What Is Bypass Surgery
Coronary artery bypass graft surgery or bypass surgery is heart surgery that reroutes blood around obstructed arteries to enhance blood flow and oxygen to the heart.
- A graft vein or artery is extracted from a healthy blood vessel in the body during bypass surgery. After that, the graft is surgically implanted to bypass the obstruction or blockage in the occluded or poorly performing artery.
- Following surgery, blood will flow via the graft vessel, bypassing the blocked channel and delivering oxygen and nutrients to the tissue beyond the obstruction.
The most common reason for bypass surgery is to avoid or circumvent a blockage by a clot or plaque in a coronary artery due to atherosclerosis. If the blockage is not removed, the heart muscle beyond the obstruction is deprived of oxygen and nutrients, resulting in cardiac damage.
Who Needs To Have Heart Surgery
People with many different heart problems need heart surgery. These include blockages in the arteries that carry blood to your heart, valves that arent working right, and abnormal heart rhythms.
Usually, heart surgery is planned in advance as part of your treatment plan. This happens when your provider diagnoses a problem with your heart, and surgery is the best or only way to fix it.
Other times, heart surgery is an emergency treatment that comes up when you dont expect it. This can happen if you have a heart attack, or if youre diagnosed with severe blockages that put you in urgent danger.
Depending on the problem, you may not need surgery. Technology is providing us with innovative ways to manage heart disease. For example, percutaneous coronary intervention repairs blocked coronary arteries. Endovascular aneurysm repair repairs an abdominal aortic aneurysm through an artery in your leg.
These methods reduce your time in the hospital and make recovery easier. Theyre especially helpful for people who would face higher risks if they had surgery.
Cardiac Surgery Survival By Procedure
Cardiac surgery programs can also report survival rates by each specific operation. These are called benchmark operations, and they are one of the ways surgical centers can compare outcomes. Note that these data do not include a patients specific risk factors prior to surgery.
In the table below, we report the total number of benchmark operations at Childrens Colorado, as well as the survival rates here compared to the national average.
What we measure:
Index case survival shows the percentage of patients who received a specific operation and were alive 30 days after their operation. It also includes patients who needed to be in the hospital longer than 30 days who were alive and successfully able to go home.
Index case survival
What it means:
For the majority of the open-heart surgeries listed above, our survival rates are higher than the national average.
It is challenging to compare outcomes by procedure alone. The procedure-alone data does not include important health-related factors such as age, other health conditions , and genetic conditions that can make procedures riskier. This is why pediatric heart surgery programs should report a wide range of outcomes, including how well patients do when they are at higher risk due to other health conditions.
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What Do We Mean By Survival Statistics
The NHS monitors childrens heart surgery in the UK by reviewing each hospitals 30-day survival rate. The 30-day survival rate is the percentage of operations where the child survived to at least 30 days after their heart surgery. Ireland also submits its data to the same audit body, NCHDA.
Approximately 3500 children under the age of 16 have heart surgery each year in the United Kingdom and Republic of Ireland.
How Often Is Sts Data Updated
Childrens Colorado and other centers submit data to the STS twice per year. The STS then verifies the data and generates reports that allow us to compare our results with our peers.
We publish our outcomes data on this website as soon as possible following the STS data release, also twice per year.
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Routinely Performed Coronary Artery Bypass Surgeries
Pediatric Heart Surgery Volumes
Finally, when it comes to congenital heart surgery, volume matters. Studies show that kids who need heart surgery do better when they are treated by medical teams that perform a high number of surgeries. This is because surgeons in high-volume centers get more experience and see a wider range of heart defects than surgeons who perform only a handful of surgeries per year.
Performing hundreds of surgeries each year indicates that the hospital is a high-volume center and is likely to have better patient outcomes. This is particularly true for patients with complex heart defects.
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What Happens After Heart Surgery
After your heart surgery is done, youll be moved to the intensive care unit . Youll recover in the ICU for at least one day. Youll then move to a regular hospital room for continued rest and care.
How long you stay in the hospital depends on the surgery you had and how your body responds to it. Each persons recovery is different. Your hospital team will keep a close eye on you and make sure youre healing as you should. Theyre also prepared to notice and respond to any problems that come up.
Good Survival Rates Found In Heart Surgery For Aged
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NEW ORLEANS Eighty-year-olds with clogged arteries or leaky heart valves used to be sent home with a pat on the arm from their doctors and pills to try to ease their symptoms. Now more are getting open-heart surgery, with remarkable survival rates rivaling those of much younger people, two new studies show.
