Introduction
Coronary Artery Diseases: The tissues of the heart muscles require oxygenated blood which is provided by the coronary arteries as the heart is not able to take up the oxygen from the blood that is passing via the heart chambers.
There are three types of coronary arteries: the Right side of the heart receives the blood from the right coronary artery. The left side of the heart receives the blood from the left anterior descending and circumflex arteries. There are many branches for each coronary arteries.
Due to the plaque formation or blood clots it results in the narrowing of the arteries, results in the decrease in the flow of blood and oxygen provided to the muscles of the heart and different organs of the body. The heart’s lining is damaged and the risk for plaque formation is due to various reasons such as smoking, increased blood pressure, increases cholesterol levels, inflammation and increased sugar levels.
In the United States, every year around 200,000 such surgeries are performed by the physicians. Coronary Artery Bypass Surgery (CABG) is performed when the coronary arteries get clogged or damaged. Due to the blockage of these arteries, the flow of blood is reduced and the functioning of the heart is affected, failing the heart.
What is bypass surgery?
CABG i.e. Coronary Artery Bypass Surgery is a surgery for the treatment of coronary artery disease. The need for this surgery is to increase the flow of blood to the muscles of the heart. In this operation, the surgeon creates new ways for the passage of blood flow. A clogged or narrow portion of the coronary artery is bypassed by using a graft. A graft is defined as the length of the vein or artery that is normally taken up from the leg i.e. saphenous vein, the wall of the chest i.e. internal mammary artery, or the forearm i.e. radial artery. It is a necessity to get one to six grafts.
Types of Bypass Surgery
Depending on the number of blocked arteries, the physician will recommend the type of surgery:
- Single Bypass: In this case, one artery is blocked.
- Double Bypass: In this case, both the arteries are blocked.
- Triple Bypass: In this case, three arteries are blocked.
- Quadruple Bypass: In this case, four arteries were blocked.
- Quintriple Bypass: In this case, all five arteries that are providing nutrient and oxygen to the heart is affected. The utmost care to be taken when doing this surgery.
Depending on the number of blocked arteries, the risk of having a heart attack, heart failure and other cardiac issues lie. The time for surgery also varies depending on the number of blockages.
The need for heart bypass surgery
When there is plaque formation in the arterial wall, the flow of blood reduces to the muscle of the heart. This sort of coronary artery disease is termed atherosclerosis.
There are chances of the heart getting exhausted and failing the heart if not getting proper blood supply. Arteries in the body are affected by atherosclerosis.
If the coronary arteries get narrowed or clogged for the risk of a heart attack, the physician may recommend surgery for a heart bypass.
When there is a sever blockage that cannot be handled with any medicines or other treatments, the doctor will suggest going for bypass surgery.
How do we decide the need for bypass surgery?
There would be a team of doctors who decide whether the surgery could be done or no. A few of the medical illnesses or diseases, could affect the surgery or eliminate it.
These medical conditions include diabetes, emphysema, kidney conditions, peripheral artery disease (PAD). Important to share these details with your doctor before moving ahead with the surgery. Surgeries that are planned are far better than the emergency ones.
The Procedure for Heart Bypass
Initially if possible, the doctors or physicians would solve the problem or the issue of blocked arteries by giving medications or any other non-invasive methods or procedures like a stent. If these methods do not work are not suiting any individual, surgeons decide to go ahead for a heart bypass surgery. Heart bypass surgery is considered to be one of the major efficient “weapons” to be used against the clogged arteries and the issues they might cause.
According to the American Heart Association (AHA), CABG includes the removal of a blood vessel from chest, arms or legs and produces a “detour” i.e. taking a different route/ way to avoid something or bypass near the blockage. This method/operation will help in the easy flow of blood to the heart.
If the blood vessel has been removed from a different area of the body, it will not considerably affect the flow of blood in the part the blood vessel has come from.
Types of Heart Bypass Surgery
This is open-heart surgery, in this treatment, the chest is opened up to reach the heart by a cut made by the surgeon. Surgery can be performed by the surgeon “on-pump” or “off-pump.”
