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Cardiac Bypass

Coronary bypass surgery or heart bypass surgery is done when coronary arteries become blocked or damaged. Arteries supply oxygenated blood to the heart and if these arteries are blocked, or have restricted blood flow then the heart doesn’t work properly which can lead to heart failure. This surgical procedure diverts the blood flow around the section of a blocked or restricted artery in heart and improves the flow of the blood to heart muscle by creating a new pathway. In coronary bypass, a healthy blood vessel is taken from patient’s leg, arm or chest and connected to the other arteries in the heart to allow the blood to bypasses the diseased, narrowed or blocked area. This can also relieve the chest pain.

There are certain types of Coronary bypass or heart bypass surgeries such as:

1. Single Bypass in which only one artery is blocked.

2. Double Bypass when two arteries are blocked.

3. Triple Bypass where three arteries are blocked.

4. Quadruple Bypass when 4 arteries are blocked.

Heart attack or heart failure depends on the numbers of blocked arteries which can also make surgery long and more complex.Cardiologist can suggest patient for coronary bypass surgery depending on the factors such as

• If patient have severe chest pain caused by narrowing of several of the arteries that supply blood to the heart leaving the muscle short of blood during even light exercise or at rest. Angioplasty and stenting can help in some cases, but for some types of blockages, heart bypass surgery may be the best option.

• Patient who may have more than one diseased or blocked/restricted coronary artery and the left ventricle which is the heart's main pumping chamber is not functioning well.

• Patient’s left ventricle (primary pumping chamber of the heart) is severely damaged.

• Patient who had previous unsuccessful angioplasty or stent placement or who already had stent placement but the artery has narrowed again (restenosis).

• In case of emergency situations such as a heart attack and patient is not responding well to the other treatments, coronary bypass surgery may be performed.

Coronary bypass surgery doesn't cure atherosclerosis or coronary artery disease which is the underlying heart disease that caused blockages in the first place. Coronary bypass surgery can be complicated for the patients who already have diabetes, emphysema, kidney disease or peripheral arterial disease (PAD). Cardiologist will discuss with the patient about their family medical history and medications taken.

As it is an open-heart surgery, patient may have possible complications depending on the health, age, severity of the heart disease during or after the coronary bypass surgery procedure that may include:

• Bleeding

• Arrhythmia (irregular heart rhythm)

• Chest pain due to the wound infection

• Blood clots

• Temporary or permanent memory loss or troubles with thinking clearly

• Kidney problems

• Heart stroke or heart attack

In coronary bypass surgery doctor will give the proper instructions to the patient on how to prepare for it and can suggest some tests like blood samples, chest x-ray, electrocardiogram (ECG), angiogram that can help doctor to get the right picture of the patient’s health situation.

Coronary bypass surgery requires general anesthesia after which patient will fall into deep and painless sleep. The number of bypasses needed can depend on the area and severity of blockages in the heart.

Mostly, coronary bypass surgeries are done through a long incision or cut in the middle of the chest and spreads open the rib cage to expose the heart while blood flow is diverted through a heart-lung machine (called on-pump coronary bypass surgery) which circulates the oxygenated blood through the body. Some procedures doesn’t require off-pump machine (heart lung machine). The surgeon may take a section of healthy blood vessel, generally from internal mammary artery inside the chest wall or from the leg, and attaches the ends above and below the blocked artery so that blood flow is bypassed around the narrowed portion of the diseased or blocked artery.

Surgeon can use other technique also in coronary bypass surgery such as off pump or beating heart surgical technique. In which surgery is being performed on the still beating heart using heart stabilizing equipment. It is not the best option for all heart patients as it is performed on moving heart making it more challenging.

Other type of technique is minimally invasive surgery. In this procedure, a smaller incision in the chest is made, often with the use of robotics and video imaging which helps the surgeon to operate in a small area. Minimally invasive surgery may be called port-access or keyhole surgery.

Coronary or heart bypass surgery is a major surgery. Patient’s heart, blood pressure, breathing and other vital signs will be monitored by keeping him or her in the ICU for a day or two with the breathing tube remained in the throat till patient is able to breathe on its own.

Proper instructions, lifestyle changes, medications will be suggested by the surgeon post surgery to lower blood cholesterol, risk of developing blood clot and infection of the chest wound for healthy functioning of the heart. Generally recovery from heart or coronary bypass surgery can take six to 12 weeks.

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