Are There Any Risks
Pretty much like all bypass surgeries, double bypass surgery also has risks and complications. Other than the risks like bleeding and infection which are associated with all surgeries, this surgery carries the following risks:
- Chest wound infection, especially in obese people, diabetics and people with a history of a similar surgery
- Post-pericardiotomy syndrome lasting up to 6 months, causing low-grade fever, chest pain and tiredness
- Loss of mental clarity and memory loss
There are fair chances of developing complications if the procedure is done in emergency or in presence of emphysema, kidney disease, diabetes or peripheral artery disease .
What Are The Alternatives To Bypass Surgery
There are a few less-invasive procedures your doctor could try instead of bypass surgery.
Angioplasty. A surgeon threads a deflated balloon attached to a special tube up to your coronary arteries. Once it’s there, they inflate the balloon to widen your blocked areas. Most times, it happens in combination with the installation of something called a stent, a wire mesh tube that props your artery open.
There’s also a version of angioplasty that, instead of a balloon, uses a laser to eliminate the plaque that clogs your arteries.
Minimally invasive heart surgery. A surgeon makes small incisions in your chest. Then, they attach veins from your leg or arteries from your chest to your heart, much like a traditional bypass surgery. In this case, though, your surgeon will put the instruments through the small incisions and use a video monitor as a guide to do the work. Unlike bypass surgery, your heart is still beating during this procedure.
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The Different Types Of Bypass Artery Vs Vein
When asking, how long does heart bypass surgery last? Its very important to understand the different types of bypass grafts used. The most important one is called the LIMA and is an artery that runs on the inside of the chest wall on the left side of the body. This artery is carefully taken down from the chest wall and almost always attached to the main artery that runs down the front of the heart called the LAD .
The other type of bypass graft we will talk about is called an SVG that is taken from the leg and is a vein used as a bypass. Although there are other types of artery bypasses , for the purposes of this article I will concentrate on the LIMA and the SVG, as they are by far the most commonly used in the US.
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Coronary Artery Bypass Grafting
When arteries that feed oxygen to the heart are blocked, the heart muscle is at risk for damage called a heart attack and even death. In an operation known as coronary artery bypass grafting , an artery or vein from another part of the body is used to reroute blood flow around the blockage. Surgeons use chest wall arteries and segments of the patients own veins to construct new pathways for blood and oxygen to reach the heart. The veins used for this reconstruction are usually taken from the patients legs, using a minimally invasive technique that leaves only a few tiny incisions. By restoring blood flow to the heart, CABG can relieve symptoms and potentially prevent a heart attack. Coronary bypass operations are performed half a million times a year with an overall success rate of almost 98 percent.
There are two types of CABG operations currently available: on-pump and off-pump surgery. On-pump procedures require the surgeon to open the chest bone , stop the patient’s heart, and place the patient on a heart-lung machine. This machine takes over the function of the patient’s heartdelivering oxygenated blood through out the body and brainwhile the bypass is performed.
What Happens Before This Procedure
CABG is major surgery, and people who have this done must first undergo a wide range of tests and other preparations.
Imaging and lab tests
Before you can undergo CABG, you will need to undergo several tests to see if it’s safe for you to have this surgery and whether or not you need the surgery in the first place.
The potential tests include, but arent limited to, the following:
- Lab tests, such as a complete blood count, that analyze your cholesterol, blood sugar, and other factors. Other possible tests include urine tests that analyze how well your kidneys function.
Information and education
Part of preparing for CABG involves informing and educating you on what to expect and what you need to do before and after surgery to help you have the best possible outcome. Topics that you’ll learn about include:
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Wound Care During The Recovery Period Following Bypass Surgery
The patient should take care of the wound during the recovery period after bypass surgery as there are metal wires that hold your breastbone which is also known as sternum together which are permanent. Skin will be healed as the stiches will slowly dissolve as the weeks pass by after the bypass surgery. You will be taught to take care of your bypass surgery wound for better recovery while you are still in the hospital. Healing the wound requires cleanliness and protection from sun. The area where the incision was done on your chest will be red and scar at first. Also the area from where the blood vessel was taken will be all red but gradually it will fade with time.
Activities During Bypass Surgery Recovery Period
The patient has to be careful while choosing the activities during bypass surgery recovery period, he or she cannot do whatever they want and have to be very careful in performing certain activities. There are a few things recommended by the team of doctor and nurses taking care of you in the hospital and they will ask you to avoid during the first few weeks after the bypass surgery. In the beginning days after you have undergone the bypass surgery you will be allowed to do some light and easy things like cooking, walking short distances, playing board games & carrying light objects. After a longer period of the bypass surgery you might be able to do a bit tougher jobs like driving, vacuuming, carrying medium weight objects, carrying babies and shearing the lawn.
