Heart Bypass Surgery

Coronary artery bypass grafting (CABG) is a kind of surgery that improves blood flow to the heart. It's
performed on people who have severe coronary heart disease (CHD).
CHD is a chronic disease in which plaque builds up inside the coronary arteries. These arteries supplies oxygenated blood to your heart. Plaque is formed of fat, cholesterol, calcium, and other substances found in the blood.
Plaque may narrow the coronary arteries and reduce blood flow to the heart. If the blockage is severe, angina, poor oxygen supply, and heart attack can occur.
Doctors who perform this kind of open heart surgery are called cardiothoracic surgeons.
Other frequently used terms for Coronary Artery Bypass Grafting are,

• 1. Bypass surgery
• 2. Coronary artery bypass surgery
• 3. Heart bypass surgery

They are

Traditional Coronary Artery Bypass Grafting:

This is the most common type. It's used when at least one major artery needs to be bypassed. During the surgery, the cardiothoracic surgeon opens up the chest bone, exposing the heart. Medications are given to stop the heart, and a heart-lung bypass machine is used to keep blood and oxygen transportation throughout the body during surgery. This allows the cardiac surgeon to operate on a still heart.
After surgery, blood flow to the heart may start on its own. In some cases, mild electric shocks are used with the help of paddles to restart the heart.
 

Off-Pump Coronary Artery Bypass Grafting:

Off pump CABG is similar to traditional CABG as here also, the surgeon opens the chest bone to access the heart. However, the heart isn't stopped, and a heart-lung bypass machine isn't used.
 

Minimally Invasive Direct Coronary Artery Bypass Grafting:

This surgery is similar to off-pump CABG.
Large incision to open the chest bone is avoided, instead of a large incision, several small incisions are made on the left side of the chest in the intercoastal space between two ribs.

Tests may be done to prepare a patient for CABG. For example, blood tests, EKG ,echocardiography, x ray of the chest, catheterization or coronary angiography.
Your cardiac surgeon will give you specific instructions about how to prepare for surgery. You are likely to be admitted to the hospital on the same day as the surgery.

Tests are done to find out which arteries are clogged, They are,

• 1. EKG (Electrocardiogram)

An EKG records your heart's electrical activity. This test is useful in determining the source of heart problems.
An EKG shows beating frequency and rhthm of your heart. It also records the strength and timing of electrical signals.

• 2. Stress Test

During stress testing, you exercise to make your heart work harder and beat fastly while tests are being performed. These tests may include heart scanning, echocardiography, and magnetic resonance imaging (MRI) and PET scanning of the heart.

• 3. Echocardiography

Echocardiography also known as echo, uses sound waves to create a moving picture of your heart. The test provides information about the size and shape of heart and how well your heart's chambers and valves are working.
The test also can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle.

• 4.Coronary Angiography

Coronary angiography uses dye and special x ray imaging techniques to show the interior part of of your coronary arteries.
The dye helps the cardiothoracic surgeon study the flow of blood through heart and blood vessels and locate blockages that can cause a heart attack.

Some possible surgical risks surgery include:

• 1. Hyperthermia (high fever)
• 2. Exaggerated immune response (causing infections)
• 3. Bleeding at the site of the incision
• 4. Anesthesia may cause some reaction
• 5. Excessive Bbood loss
• 6. Formation of blood clots that could affect the lungs as lungs are nearer to heart
• 7. Stroke
• 8. Arrythmia (Problems in rhythm of heart during beating)
• 9. Pneumonia
• 10. Difficulty in breathing
• 11. Kidney failure
• 12. Impairment of cognitive functions due to surgery

Complications can arise during or after coronary artery bypass, it includes,

1. Blood flow to the heart may get interrupted if bypass isn't functioning properly.
2. Blocking of the new bypass blood vessel.
3. Death during surgery.
4. Nerve damage in the leg from where the graft is taken for CABG.
5. Pain and swelling in the legs.

The benefits of coronary artery bypass surgery are:

1. Relief from chest pain or angina.
2. A decreased risk of a heart attack.
3. Results last longer as a surgical revascularization is long lasting when compared to a stent procedure.

