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How Is The Heart Stopped During Bypass Surgery

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Immediately after your surgery

While you are still unconscious, you will probably be taken to the intensive care unit, a special ward reserved for people who have just had significant surgeries. You might be in this unit for 1 to 3 days. A longer stay does not mean that your CABG surgery was not successful.

What Are The Risks And Benefits Of Such Surgery

It is important to keep in mind that every medical choice involves a trade-off between risks and benefitswhether it is to undergo surgery, take medication, or even just carefully monitor a condition .

In the case of CABG, deciding whether surgery is advisable is sometimes an emergency, life-or-death matter. But sometimes, it involves balancing the risks involved in any heart surgery against the increasing likelihood that your symptoms of CAD, angina or congestive heart failure will worsen. Patients with severe CAD, for example, have a 35% to 50% risk of dying within five years of their diagnosis if they don’t have bypass surgery.

The risks involved in surgery are far lower. A given patient’s risk will vary, depending on such factors as age and overall health status, but the average mortality, or risk of death, from bypass surgery is from 1% to 2%. Bypass surgery is also associated with a risk of between less than 1% and 2% of a blood clot that causes a serious heart attack or stroke. And any surgical procedure involves a very small risk of other complications, such as infection.

The risks are typically higher when bypass surgery must be performed on an emergency basis. But in nonemergency situations, patients who smoke can reduce their risk of complications if they stop smoking at least 2 to 4 weeks before their surgery .

Why Might A Person Need Heart Bypass Surgery

When a material in your blood called plaque builds up on your arterial walls, less blood flows to the heart muscle. This type of coronary artery disease is known as atherosclerosis.

The heart is more likely to become exhausted and fail if its not receiving enough blood. Atherosclerosis can affect any arteries in the body.

Your doctor may recommend heart bypass surgery if your coronary arteries become so narrowed or blocked that you run a high risk of a heart attack.

Your doctor will also recommend bypass surgery when the blockage is too severe to manage with medication or other treatments.

A team of doctors, including a cardiologist, identify whether you can undergo open-heart surgery. Some medical conditions can complicate surgery or eliminate it as a possibility.

Conditions that can cause complications include:

In the past decade, more alternatives to heart bypass surgery have become available. These include:

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Preparing For Open Heart Surgery

Heart surgery corrects problems when other treatments dont work or cant be used for some reason. The most common type of heart surgery for adults iscoronary artery bypass grafting. In bypass surgery, arteries or veins are removed from elsewhere in your body and grafted to reroute blood around a clogged artery to supply blood to your heart muscle.

Your health care team which may include surgeons, cardiologists, anesthesiologists, nurses, and therapists will discuss your operation with you. Theyll welcome your questions.

If your heart surgery is planned, and not an emergency, youll meet first with your doctor and health care team. Theyll tell you what to expect and how to prepare. Before your surgery:

What To Expect On The Day Of Surgery

Healthier You

General anesthesia is started right before the surgical procedure. Then the cardiothoracic surgeon starts harvesting veins from the legs or arms. These vessels are used for bypass grafts.

The surgical team will confirm that the vessels are healthy enough to be used to bypass the diseased coronary arteries. Meanwhile, the surgeon opens the chest and begins preparing the heart. They may also remove another vessel from the left chest, to supplement the other veins already harvested.

During the vast majority of quadruple bypass surgeries, the heart is stopped to prevent motion. A heart-lung bypass machine is used to allow both the heart and lungs to be still.

This helps the surgical team complete the graft portion of the surgery safely and quickly. The machine supplies oxygen to the blood instead of the lungs doing so. It pumps the oxygenated blood through the body as the heart would normally do.

During surgery, the blood vessels are attached to the existing heart vessel, around the areas of blockage. It’s similar to a quick detour you might take to avoid traffic, with the blood literally rerouted around the blocked portion of the cardiac artery.

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Who Needs To Have Off

Off-pump bypass surgery is a treatment option for coronary artery disease .

In a person with CAD, plaque builds up in the arteries, restricting or blocking blood flow. It can cause symptoms like chest pain and shortness of breath. A completely blocked artery can lead to a heart attack.

Severe cases of CAD that dont respond to lifestyle changes, medications and other procedures may require bypass surgery. It can improve symptoms, reduce the risk of a heart attack and improve survival. Off-pump bypass surgery is an option for some people who choose CABG.

Conventional On Pump Coronary Artery Bypass Surgery

More than 70%2 of all bypass surgeries are performed on a stopped heart. Unlike beating heart surgery, during conventional on pump heart bypass, medication is used to stop the heart.

A heart-lung machine takes over the function of the heart and lungs during the surgery.The heart-lung machine is also called a cardiopulmonary bypass machine. It has a pump to function as the heart and a membrane oxygenator to function as the lungs.

A patient is placed on cardiopulmonary bypass during conventional open heart surgery , this keeps oxygen rich blood circulating throughout the body so the surgeon can perform on a still heart.

