Post on 20-Dec-2015
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Bypass Surgery
Navigate your way to a Healthy Heart
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What is a bypass surgery?
Imagine traveling by road and getting stuck in a traffic jam. To
'bypass' the jam, you take another route and join the same road
back again. That's exactly what takes place in a CABG (Coronary
Artery Bypass Graft surgery) or commonly known as bypass
surgery.
Coronary Artery Bypass Grafting (CABG) is a surgical procedure
done to create a 'bypass' around the blocked part of a coronary
artery (blood vessels that supply blood to the heart) to restore
blood supply to the heart muscle. The bypass is made with the
help of blood vessels (known as grafts taken from the other parts
of the body (leg, hand, chest wall, etc.)
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Why and when is a bypass done?
When one or more of the coronary arteries becomes partially or
totally blocked, the heart does not get adequate blood supply.
This is called an ischemic heart disease or Coronary Artery
Disease (CAD). It can cause heart pain (angina) or a heart
attack (myocardial infarction).
CABG is one of the treatment options for ischemic heart
disease. Bypass surgery is advised for:
1. Disease of the left main coronary artery
2. Significant, multiple blockages in all three main vessels
of the heart
3. Failure of angioplasty
4. When the efficiency of the left ventricle is reduced to less
than adequate.http://www.asianheartinstitute.org/
How is the surgery done?
Before the surgery
Once the patient has been diagnosed with a triple vessel disease
and has been advised to undergo a bypass surgery he has to plan
accordingly.For a bypass surgery a stay in the hospital of
approximately 10 days is expected with a recovery time of a month
after the surgery to get back to the normal routine.
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The pre-operative investigations include the following:
• Blood tests: includes CBC, Serological tests, blood grouping,
blood sugars,
• Urine tests: creatinine, electrolytes
• Chest x-ray
• Ultra sonography
• Carotid and radial Doppler studies
• 2D Echo
• CT angiography of the internal mammary arteries
• Sputum and nasal swabs to check for any active infections
in the body
• Lung function tests
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Preparing the patient:
• On the day of surgery the patient is given medicines to
reduce anxiety and then rolled into the Operation Theatre
(OT)
• Electrodes connected to ECG monitor are attached to the
patient’s back to monitor the heart’s activity during the
operation
• Intravenous lines are then inserted into the veins of the
wrist or arm for administration of medicines and salt
solutions
• One IV line is threaded up the vein all the way to the vena
cava ( the biggest vessel that carries impure blood from all
the parts of the body to the heart) to allow administration of
medication directly to the heart.
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Surgery:
• For the surgery, first the chest is cut open at the mid line of
the breast bone ( sternum) and the sternum is separated.
• Then the internal mammary artery to be used for the surgery
is separated from the chest wall gently.
• Then the surgeon will work on the patients limbs to remove
the vein or the artery.
• After this the grafting of the conduits is done.
• After several hours of grafting the chest closure is done in
layers.
• The patient is then shifted to the ICU
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However, in a beating heart surgery the heart lung machine is
not used and the surgery is performed on a beating heart. This
method is know as an Off-Pump Coronary Artery Bypass
surgery (OPCAB) or beating heart surgery.
It allows the bypass to be created while the heart is still beating
by using a device known as 'octopus'. The advantage is a
quicker recovery, fewer complications and better long term
outcome, especially in elderly patients and in patients with
problems like kidney failure, previous brain strokes, etc. Asian
Heart Institute is one of the few centers in the world that
specializes in this type of surgery, performing nearly 100% of
its bypass surgeries on a beating heart with a very significant
percentage using total arterial grafting.
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Redo bypass surgery
A second or redo bypass surgery is needed if blockages
develop after the first surgery. It is complex and risky because
after surgery, the heart and lungs stick to the breast bone. A
beating heart surgery using arterial grafts reduces the risk of a
redo bypass surgery. At Asian Heart Institute redo bypass
surgery is also performed 'Off-Pump', thereby suggesting the
competence of the team.
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Frequently Asked Questions After Bypass Surgery
1. When can I drive on my own?
It is wise to wait for 2 months after surgery, before driving on your
own. This is the amount of time it takes for the healing of your
sternum (breast bone), which was cut open during surgery. Any
chance injury, can cause damage if driving is started too early.
Please consult with your surgical team before undertaking any
activity after a bypass.
2. Can I travel by car?
Yes. You may travel by car as soon as you are discharged. However,
for the first few weeks, it is advisable to restrict your travel to less
than two hours. If the drive is going to be longer, then take a break
every two hours and walk around for a few minutes.
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3. Should I speak less?
There is no reason for you to 'speak less' after surgery.
However, during the first few days of your recovery, you
might feel short of breath while speaking for a long period of
time. If so, your body is telling you to rest, and your may
keep silent for some time.
4. Will eating curd or watermelon affect the
stitches and slow down the healing of the breast bone?
No. Eating curd or watermelon has no effect on your stitches
and healing process.
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5. When can I start climbing the staircase?
If there is an elevator, there is no need to climb stairs just for the
sake of exercising. If you do not have an elevator and have to take
the staircase, you can do so as soon as you are discharged. While
climbing, pace yourself. Take a minute's rest after climbing 10-12
steps during the first week after discharge. As your walking
capacity increases, there is no restriction on climbing steps, as
long as you do not run out of breath.
6. When can I go back to work?
It is advisable to wait for at least 2 months after surgery before
returning to work. However, depending on the condition of your
heart, you may be able to start light work after a month. Please
consult with your doctor before returning back to work.
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7. What about the blockages in the arteries, will they remain?
The blockages which are present is the arteries remain as they were.
The 'graft' which provides the 'new blood supply' is connected below
your old blockages, thereby providing adequate blood to the heart
muscle.
8. After my surgery, why do I still feel pain in my chest?
To perform your surgery, your chest-bone was cut open and stitched
together after surgery. It is quite normal to feel some pain or altered
sensations in your chest region for a few months after surgery.
However, this pain will be different from the pain of 'angina' which
you might have experienced before surgery.
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The AHI Advantage
The latest trend in healthcare is to have lesser invasive
surgeries, i.e. surgeries which involve minimal cuts & ensure
that patient has a faster recovery. Keyhole or Minimally Invasive
Surgery (MIS) is a modern innovative surgical technique that
reduces the patient's post-surgery distress & allows them to
return back to their normal life in just a couple of days. In
Minimally Invasive Surgery (MIS) is a modern innovative surgical
technique that reduces the patient's post-surgery distress &
allows them to return back to their normal life in just a couple of
days.
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Recovery/ Prognosis:
Recovery from the surgery takes time. The patient who has
received a CABG can expect considerable relief from symptoms
and in many cases, increase life span. It should be remembered
however that the graft vessels are subject to fatty blockage at
any increased rate, so care must still be taken to reduce the risk
factors that cause the original blockage.
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You can do many things to reduce the risk factors like:• Not smoking• Regular exercising• Control of vitals like Blood Pressure, sugar levels, cholesterol levels etc• Rectification of other clinical conditions if any
Related Tags: Best cardiac arrest treatment | Hospitals for cardiac arrest treatment | Best cardiologist for angioplasty
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