Why Might A Person Need Heart Bypass Surgery
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:
What Is This Procedure
Coronary artery bypass grafting is a surgery that restores blood flow to areas of your heart that arent getting enough blood. This surgery can improve your heart function and how you feel, especially when youve just had a heart attack or theres an increased risk for you to have one in the near future.
Youll Play A Key Role In Managing Your Pain
Post-surgical pain is unavoidable but can be managed in a variety of ways. Because of recent national legislation changes, physicians can prescribe no more than a seven-day supply of opioids to patients at the time of their hospital discharge.
Weaning yourself off opioids as soon as possible is important. You may need less than a seven-day supply, depending on your condition. Some patients do not require any opioids for pain management.
Other options for pain management include:
Oral and topical analgesics such as acetaminophen and Salonpas patches
Applying a warm cloth to the area, using caution near the incision because nerve sensitivity may be decreased, causing the skin to burn
Relaxation techniques such as meditation and guided imagery
If you are on long-term opioids, you should meet with your prescribing physician to begin to wean down to the lowest dose possible before surgery.
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Overview Of Open Heart Surgery
Open heart bypass surgery is a treatment for coronary artery disease , also known as heart disease. CAD is narrowing or blockage of the coronary arteries, which are essential for your heart to function properly.
Heart bypass surgery is known medically as coronary artery bypass graft surgery. CABG surgery creates a new route for blood to flow around the blocked part of the coronary artery to the heart muscle.
CABG is an incredibly common procedure, with more than 200,000 performed in the United States each year. If you or a loved one may be a candidate for CABG, talk with your doctor to understand how this treatment could help reduce symptoms and treat your heart disease.
Our team of expert cardiac surgeons at Dignity Health performs open heart bypass surgery. If you would like to learn more, Find a Doctor near you today.
How Do You Prepare For Bypass Surgery
Before your surgery, youâll get blood tests, chest X-rays, and an electrocardiogram . Your doctor may also do an X-ray procedure called a coronary angiogram. It uses a special dye to show how the blood moves through your arteries.
Your doctor will also let you know if you need to make any changes to your diet or lifestyle before the surgery and make any changes to medicines you take. Also tell your doctor about any vitamins and supplements you take, even if they are natural, in case they could affect your risk of bleeding.
Youâll also need to make plans for recovery after your surgery.
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Does Your Personality Change After Open
When recovering from heart surgery, some patients report trouble remembering, slower mental processing and difficulty focusing. Although this condition, often referred to as pumphead, is usually short-lived, one study of bypass patients has suggested that the associated cognitive changes might worsen over time.
What To Expect On The Day Of Surgery
Prepping you for surgery will involve several steps, including checking your vitals, placing an IV in your hand, arm, or neck to deliver fluids and medications during surgery, and placing an arterial line to monitor your blood pressure.
Once you are in the operating room, an anesthesiologist will give you medications to put you to sleep and a breathing tube will be inserted. This tube is connected to a ventilator to assist with breathing during surgery.
A Foley catheter will also be placed at this time to drain urine. In select cases, the surgeon may place a thin tube called a Swan-Ganz catheter in a vein in your neck. This catheter measures pressures in and around the heart and is used for monitoring purposes during and right after surgery.
The precise steps of your open heart surgery depend on what exactly is being done and what technique is being used.
That said, here is a general breakdown of a traditional open heart surgery:
You will be wheeled into a post-anesthesia care unit where you will wake up from anesthesia.
The duration of open heart surgery depends on the specific operation being performed. For example, a CABG takes approximately three to five hours. A heart transplant surgery, on the other hand, may take up to eight hours.
If you have loved ones in the waiting room, a hospital staff member or member of the surgical team will provide them with updates during the surgery.
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Why Is Coronary Bypass Surgery Done
Your heart works 24/7, supplying your entire body with blood. To do its job, your heart also needs blood flow, which it gets through a network of supply arteries that wrap around it. When tissues in your body arent getting enough blood flow, this causes a problem called ischemia .
The muscle cells in your heart are especially sensitive to ischemia, and when it’s severe, those heart muscle cells will start to die. Coronary artery bypass grafting treats ischemia by restoring blood flow to the affected heart muscle.
Coronary Artery Bypass Grafting
Coronary artery bypass grafting, also called revascularization, is a common surgical procedure to create an alternative path to deliver blood supply to the heart and body, with the goal of preventing clot formation. This can be done in many ways, and the arteries used can be taken from several areas of the body. Arteries are typically harvested from the chest, arm, or wrist and then attached to a portion of the coronary artery, relieving pressure and limiting clotting factors in that area of the heart.