If your job is not physically challenging then you might get back to your job in 6 to 8 weeks. Getting back to your job also depends on the complications that you may or may not have faced. Also if your job involves a lot of time involved in lifting and standing it is recommended to take off for a longer period of time or till the time you are perfectly fit for it. Taking rest is the most important key to bypass surgery recovery period. Also it is recommended that you take up all the activities slowly to get time for relaxing.
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Do You Have To Make Any Dietary Changes After Heart Bypass Surgery
A heart smart diet is always a good choice, whether you have had surgery, or are simply trying to stay healthy and strong. The Mediterranean diet is a great option.
This eating plan is rich in:
This easy-to-follow diet has been proven to reduce heart attack risk and improve the health of the arteries. For some people, cutting back on salt is also important, since salt may contribute to high blood pressure and fluid buildup.
Our Approach To Coronary Bypass Surgery
Our cardiac surgeons and cardiac anesthesiologists have extensive expertise in the surgical techniques needed to safely and effectively perform coronary bypass surgery.
To offer improved outcomes and reduced recovery times, we were one of the first hospitals in the nation to build hybrid operating rooms which combine breakthrough technologies with traditional surgery capabilities. This combination of technologies enables our experts to more rapidly diagnose and treat a wide range of heart and vascular conditions. Not only does this streamline your care, it also reduces the risk of complications and time it takes to recover.
In addition, we know that having open-heart surgery can be a life-changing procedure for you and your family. After your surgery, our cardiac rehabilitation experts are here to help with your recovery beyond your stay with us.
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The Lima The King Of The Heart Bypass Surgery Grafts
We call it the LIMA graft and its the gold standard of bypass grafts and almost always attached to main artery that runs down the front of the heart called the LAD . This is by a mile the most important graft, and in fact many people can simply live off the blood supply they get from this graft. The LIMA graft has superior biological properties to other grafts such as vein grafts and therefore has an excellent chance of staying open.
Now we can start to answer the question how long does heart bypass surgery last? Studies have shown thatthe LIMA graft is around 95-99% likely to be open and working at 1 month after operation, 90-95% likely to be open at 1 year 5 years, and around 80-90% likely to be open at > 10 years. These studies show that the LIMA graft has excellent not only short, but long term results. Unfortunately there is only 1 LIMA graft but often patients have many blockages requiring bypass so we have to use veins or other arteries.
Endoscopic Saphenous Vein Harvesting
Endoscopic saphenous vein harvesting is a less invasive method of removing the veins from your legs.
Rather than making a large cut in your leg, the surgeon makes a number of small ones near your knee. This is known as keyhole surgery.
A special device called an endoscope will be inserted into the cut.
An endoscope is a thin, long flexible tube with a light source and video camera at one end, so that images of the inside of your body can be relayed to an external television monitor.
The endoscope allows the surgeon to locate your saphenous vein. Surgical instruments can also be passed along the endoscope to remove a section of the vein. Nearby tissue is then sterilised with antibiotic fluid and the cut is healed.
The main advantages of this technique are that there’s likely to be a:
- shorter hospital stay
- lower risk of leg wound infections
- quicker recovery from CABG
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How Is A Coronary Artery Bypass Graft Accomplished
The basic premise of CABG surgery is that healthy blood vessels from elsewhere in your bodymost often, veins from your legs and/or mammary arteries from your chestare used to replace your blocked coronary arteries. The procedure can be performed on just one coronary artery or on several at the same time you may hear bypass surgery called a “two-way bypass” or “double bypass,” for example, or a “four-way bypass” or “quadruple bypass”this is a reference to the number of arteries involved.
The term “bypass” in the procedure’s name means your circulation will bypass, or be routed around, the blocked portions of your coronary arteries. And “graft” is a term used to describe the transplantation of living tissue from one place to another. You may also hear a couple of other terms in references to bypass surgery. An “anastomosis” is a surgical connection between one tubular organ and anotherin the case of a CABG, between your coronary arteries and the veins or arteries from elsewhere in your body. And “revascularization” means re-establishing an adequate flow of blood to a part of the body that has suffered from a poor blood supply . In other words, CAD results in cardiac ischemia, or a poor supply of blood to your heart, while a CABG results in revascularization, or the restoration of a good blood supply, thanks to a procedure involving anastomosis.
How Long Does Heart Bypass Surgery Recovery Usually Take
After CABG, most people stay in the hospital for 5 to 7 days. While youre there, you can expect the following:
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You will probably be on a ventilator, or breathing machine. In most cases, the ventilator can be removed after a few hours.