On-pump surgery means the use of heart-lung equipment that helps in the circulation of the blood and “breathes for the body.” To make the treatment/ surgery easier, this equipment allows the physician to “stop the heart.”
Off-Pump surgery means “beating heart surgery”, this occurs while still, the heart is beating. But does not make the use of the heart-lung machine.
A few times, the surgery can be done without the chest being opened by the surgeon. The risk factors and related complications differ from person to person. A physician can conclude which method is the best way to treat the problem.
Risk Factors for Heart Bypass Surgery
There is a risk with any of the procedures, so the same with the heart bypass surgery. There are chances of surgery being successful, due to advancements in the new technology.
Risks that occur after surgery include:
- Bleeding
- Arrhythmias
- A clot in the blood
- Pain in the chest
- Infection
- Failure of Kidney
- Heart Attack or Stroke
Preparing one-self before surgery
Before performing the surgery, important to bring out life-style changes and also maintain the same for the long-term to benefit out from the surgery. Also getting ready for the surgery on emotional terms.
Smoking: Important to stop smoking, for a better recovery. Smoking results in problems in breathing post-surgery and higher the chances of the new graft getting clogged.
Work and legal issues: Recovery post-surgery will take approximately two to three months. It is important to inform the head in the office related to your return to work in a span of six to twelve weeks. In-case any help related to finance is required, could ask a doctor to give a referral for work and income.
Travel Arrangements: If surgery requires a shift to a different center, the “referring hospital” will help with the traveling cost and expenses.
Stay for relatives: The units mainly for cardiac surgery helps in the stay and ways to deal with emotional, social, emotional or practical problems. These issues could happen when the surgery is done a long way from the home-town.
Wait for the surgery: If an emergency case arises, the surgery might get postponed, even if the date and time for surgery have been given or “when admitted for surgery.”
Before surgery
Admission is one day before the operation/surgery.
Medical History (Allergies) and all details will be recorded. At the end need to sign a letter, as a confirmation or consent from your end to move ahead with the treatment.
Carry a lose-fitting night-dress and clothes to the hospital. Once the surgery is done, the muscles and wounds become sensitive and to avoid any sort of irritation it is important to wear loose clothes.
Some tests might be required before the surgery needs to be done, like blood tests, chest X-ray and an Electrocardiogram (ECG). Medications would be given before surgery via the IV line.
Areas around the chest, legs, and arms will be removed or shaved.
Final Day of Surgery
On the day of surgery, the physician or nurse will ask you to stop eating or drinking at their time. Medicines will be given which helps to relax and makes you feel dizzy.
In the procedure of the treatment or surgery, a cut will be made in the middle of the chest, via the breastbone (sternum) to extend to the heart. The heart stops temporarily until the treatment or surgery is done. In this phase/stage, the blood flow is diverted via heart-lung equipment. This by-pass equipment performs the function of the heart i.e. pumping and lungs i.e. breathing.
They might also undergo off-pump bypass surgery, in this case, the heart/lung equipment is not required.
The surgery for Coronary Artery Bypass takes approximately three to six hours, based on the requirement.
The grafting will be done from either the chest, arms or legs. For the initial few days after the operation, a bandage will be there or dressing would be done.
An Endoscopic Vein Harvesting would be done i.e. the vein is taken from the leg that uses up-to three tiny cuts/openings that decrease the scars.
Post-operative stage
Post-Surgery you will be shifted to the Intensive Care Unit (ICU). Monitoring will be done for initial 24-48 hours, till the time you gain back consciousness. There could be a tube for breathing in the mouth, which once you wake up will be removed and the patient will be shifted to an oxygen mask or nasal prongs for efficient breathing.
There would be a tube located in the neck i.e. called a central line to give medicines and fluids, studies blood pressure and helps to take samples of the blood. There would be machines to monitor your heart and other conditions of the body. There would be tubes attached to the arms to pass fluids and medicines. Due to surgery, there would be drainage of excess fluid which is via the tubes in the chest. Urine is excreted out via the tube in the bladder (catheter).