Read Also: Is Heart Attack And Cardiac Arrest The Same Thing

What Is Triple Bypass Surgery

Triple bypass surgery is the grafting of three vessels from the body to bypass damaged arteries of the heart in order to improve heart muscle oxygenation. This is an inpatient procedure that is done by cardiovascular surgeons.

Triple bypass surgery can be done as emergency surgery or as a semi-urgent scheduled surgery.

The surgery is done when atherosclerosis causes plaque buildup and narrowing of the coronary arteries. This process usually occurs in adults however, it can occur in children.

The blood vessels that are used for the graft can be taken from your leg , inside your chest , or your arm . Your surgeon will determine which vessels to use.

The chest is opened so the vessels can be placed into the appropriate areas of the heart, and then the chest is closed using sutures and metal wires. The procedure may be done with a cardiopulmonary bypass to maintain blood flow throughout the body during surgery.

What Happens After Off

Heart Bypass Surgery (CABG)

After off-pump bypass surgery, youll be moved to a recovery room, where the surgical team will monitor you. You may:

  • Take a couple of hours to wake up.
  • Have a tube in your throat to help you breathe.
  • Have another tube in your chest to remove excess fluids.
  • Feel some discomfort, but no pain. If you experience pain, tell a healthcare provider, who can provide pain medications.

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Coronary Artery Bypass Surgery:

This is the process which is mainly used to unclog the clots in the coronary arteries or replace the artery in the heart, which has narrowed down. Narrowed coronary arteries are the main cause of the heart attacks, angina and cardiac arrests, which is why doctors highly recommend an open heart surgery in such cases. The surgery takes a minimum of 6 hours and maximum 12 hours in serious cases. The artery is grafted in place of the coronary artery which is blocked. This artery can be taken from the chest or even the leg.

Results Compared To Stent Placement

CABG or stent placement is indicated when medical management â anti-angina medications, statins, antihypertensives, smoking cessation, and/or tight blood sugar control in diabetics â do not satisfactorily relieve ischemic symptoms.

A 2018 meta-analysis with over 4000 patient cases found hybrid coronary revascularization to have significant advantages compared with conventional CABG. Reduced incidence of blood transfusion, reduced hospital stay duration and reduced intubation duration were all reported. In contrast, HCR was found to be significantly more expensive compared to CABG.

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Who Will Help Perform The Bypass Surgery

Throughout the surgery, several types of specialists ensure the procedure is performed properly. A perfusion technologist works with the cardiopulmonary bypass machine.

A cardiovascular surgeon performs the procedure and an anesthesiologist ensures anesthesia is delivered to your body properly to keep you unconscious during the procedure.

Imaging specialists may also be present to take X-rays or help ensure that the team can view the site of the surgery and the tissues around it.

When you wake up from heart bypass surgery, youll have a tube in your mouth. You may also feel pain or have side effects from the procedure, including:

  • pain at the incision site
  • pain with deep breaths
  • pain with coughing

Youll likely be in the ICU for one to two days so your vital signs can be monitored. Once youre stable, youll be moved to another room. Be prepared to stay in the hospital for several days.

Before you leave the hospital, your medical team will give you instructions on how to care for yourself, including:

  • caring for your incision wounds
  • getting plenty of rest
  • refraining from heavy lifting

Even without complications, recovery from heart bypass surgery can take 6 to 12 weeks. Thats the least amount of time it takes for your breastbone to heal.

During this time, you should avoid heavy exertion. Follow your doctors orders regarding physical activity. Also, you shouldnt drive until you get approval from your doctor.

  • fever over 100.4°F
  • increasing pain in your chest
  • rapid heart rate

Frequently Asked Questions: Beating

Treating Adult Heart Conditions

What is beating-heart coronary artery bypass surgery and how is it performed?

In an open-chest, beating-heart bypass procedure, surgeons make an incision through the breastbone to gain access to the heart. In many cases, surgeons do a partial sternotomy which is a shorter incision through the breastbone than a full sternotomy. Unlike traditional bypass surgery, the heart is not stopped during a beating-heart bypass procedure. This approach uses special devices to stabilize the part of the heart the surgeon is operating on.

At UChicago Medicine, beating-heart bypass is typically performed without the use of a heart-lung bypass machine, though it may be performed with the support of the machine in select cases.

What are the benefits of beating-heart bypass surgery?

In comparison to traditional bypass surgery, the benefits of beating-heart bypass surgery include:

  • Quicker recovery
  • Reduced risk of neurological injury, including stroke and damage to the memory function
  • Better preservation of heart function
  • Less chance for heart rhythm, kidney or liver complications
  • Better survival rate, especially among high-risk patients

Who is a candidate for the beating-heart approach?

Is beating-heart bypass surgery widely available?

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What Happens During Heart Bypass Surgery

Youâll be asleep the whole time. Most operations take between 3 and 6 hours. A breathing tube goes in your mouth. It’s attached to a ventilator, which will breathe for you during the procedure and right afterward.

A surgeon makes a long cut down the middle of your chest. Then they’ll spread your rib cage open so that they can reach your heart.