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You will also have little patches with wires attached to your chest that allow your medical team to monitor your heart rate and rhythm.
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You will have tubes coming out of your chest, which drain fluid and help your lungs recover.
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You will have several other smaller tubes that go into your blood vessels. Medications are given through intravenous catheters. Others are used to monitor your blood pressure and heart function.
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The surgeon has to cut through the breastbone, or sternum, to get to your heart. So, you will have a bandage or dressing down the center of your chest to keep that area clean and protected.
Over the next few days, as you recover, those tubes will gradually be removed. And even while you have those tubes in place, your care team, including nurses and therapists, will get you out of bed as soon as it is safe. Moving around helps your breathing, blood flow, and strength. Although this sounds uncomfortable, medication will help to ease the process.
When you leave the hospital, you will likely go home. But if you are very weak or need extra help, you may go to a rehabilitation hospital for a few weeks. There you can rebuild your strength and make sure youre ready to resume daily activities.
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Twelve Weeks After Heart Bypass Surgery
For the first three months after heart bypass surgery, you should avoid any type of strenuous exercise that could strain your chest or upper arms, this includes activities such as:
- Pushing a lawn mower
- Lifting heavy objects
- Other activities that put strain on your chest and upper arms
Most people are fully recovered at the 12-week mark after heart bypass surgery, and able to resume all normal, pre-surgery activities. Be sure to get the okay from your surgeon or cardiologist before resuming any type of exercise or other strenuous activity after your surgery.
How Do I Manage Post
A cardiac anesthesiologist is also a pain management specialist for conditions related to surgery. Your anesthesiologist will talk to you about your options for managing post-operative pain. Before your surgery, the anesthesiologist may ask about your pain tolerance to help gauge how best to manage your post-operative pain, guiding decisions such as the proper narcotics dosage, the feasibility of nonnarcotic pain medication options, and the need for nerve blocks.
Although most heart surgeries are major surgeries, they are typically not a source of long-term pain. Even in the short term, the pain may be less severe than with operations on other areas of the body. Opioids are used when necessary, but there are many other pain management options, including:
- Lidocaine infusion
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The First Few Weeks At Home
During the first few weeks after hospital discharge, many people who have undergone heart bypass surgery:
- Experience low energy levels and feel fatigued frequently
- Have intermittent post-operative pain
- Need to continue taking pain medication, as ordered by the healthcare provider
- Are not yet able to return to work
- Have strict activity limitations such as a lifting and driving restrictions
- May experience sadness and mood swings
- Commonly have symptoms of major depression
Coping During the First Few Weeks at Home
You should rest often and sleep when you feel tired. Sleep will help your body recover and help to replenish your energy level. If you have trouble getting enough sleep at night, there are some things you can do to help, including:
- Be sure to establish a regular pattern of going to bed and getting up at the same time every day.
- If you have frequent insomnia, you may want to eliminate naps to ensure you are tired at night.
- Take your pain pills before you go to bed
- Be sure to sleep on your back for the first four to six weeks while your breastbone heals.
Coping with Pain
Pain after bypass surgery is common, some things you can do to relieve pain include:
Important Activity Warning
- Lifting objects that weigh over 10 lbs: This includes children, laundry baskets, trash receptacles and other objects.
- Driving: Even a minor car crash could cause the chest area to slam into the steering wheel.
The First 24 To 48 Hours After Surgery
A heart bypass procedure usually takes approximately four to six hours to complete. After your surgical procedure is complete, you will be transferred to the cardiac intensive care unit or intensive care unit . Most people are transferred out of the CICU unit, to a lower level of care in one to three days.
On the day of surgery, most people who have undergone heart bypass surgery:
- Begin drinking clear liquids: You will also start eating easy-to-digest solids once your body can tolerate it. You’ll stay away from food that are fried, greasy, processed or spicy.
- Are asked to sit up: Your healthcare team will encourage you to move your body by sitting up on the side of the bed.
- Are coached to cough and do deep breathing exercises frequently: This is to prevent lung complications such as pneumonia.
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Coronary Artery Bypass Surgery
Once your doctor has opened the chest, he or she will stabilize the area around the artery to be bypassed with a special instrument.
The rest of the heart will continue to function and pump blood through the body.
The heart-lung bypass machine and the person who runs it may be kept on stand-by just in case the procedure need to be completed on bypass.
The doctor will do the bypass graft procedure by sewing one end of a section of vein over a tiny opening made in the aorta, and the other end over a tiny opening made in the coronary artery just below the blockage.
You may have more than one bypass graft done, depending on how many blockages you have and where they are located.
Before the chest is closed, the doctor will closely examine the grafts to make sure they are working.