Initially, you might be quite sleepy, which is very much normal.
Going back to the normal ward from ICU, once completely conscious and total care will be taken by the doctors and nurses. Medicines would be changed initially, which will take time for the body to get used to. Initially would feel tired/fatigue/uncomfortable.
Few common side-effects of post-surgery
- Pain: Pain relief medications will be on-going. A device would be given to you, for the administration of pain relief medicines intravenously. This device is called Patient Controlled Analgesia (PCA). There could be soreness in the arms and shoulder for few days post-operation.
- Heart Rhythm: Irregular heart-beats or rhythms would be noticed post-surgery which is to be taken care of.
- Altered perception: There could be an experience of “vivid dream”, “visual disturbance”, and intermittent confusion for the initial few days after the operation.
- Nausea Feeling: It is common to observe this post-surgery and will be started with medications.
- Irregular Sleeping pattern: Sometimes it gets difficult to sleep immediately post-surgery might be due to pain. Pain relief could help get better sleep.
- Loss of Memory: This happens post-surgery temporarily, which gets better after 6 months.
- Constipation: This could an issue for a few days following the surgery.
- Alteration in taste: A metallic taste would be experienced in your mouth, which goes away with some time.
- Depression: For some days or weeks, you may observe “cardiac blues.” Mood swings could be seen. Talk to people who have undergone the same procedure to discuss your issues and problem. If this aggravates, do have a word with the doctor or nurse for help and guidance.
Physiotherapists
They come for a visit post-surgery and they help to be back on your legs within one or two days post-surgery.
They guide you with the following:
Techniques to avoid any sort of discomfort.
Breathing techniques, movement and “supported coughing” for the improvement of lungs. This helps to avoid any sort of infections in the chest and clots in the blood, to improve the fitness by guiding the exercises and ways to come back to the normal routine.
Heavy objects will be asked to be avoided for the healing of the muscles, bones, and joints of the chest.
Back Home
Hospital Stay would be for approximately five to seven days post-surgery. Supportive stockings might need to be worn in the hospital and for a few days at home. To decrease the risk of clots in the blood.
Important to keep a check, to have someone at home to take care of the patient initially for a few days. Important to be calm and taking deep breaths.
Recovery
For the breast-bone (sternum) to heal/recover it takes approximately three months, in this phase, there could be some discomfort feeling in the chest. Slowly increase your daily routine or activities majorly walking, for an increase in the speed of healing and recovery. Till the time there is no healing/recovery for arms and legs, the dressing would be required. If there is swelling in the scare, keep the leg elevated for approximately one to two hours. The tissue below the scar may get hard and gentle but gets normal slowly. Near the scar areas, the patient would experience numbness, tingling, stabbing, pins, and needles which goes away with recovery.
Due to a change in memory and concentration temporarily, joining work at an early stage would not be recommended.
Driving post-surgery
According to the NZ Transport Agency’s (NZTA) mentions that driving should be restricted for approximately four weeks, some may mention six weeks. Before going back to driving, an analysis needs to be done by an expert.
Traveling by air
Important to keep patience for 10 days post-surgery for any travel. Then discuss the travel plans with the physician. There would be a variation in the rules and regulations for different airlines post-surgery. If going for an overseas trip, discuss with the physician about the medications due to difference in time.
Conclusion
The main motive of the surgery is to decrease the chances of angina and heart attack. For eight patients out of ten, surgery would be a favorable outcome. That provides an instant and long-lasting “relief” from chest pain i.e. angina. For some, the surgery would include chest pain i.e. angina. Important to consume medicines for the heart regularly along with lifestyle changes to avoid any further heart disease. Some lifestyle changes include avoid smoking, taking medications, healthy eating habits and heart-friendly foods, Increase physical activity and losing weight. Rehabilitation programs for heart can help in improving the heart’s health and decrease the risk of getting another attack.
References
- http://www.annalscts.com/article/view/2425/3291
- https://www.hindawi.com/journals/srp/2014/726158/
- http://jtd.amegroups.com/article/view/19986/15548
Stella Richards