Alternatives to coronary artery bypass grafting include:

1. Medications that dilates blood vessels.
2. Lifestyle changes,
3. Balloon Angioplasty
4. Coronary Stenting
5. Laser Angioplasty

The post-procedure guidelines after undergoing a coronary artery bypass grafting are:

1. You will be shifted to the Intensive Care Unit(ICU) where you will be constantly monitored for 2 days at minimum.
2. There will be a breathing tube in your windpipe.
3. You will be advised to take deep breaths and also to cough atleast, 10 to 20 times an hour after surgery in order to prevent fluid build-up in lungs.
4. Some tests such as chest x-ray, ECG, and blood tests will be done on you to rule out any form of complications.
5. You may feel fatigue after the surgery, as you may suffer from anemia for sometime after surgery.
6. Most of the stitches and will dissolve over time. The staples are taken out after about seven days.
7. You will be asked to come for follow-up visits to the hospital after regular intervals.

The recovery period from coronary artery bypass usually takes six to twelve weeks.

Heart surgery costs Rs.1.5 lakh to Rs.2.25 lakh; in India. It may go as high as 4 to 8 lakh depending upon the kind of hospital you choose for your surgery.

Many foreigners visit India for bypass surgery due to following reasons,

• Top and Qualified Doctors: India has top and qualified doctors, specialists.
• Low Cost: For international patients, these treatments are inexpensive and don’t hamper their budget making it affordable at low cost.
• Visa: The government of India is also encouraging the medical tourism by providing M-VISA to foreigners which is why it is quite easy to get a medical visa.
• Medical Tourism Facilitation: The ISO certified companies provides medical treatment or procedure packages & amp services along with arrangement of hotel, food, visa & transportation.

Minimally Invasive Direct Coronary Artery Bypass Grafting (MIDCAB) is one of the recently discovered heart surgery. Complications are low, the success rate is high, and the mortality is low in this minimally invasive procedure.

The cost of Heart Bypass Surgery in India varies across different cities and hospitals.

Heart bypass surgery or coronary artery bypass graft is a surgical procedure done to redirect the blood around a section of a blocked artery in the heart. 
The procedure is performed by taking a healthy blood vessel from the arm, chest, or leg and connecting it above and below the blocked arteries in the heart.

Heart bypass surgery is classified into the following types, based on how it is performed:

• Open-heart surgery: The surgeon opens the chest area to reach the heart in this type of surgery. It can be performed in the following ways:
• On-pump surgery: The surgeon uses a heart-lung bypass machine to circulate the air and blood through the body. The heart can be stopped during the surgery, which makes the procedure easier to perform.
• Off-pump surgery: This type of surgery does not involve the use of a heart-lung machine and is done while the heart is still beating.
• Minimally invasive surgery: This type of surgery is performed without opening the chest by the surgeon.

A heart bypass surgery is performed in the following conditions:

• Coronary artery disease (a condition in which a waxy substance called plaque builds up inside the arteries in the heart, and blocks the oxygen and blood from reaching the heart)
• Chest pain due to the blockage of several arteries supplying blood to the heart
• Blockage in the main left coronary artery, which gives the left ventricle most of its blood
• A disease in one of the coronary arteries that cause the left ventricle (the heart chamber that helps the heart to pump blood to the rest of the body) to not function properly
• New blockages
• Failure of other heart procedures
• Narrowing of the arteries again after treatment
• Heart attack

The following tests may be recommended before a heart bypass surgery:

1. Physical examination: The doctor will evaluate the patient’s overall physical health status. The symptoms, medical history, and family history of the patient are also noted.
2. Blood tests: This test helps to evaluate the overall well-being of the patient, and to check for any underlying medical conditions.
3. Urine tests: This test helps in diagnosing any infections that may be present.
4. Chest x-ray: This test helps the doctor to check the condition of the heart and lungs.
5. Electrocardiogram (ECG): This test records the electrical activity of the heart.
6. Coronary angiogram: This is a test done to check for any blockage that may be present in the coronary artery.

Heart bypass surgery is performed by a Cardiovascular surgeon.

