create an opening and expose the heart. The heart is temporarily stopped and the patient is then connected to a cardiopulmonary bypass machine (heart-lung machine) which performs the functions of the lung and heart during the procedure. The surgeon then extracts a vein or healthy blood vessel from usually the leg or chest and connects the ends above and below the damaged artery thereby creating a bypass for the blood to flow. Once the bypass is created, the rib cage is wired together and the incision is closed with stitches. This procedure may also be performed off-pump, which is without the use of the heart-lung machine, on a beating heart.

Risks

A coronary artery bypass surgery may present with the following risks:

• Bleeding
• Infection at the site of the incision
• Arrhythmia (irregularities in the heart rhythm)
• Memory loss and trouble with clarity in thought
• Chances of a heart attack or stroke
• Kidney failure
• Fever or chest pain 

After Procedure

The surgery is usually 3-6 hours long which may vary depending on the number of arteries that need to be bypassed. The patient will be kept in the intensive care unit (ICU) for the next 1-2 days where his vital signs will be monitored. If there are no complications, the patient would be discharged within 3-5 days. Recovery usually takes about 6-12 weeks and the patient may be able to return to light ohysical activities in 6-8 weeks post consultation with a doctor.