What is Heart Bypass Surgery?
Cardiovascular and Thoracic Surgeon, 39 years of experience
What is the meaning of Heart Bypass Surgery?
Heart bypass surgery is performed when the arteries that supply blood to the heart muscles become damaged. The main function of your heart is to pump blood throughout your body. First, this blood is sent to the lungs, where it mixes with oxygen. The oxygenated blood is then pumped through the heart to all the organs of the body. This work is essential for our body as no part of the body functions without blood and oxygen.
Similarly, if the heart muscles do not get proper blood supply, it can create serious complications in the heart. In heart bypass surgery, a healthy artery is taken from another area of the body (most commonly from the arm, or chest), and/or a vein is taken from the leg and is connected to the blocked arteries in the heart. It allows the blood to bypass the damaged artery and improves the functioning of heart muscles.
In this article, you will get detailed information about Heart Bypass Surgery.
- What is the purpose of Heart Bypass Surgery?
- Types of Heart Bypass Surgery
- Preparation before Heart Bypass Surgery
- What is the procedure of Heart Bypass Surgery?
- How to care for Heart Bypass Surgery?
- Risks of Heart Bypass Surgery
- The success rate of Heart Bypass Surgery
- Alternatives to Heart Bypass Surgery
- What is the cost of Heart Bypass Surgery in India?
What is the purpose of Heart Bypass Surgery?
Bypass surgery may be recommended in some of the following heart conditions:
- Angina or chest pain, caused by the narrowing of several arteries that supply blood to the heart.
- If more than one coronary artery that supplies the majority of blood to the heart muscle is diseased.
- The left ventricle, the main blood-pumping chamber of the heart, is not functioning well.
- A blocked artery cannot be treated by other methods such as angioplasty in which a tiny balloon is inserted and inflated to widen the artery.
- Previous unsuccessful angioplasty or stent surgery
- Atherosclerosis- a condition in which there is a narrowing of arteries due to the buildup of plaque.
- Coronary bypass surgery might also be performed during an emergency such as a heart attack when other medications and treatments aren’t responding and angiography shows multiple blocked vessels.
The following signs and symptoms may indicate coronary artery disease-
- Angina or chest pain
- Shortness of breath
- Abnormal heart rhythms or arrhythmia
- Swelling (edema) in the hands and feet
However, in early coronary artery disease, you might not experience any signs and symptoms until the blockage is large enough to cause symptoms and complications. Hence it is important to undergo routine cardiovascular screening tests with advancing age.
Do (Know more about-What is Cardiac Arrest and Heart Attacks? Causes, Symptoms, and Treatment)
Types of Heart Bypass surgery
- Depending on the number of blocked arteries, the following surgeries can be performed-
- Single bypass in which there is only 1 blocked artery.
- Double bypass in which 2 arteries are blocked.
- Triple bypass in which 3 arteries are blocked.
- Quadruple bypass or multi-vessel bypass depending upon the number of arteries that need grafting.
1. The cardiac bypass surgery can be done with the help of CPB or it can be done without CPB called beating heart surgery or off-pump coronary artery bypass grafting (OP- CABG).
2. Depending upon the approach used for surgery it can be
- Midline sternotomy: where the sternal bone is cut in the midline to expose the heart and conduct the surgery
- Minimally invasive: In this, the front bone or sternal bone is not cut. The surgery is done from a small incision on the left side of the chest. The advantage is minimal pain, faster recovery, and fewer complications but this facility is not available at all centers.
- Robotic-assisted bypass surgery: In this technique, a robot is used to harvest the internal mammary artery for bypass grafting and surgery is then completed by minimally invasive technique to complete the bypass grafting. In this the chest wall retraction is less to post-operative pain is very low and recovery is very fast.
3. Depending upon the type of conduits used, cardiac bypass surgery can be classified as:
- 1. Total arterial bypass grafting where all the blocked vessels are bypassed with arterial grafts. In this, the conduit vessels are either harvested from both sides of the chest or one artery is taken from the chest and the other is taken from the hand.