If the procedure is not done under emergency and is scheduled in advance, the following preparation may be required before the surgery:

• Inform the doctor about any medical disorders that you may be having.
• Tell the doctor if you are taking any medications, supplements, or herbs.
• If you have any known allergy to anesthesia, latex, iodine, tape, or medications, tell the doctor about the same.
• Stop smoking as soon as possible.
• You will be told to stop taking blood-thinners like aspirin and warfarin a few days before the procedure.
• You will be asked to not eat or drink anything eight hours before the procedure.
• Tell your doctor if you have symptoms of cold and flu just before the surgery. The procedure is usually delayed till the symptoms of flu subside.
• The doctor may recommend a special antibacterial soap with which you can wash your body the day before the surgery to kill the germs.

A heart bypass surgery is generally performed under general anesthesia, that is, the patient is put to sleep during the surgery.
The number of bypasses done depends on where the blockage is and how severe the blockage in the heart is.
The surgery takes about 3 to 6 hours to finish.
A heart bypass surgery can be done in the following different ways:

1. Open-heart surgery:
The surgeon makes a long incision or cut in the chest area.
Open-heart surgery can be performed in the following ways:
On-pump heart bypass surgery:
The surgeon cuts through the center of the chest along the breastbone.
The rib cage is spread open by the surgeon to expose the heart.
After the chest is opened, the heart is stopped temporarily using some medication and a heart-lung bypass machine.
The bypass machine takes over the function of the heart and lungs and circulates blood to the rest of the body.
A section of a healthy blood vessel is excised by the surgeon, usually from the lower leg or from inside the wall of the chest.
The ends of the healthy blood vessel are attached above and below the blocked artery in order to redirect the blood flow around the narrow part of the diseased artery.
After the graft placement is completed, the heartbeat is restored and the patient is disconnected from the heart-lung bypass machine.
A wire is used by the surgeon to close the chest bone. This wire will remain in the body after the bone heals.
The incision in the chest region is closed by the surgeon using sutures (stitches).
Off-pump surgery:
This procedure involves performing the surgery on a beating heart using special equipment for stabilizing the area of the heart which is being operated on.
This type of open-heart surgery is challenging since the heart is still moving while performing this surgery.

2. Minimally-invasive surgery:
The surgeon makes small key-hole incisions in the chest region to perform this type of heart bypass surgery.
The procedure can also be done by robotic arms that are guided by the surgeon through a monitor.

The following are the post-procedure steps after a heart bypass surgery:

• There will be some wires and a breathing tube connected to the patient after the surgery. They are normally removed after two days.
• The patient is usually kept in the hospital for five to seven days after the procedure.
• It is normal to feel some pain and stiffness in the chest after the procedure.
• The doctor may prescribe medications to relieve the pain and discomfort.
• Follow-up appointments with the doctor can help you in discussing medications, wound care, and physical activity.
• The doctor may advise you to attend a cardiac rehabilitation program, which is a supervised exercise and nutrition program that will help you in recovering from the surgery.
• It is normal to have a loss of appetite and constipation after the surgery.
• In case of the removal of a healthy vein from the leg, it is normal to have some swelling in that area after the procedure.
• You may be able to return to your daily activities 6 weeks after the surgery.
• Avoid driving for 4 to 6 weeks after the surgery.
• Avoid sexual activity for at least 3 weeks after the surgery.
• Complete recovery may take 2 to 3 months.

The risks involved with a heart bypass surgery are:

• Bleeding
• Infection
• Chest pain
• Arrhythmia (irregular heart rhythm)
• Blood clot formation
• Kidney failure
• Heart attack
• Stroke (a condition in which the blood supply to the brain is interrupted)

• Following a heart bypass surgery, most people remain symptom-free and feel better for 10 to 15 years.
• However, with the passage of time, the arteries or the new graft placed may become clogged and require another bypass surgery.
• The long-term outcome is more favorable by making the following lifestyle choices:
• Take your medications regularly to prevent blood clot formation
• Control your blood sugar levels
• Keep your blood pressure under control
• Keep your cholesterol levels under control
• Quit smoking
• Eat a well-balanced, healthy diet
• Maintain a healthy weight
• Manage your stress
• Exercise regularly