The procedure is typically performed because of coronary artery disease , in which a plaque-like substance builds up in the coronary artery, the main pathway carrying oxygen-rich blood to the heart. This can cause a blockage and/or a rupture, which can lead to a heart attack.
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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 Are Some Types Of Heart Surgery
There are many types of heart surgery. The National Heart, Lung, and Blood Institute, which is part of the National Institutes of Health, lists the following as among the most common coronary surgical procedures.
In addition to these surgeries, a minimally invasive alternative to open-heart surgery that is becoming more common is transcatheter structural heart surgery. This involves guiding a long, thin, flexible tube called a catheter to your heart through blood vessels that can be accessed from the groin, thigh, abdomen, chest, neck, or collarbone. A small incision is necessary. This type of surgery includes transcatheter aortic valve implantation to replace a faulty aortic valve with a valve made from animal tissue, MitraClipÂ® placement for mitral valve abnormalities, and WATCHMANÂ® placement for nonvalvular atrial fibrillation patients.
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Immediately After Heart Bypass Surgery
You should talk to the medical staff if you have any fears or anxieties over the few days immediately after the operation, as emotional stress can make demands on your heart.Following the operation:
- You spend a day or two in the intensive care unit. You have numerous monitors attached to you that are located by your bed.
- You have a couple of intravenous lines to keep your body fluids and electrolyte levels in balance.
- The medical and nursing staff are trained to look out for any complications or potential complications. They keep an expert eye on your heart tracings, and treat any irregularities if they arise.
- You have a nasogastric tube to drain any excess stomach fluids, and a tube into your bladder to drain off and measure your urine output.
- You are shown how to care for your wounds. Often, washing with soap and water is enough.
- You are given advice on angina , such as how to treat it and when to get medical help.
- Your doctor advises on when you can return to work, resume driving, and exercise strenuously.
- You are shown breathing exercises and other exercises by a physiotherapist.
- Before you leave hospital, your doctor should provide guidelines about restarting sexual activity. You should be given advice on positions that reduce exertion during sex, and what to do if you experience angina.
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
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Purpose Of Quadruple Bypass
The coronary arteries can become blocked when plaque builds up inside the blood vessels. This condition is known as coronary artery disease.
If the blockage in the coronary artery is severe, it can interfere with blood flow to a section of the heart muscle and cause chest pain, also known as angina. It is possible to have several arteries blocked at the same time, which can pose a significant risk to the heart.
Usually, the chest pain occurs during physical exertion. This is because the demand for oxygen in the heart is greater. The narrowed vessels are not able to meet the increase in the heart muscle’s needs. That is when the chest pain will begin.
If the blockage severely or completely prevents blood from flowing to a part of the heart muscle, a heart attack may occur.
In many cases, coronary artery disease can be treated with medication or lifestyle changes. It also may be treated with surgery that is less invasive than a quadruple bypass, such as angioplasty. A stent, a tube that holds the artery open to restore blood flow, may be placed in the artery.
In general, if one or two vessels need to be repaired, or if the blockage is too long to place a stent, then surgery is likely to be recommended. At the time of bypass surgery, all of the blocked vessels will usually be treated at the same time.
Whats Recovery Like After Bypass Surgery
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.
Procedure Completion Both Methods
Your doctor will sew the sternum together with small wires .
He or she will insert tubes into your chest to drain blood and other fluids from around the heart.
Your doctor will sew the skin over the sternum back together.
Your doctor will put a tube through your mouth or nose into your stomach to drain stomach fluids.
He or she will then apply a sterile bandage or dressing.
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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What Happens During This Procedure
CABG is a complicated procedure that takes several hours to complete . The following steps happen for most of these surgeries.
Anesthesia and life support
Like most major surgeries, the first step to this surgery is to put you into a state of deep sleep. This keeps you from feeling pain during the surgery. It also helps relax you for other steps in the preparation.
Because CABG involves work on your heart, it usually involves multiple types of life support. These include:
Blood vessel harvesting
CABG involves creating a bypass for blood to use to reach blocked areas of your heart. A bypass is like a detour for your blood to use to get around an obstacle. Creating that bypass involves taking a blood vessel from somewhere else in your body, such as your leg, arm or chest, and using it to craft the detour around the blockage. In cases where theres more than one blocked artery, multiple bypasses may be necessary. These are double , triple and quadruple bypasses.
To reach your heart to perform the surgery, a cardiothoracic surgeon will make an incision in the center of your chest. Theyll also split your breastbone down the middle, then spread and lift your rib cage to make it easier to access your heart.
Once the bypass is in place, the surgeon can restart your heart and get your blood flowing again. Theyll then lower your rib cage back into place and wire it together so it can heal. Theyll then close the incision in your chest with staples and sutures .
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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