- 2. CABG where one or more vessels are bypassed with the help of a vein and another vessel is bypassed with the help of an artery taken from the chest wall.
- Sometimes in some cases, all the vessels are bypassed with the help of a vein only.
The type of conduit used depends upon the distal vessel runoff on angiography, size of the vessel, quality of the vessel, and left ventricular dysfunction and general condition of the patient along with co-morbidities and is best decided by the operating team.
The risk of heart failure, heart attack, and other cardiac problems depends on the number of arteries blocked. The procedures involving more blocked arteries are also longer and more complex.
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Preparation before Heart Bypass Surgery
If a heart bypass surgery has been recommended for you, your doctor will explain to you the entire procedure and give you complete instructions on how to prepare for it:
- Your doctor will take your medical history and do a thorough physical examination to make sure you are in good health before the procedure.
- It is important to tell your doctor if you are allergic to any medications, anesthesia, latex, tape, etc., and inform him/her about all the medications, vitamins, supplements that you are taking. Certain medications such as blood thinners, aspirin, and other drugs that affect blood clotting need to be stopped before the procedure.
- You will be asked to undergo investigations and diagnostic tests such as blood tests, chest X-rays, electrocardiogram (ECG or EKG), and angiogram (X-rays to visualize the heart’s blood vessels), echocardiography, and carotid and peripheral arterial Doppler.
- You will be asked to be on an empty stomach for 8 hours before the surgery.
- If you are a smoker, quit smoking as soon as possible as it can delay the healing time after the surgery.
- Make arrangements to stay in the hospital for several days post-surgery.
- Take a bath before the procedure with soap to reduce the risk of infection and keep your body germ-free until surgery. You will also have to shave your hair if it is present on the incision site.
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What is the procedure of Heart Bypass Surgery?
Before surgery, you will change into a hospital gown and receive medication, fluids, and anesthesia. For general anesthesia, a breathing tube is inserted through your mouth that is attached to a ventilator. The ventilator breathes for you during and immediately after the surgery. When anesthesia starts working, you will fall into a deep, painless sleep.
- A heart bypass surgery usually takes about three to six hours, but this can vary depending on the number of blocked arteries and complications involved.
- 1. the First step- Your surgeon starts by making an incision or cut in the middle of your chest. 2. Then, the rib cage is spread apart to reach the heart.
- 3. Your surgeon may also opt for minimally invasive surgery involving smaller cuts and special miniaturized instruments and robotic procedures but this will be discussed with you before the procedure.
- 4. Most of the cardiac bypass procedures performed at the center are done without bypass i.e. off-pump bypass grafting ( OP- CABG) or beating heart surgery.
- 5. In some rare cases, the bypass will be conducted on CPB. In this case, you will be connected to a cardiopulmonary bypass machine that circulates oxygen-rich blood through your body while your surgeon operates on your heart.
- 6. Grafting – Your surgeon then harvests the conduits to bypass the blocked or damaged portion of your artery depending on the surgical plan. One end of the graft is attached above the blockage, and the other end is attached distally to the graft.
- Final step – When your surgeon is done, the function of the bypass is checked. Once the bypass is working, the chest is closed, you will be taken to the Intensive Care Unit (ICU) for monitoring.
Heart bypass surgery takes around three to six hours. It is a complex process. The more arteries that need grafting, the longer it takes.
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How to care about Heart Bypass Surgery?
After the surgery, you will be kept in the intensive care unit (ICU) for about one to two days, where you will be monitored. Machines will constantly display your ECG tracing, blood pressure, breathing, heart rate, and oxygen level. The breathing tube will still be attached until you wake up and can breathe on your own.
Your cardiac rehabilitation will begin while you are in the hospital itself, and your doctor will give you a special exercise and education program that will help you recover. You will continue with monitored programs in an outpatient department (OPD) until you can follow a home-based maintenance program safely.
