Overview
Heart Bypass Surgery
The heart muscle is supplied blood through the coronary arteries. The left coronary artery supplies blood to the left ventricle. The right coronary artery supplies blood to the right ventricle.
Coronary artery bypass grafting (CABG) or heart bypass surgery is recommended when one or more coronary arteries are seriously blocked and blood supply to the heart muscle is insufficient. Several tests are done to identify the cause of the chest pain (angina), such as blood tests and x-ray studies (angiograms).
Although the heart itself is not "opened", the heart-lung bypass machine is used to re-route the blood from the heart while the surgery is being done to provide adequate circulation to the brain and other vital organs.
Coronary bypass surgery is an open heart surgery (the chest is opened, but not the heart itself). It is done through an opening through the breast bone. While one surgeon is working on the chest, another surgeon works on taking a length of vein (saphenous vein) for the bypass through a long incision along the inside of the lower leg. The vein is sewn in above and below the blockage in the coronary artery. Alternatively, an artery from the interior aspect of the chest wall (internal mammary artery), or the arm (radial artery) is used.
In many cases, more than one coronary artery must be bypassed, and both the internal mammary and radial arteries and the saphenous vein are used to perform the bypasses.
After the operation, the patient will spend 7 to 10 days in the hospital, the first 1 to 3 days in an intensive-care unit (ICU). Chest tubes will be in place for the first 2 to 3 days to drain any residual blood and fluid from around the heart. Heart functions will be monitored. The full benefits from the operation may not be ascertained until 3 to 6 months after surgery. Sexual activity may be resumed 3 to 4 weeks after surgery. All activities that do not cause fatigue are permitted, but the patient must not strain the healing chest bone (sternum).
What is Traditional Bypass Surgery?
Coronary artery bypass surgery became routine in the late 1950s with the invention of the heart-lung machine. With "traditional" bypass surgery, surgeons use the assistance of the heart-lung machine along with medications to stop the heart so the bypass can be performed on a motionless field. The heart-lung machine is referred to as a "pump" because it continues to mechanically pump oxygen and nutrients to the body during surgery.
Beating Heart Bypass Surgery
Recent advances in surgery and medical devices allow doctors to have less invasive options in the treatment of coronary artery disease (CAD), such as Beating Heart or "Off-Pump" Bypass Surgery. Now individuals who have medical conditions such as diabetes, history of stroke, or poor physical health, can undergo cardiac surgery with lower risk for developing complications.
Clinical Benefits of Beating Heart Bypass Surgery
Your physician may choose the beating heart bypass procedure for you because of benefits such as:
Decreased length of hospital stayLess trauma due to the elimination of the heart-lung machineReduction in need for blood transfusionsFewer cognitive and neurological consequences
After Surgery :
If the procedure was done "on pump," electric shocks start the heart pumping again after the grafts have been completed. The heart-lung machine is turned off and the blood slowly returns to normal. Pacing wires and a chest tube to drain fluid are placed before the sternum is closed surgically with special sternal wires and the chest with special internal or traditional external stitches. Sometimes a temporary pacemaker is attached to the pacing wires to regulate the heart rhythm until your condition improves.
The patient is transferred to an intensive care unit for close monitoring for about one to two days after the surgery. The monitoring during recovery includes frequent checks of vital signs and other parameters, such as heart sounds and blood work.
Once the patient is transferred to the nursing unit, the hospital stay is about 3 to 5 more days
What can I expect after my heart surgery?
After successful heart surgery, patients can expect to return to their preoperative condition or better.
When you leave the hospital after heart surgery, you will be given instructions on how to care for yourself during the first phase of recovery which lasts about six to eight weeks. Those who have had minimally invasive surgery may have a shorter recovery time.
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