Your surgical team will use medication to temporarily stop your heart. A machine called a heart-lung machine will keep blood and oxygen flowing through your body while your heart isn’t beating.

Then the surgeon will remove a blood vessel, called a graft, from another part of your body, like your chest, leg, or arm. They’ll attach one end of it to your aorta, a large artery that comes out of your heart. Then, they’ll the other end to an artery below the blockage.

The graft creates a new route for blood to travel to your heart. If you have multiple blockages, your surgeon may do more bypass procedures during the same surgery .

In some cases, the surgeon may not need to stop your heart. These are called âoff-pumpâ procedures. Others need only tiny cuts. These are called âkeyholeâ procedures.

Some surgeries rely on the help of robotic devices. Your surgeon will recommend the best operation for you.

When Is A Coronary Artery Bypass Graft Advisable

A coronary artery bypass graft involves creating a new pathway for blood to flow around a blockage in one or more of the arteries that supply the heart itself with blood these are known as your coronary arteries. CABG surgery is the most-often-performed kind of open-heart procedure in the U.S. Bypass operations have been more extensively performed and more extensively studied than any other cardiac operation in the country, ever since the procedure’s inception in the 1960s.

It is a highly effective treatment for a condition known as coronary artery disease or coronary heart diseasea blockage in the coronary arteries that is usually due to a problem called atherosclerosis atherosclerosis is caused by the progressive buildup of plaque, or deposits of cholesterol, inflammatory cells and other substances on the arterial walls. In some situationssuch as when a major heart attack is determined to have been caused by CAD or when CAD is causing severe symptoms involving multiple coronary arteriescoronary artery disease may be life-threatening, and emergency bypass surgery may be required.

Should you need CABG surgery on an emergency basis, or should you and your surgeon decide the time is right for bypass surgery, keep in mind that our cardiac surgeons have considerable expertise in performing this very common procedure.

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Preparing For The Surgery

Preparation for open heart surgery starts the night before. A person should eat an evening meal as usual but must not consume any food or drink after midnight.

It is a good idea to wear loose, comfortable clothing to assist with restricted movement following surgery, but wear whatever is comfortable.

Be sure to have all personal medical information on hand. This might include a list of medications, recent illness, and insurance information.

It is normal to feel anxious before an anesthetic, and people should not hesitate to seek reassurance from the healthcare team.

The doctor may request that the person washes their upper body with antibacterial soap. A member of the healthcare team may need to shave the persons chest area before they can have the anesthetic.

The doctors may also need to run tests before surgery, such as monitoring the heart or taking blood samples. A doctor or nurse might place a line into a vein to enable the delivery of fluids.

After the medical team has completed the preliminary tasks, the anesthesiologist will administer general anesthesia.

Whats Recovery Like After Bypass Surgery

Open Heart Surgery: What to Expect (English CC)

Itâs a gradual process. You may feel worse right after surgery than you did before. You might not be hungry and even be constipated for a few weeks after the surgery. You could have trouble sleeping while youâre in the hospital. If the surgeon takes out a piece of healthy vein from your leg, you may have some swelling there. This is normal.

Your body needs time to recover, but youâll feel better each day. It’ll take about 2 months for your body to feel better after surgery.

Youâll visit your doctor several times during the first few months to track your progress. Call them if your symptoms donât improve or youâre feeling worse.

Talk with your doctor about the best time to return to your normal day-to-day activities. What’s right for you will depend on a few things, including:

  • Your overall health
  • How many bypasses you’ve had
  • Which types of activity you try

You’ll need to ease back in. Some common plans include:

Driving. Usually 4 to 6 weeks, but you need to make sure your concentration is back before you get behind the wheel.

Housework. Take it slow. Start with the simple things you like to do and have your family help with the heavy stuff for a bit while you recover.

Sex. In most cases, you should be physically good to go in about 3 weeks. But you may lose interest in sex for a while after your surgery, so it could be as long as 3 months before you’re ready to be intimate again.

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What Happens After Heart Bypass Surgery

Youâll wake up in an intensive care unit . The breathing tube will still be in your mouth. You wonât be able to talk, and you’ll feel uncomfortable. Nurses will be there to help you. Theyâll remove the tube after a few hours, when you can breathe on your own.

During the procedure, the medical team will probably have put a thin tube called a catheter into your bladder to collect urine. When youâre able to get up and use the bathroom on your own, theyâll remove it.

They also attached an IV line before the surgery to give you fluids and medications. Youâll get it removed once youâre able to eat and drink on your own and no longer need IV medications.

Fluids will build up around your heart after the procedure, so your doctor will put tubes into your chest. Theyâll be there for 1 to 3 days after surgery to allow the fluid to drain.

You may feel soreness in your chest. Youâll have the most discomfort in the first 2 to 3 days after the procedure. You will probably get pain medicines for that.

Youâll also be hooked up to machines that monitor your vital signs — like your heart rate and blood pressure — around the clock.

You should be able to start walking 1 to 2 days after surgery. Youâll stay in the ICU for a few days before you’re moved to a hospital room. Youâll stay there for 3 to 5 days before you go home.

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