You will be taught how to take care of your incision site to prevent any risk of infection and other complications. It is normal to experience some pain at the incision site, pain with deep breaths, and pain while coughing. Your doctor will prescribe some medications such as ibuprofen and acetaminophen to manage your pain.
You will be discharged from the hospital within a week if you do not have any complications. You will still find it difficult to walk short distances and do your daily chores immediately after the surgery.
If you experience any of the following symptoms after returning home, call your doctor immediately –
- Fever over 38 degrees Celsius
- New or increasing pain around the chest.
- Rapid heart rate
- Reddening or bleeding or discharge from the chest wound
- Persistent vomiting and nausea
- Swelling or edema in the legs and numbness in the arms
Recovery from bypass surgery can take about 6 to 12 weeks. During this period, you must avoid strenuous exertion and follow all the instructions given by your doctor. If your doctor permits, you can return to work and begin light exercises.
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Risks of Heart Bypass Surgery
As heart bypass surgery is an open-heart surgery you might have complications during and after the procedure. These risks include-
- Bleeding during and after the procedure
- Irregular heart rhythm or arrhythmias
- Blood clots causing heart attack and stroke.
- Infections of the chest wound and chest pain.
- Kidney failure
- Graft failure
- Difficulty in breathing
- Memory loss or trouble in thinking clearly
Many things affect these risks, including your age, how many bypasses you have undergone, and if you have other medical conditions, such as emphysema, kidney disease, diabetes, or blocked arteries in your legs.
The success rate of Heart Bypass Surgery
A heart bypass surgery is a serious operation but is relatively safe. Cardiac surgeons perform a large number of heart bypass operations every year and many of those who have the surgery get relief from their symptoms without needing long-term medication. However, if the heart disease is very severe, there is a higher risk of complications. The mortality rate after a heart bypass surgery is about 1% in normal risk patients though the risk increases in patients with multiple co-morbidities or severe left ventricular dysfunction etc. Most patients are doing well after five to ten years post-surgery and thereafter depending upon the co-morbidities and associated conditions.
If there are no complications, most people can expect a better quality of life soon after the surgery. After surgery, your chest pain as well as other symptoms related to blocked coronary arteries will significantly reduce. A successful heart bypass surgery typically means that a person is at a much lower risk of heart attack and death.
Alternatives to Heart Bypass Surgery
- Angioplasty– It is an alternative procedure in which a tube is threaded through your blocked artery, and a small balloon is inflated to widen the artery. The tube and balloon are then removed, and a small metal scaffold, also known as a stent, will be left in place. This stent keeps the artery from narrowing again and returning to its original size.
- Medications– Before opting for a surgical procedure, you can try certain medications such as beta-blockers, cholesterol-reducing drugs, aspirin, etc.
- Diet and lifestyle changes- The best way to prevent and reduce the risks of heart disease is by following a heart-healthy lifestyle that consists of a diet high in omega-3 fatty acids and low in saturated and trans fats. Regular exercise also greatly helps your heart stay healthy.
( Know more about- What is Coronary Angioplasty? Causes, Procedure, Aftercare, Cost)
What is the cost of Heart Bypass Surgery in India?
The total cost of heart bypass surgery in India can range from around INR 3,25,000 to INR 5,25,000. However, the cost of surgery may vary across different hospitals. There are many big hospitals and specialized doctors in India for heart bypass surgery.
If you are coming from abroad, in addition to the expenses of heart bypass surgery, there will be a cost of staying in a hotel, cost of living, and cost of local travel. Apart from this, after the surgery, the patient is kept in hospital for 8 days and in the hotel for 12 days for recovery. So, the total cost of heart bypass surgery in India will be around INR 4,50,000 to INR 6,00,000.
We hope we were able to answer your questions on Heart Bypass Surgery in this article.
If you want further information and treatment of Heart Bypass Surgery then contact a Cardiovascular and Thoracic Surgeon.
We only aim to provide you with information through this article. We don’t recommend any medication or surgery of any kind. Only a doctor can give you the best advice and correct treatment plan.