Years ago, physicians were told we were pushing the envelope to operate on a 70-year-old, said Dr. Vincent J. Bufalino, a cardiologist at Loyola University Chicago. But today we have elderly folks who are extremely viable, mentally quite sharp, who want to decide for themselves whether to take the risk, said Dr. Bufalino, one of those who reviewed the studies for the American Heart Association.
Even 90-year-olds are having open-heart surgery, said Dr. Harlan M. Krumholz, a Yale cardiologist who has done other research on older heart patients. Age itself shouldnt be an automatic exclusion, Dr. Krumholz said.
Not every older person can undergo such a challenging operation, but the results seen in the new studies show that doctors have become good at figuring out who can.
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What Are The Four Types Of Heart Valves
The heart is made up of four pumping chambers:
- Two atria: Upper chambers of the heart
- Two ventricles: Lower chambers of the heart
There are valves between each of the heart’s pumping chambers that open and close in coordination with each other. Their action keeps blood flowing forward through the heart. There are four valves in the heart:
- Tricuspid valve: Between the right atrium and the right ventricle
- Pulmonary valve: Between the right ventricle and the pulmonary artery
- Aortic valve: Between the left ventricle and the aorta
When Should I See My Healthcare Provider
- Signs of infection by your incision, like oozing or redness.
- Slurred speech or other signs of a stroke.
It may be hard to know when a symptom is just a part of recovery, or when its a sign of a complication. When in doubt, pick up the phone and call your care team. Its better to get checked out and learn nothings wrong than to ignore a problem that needs medical care.
A note from Cleveland Clinic
Heart surgery is a life-changing event for you and your loved ones. Take the time to learn more about your condition and the surgery that you need. Talk with your healthcare provider and ask any question that comes to mind. Keep your support system close during this journey, and dont be afraid to ask for help when you need it. If you dont have family and friends nearby, talk with your provider about available resources and support groups.
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How To Prepare For Open
Tell your doctor about any drugs you are taking, even over-the-counter medications, vitamins, and herbs. Inform them of any illnesses you have, including herpes outbreak, cold, flu, or fever.
In the two weeks before the surgery, your doctor may ask you to quit smoking and stop taking blood-thinning medications, such as aspirin, ibuprofen, or naproxen.
Its important to talk to your doctor about your alcohol consumption before you prepare for the surgery. If you typically have three or more drinks a day and stop right before you go into surgery, you may go into alcohol withdrawal. This may cause life-threatening complications after open-heart surgery, including seizures or tremors. Your doctor can help you with alcohol withdrawal to reduce the likelihood of these complications.
The day before the surgery, you may be asked to wash yourself with a special soap. This soap is used to kill bacteria on your skin and will lessen the chance of an infection after surgery. You may also be asked not to eat or drink anything after midnight.
Your healthcare provider will give you more detailed instructions when you arrive at the hospital for surgery.
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.
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Open Heart Surgery Survival Rates
Heart surgery programs typically report their overall survival rate as well as survival rates based on the complexity of the surgery.
What we measure:
The percentage of heart surgery patients who survive their open heart surgery.
At Childrens Colorado, our overall survival rate for all cardiac surgery patients, regardless of how complex the surgeries are, is 97.2%. This is the same as the national average.
What it means:
Having a higher survival rate indicates that a pediatric heart center is more experienced and better equipped for congenital heart surgery, and that fewer patients pass away during or after surgery.
Some heart centers take more complicated cases than others, which is why its important to also compare survival rates by complexity and type of defect.
The Life Expectancy Of Elderly People After Coronary Bypass Surgery Is Receiving Increasing Attention Since The Population Of Advanced Age People Is Ever
This means more and more elderly people, including octogenarians, are having coronary bypass surgery .
Life expectancy after CABG is difficult to determine because so many factors are involved, says Dr. Michael Fiocco, Chief of Open Heart Surgery at Union Memorial Hospital, one of the nations top 50 heart hospitals.
And this applies to the elderly population.
Mortality within 30 days of CABG is less than 2 percent, and that is including some very sick patients undergoing CABG, says Dr. Fiocco.
When an elderly person has coronary bypass surgery, other factors still remain an important part of the life-expectancy equation:
In other words, the CABG and post-op may have gone without a hitch, but an elderly individual inherently is at risk for other serious conditions such as cancer, Alzheimers disease and dying in a car accident that otherwise would result in only moderate injuries for someone much younger.
Thus, the question of What is the life expectancy for the very old patient after coronary bypass surgery almost doesnt seem to make a lot of sense.
Again, this is about life expectancy, rather than a more immediate survival rate.
Once the elderly patient is out of the woods in terms of possible post-op complications , the life expectancy is extremely variable.
But of course, its within the confines of how much longer any 80-year-old is expected to live.
For elective coronary bypass surgery , the mortality rate falls below 1 percent 30 days post-op.
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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.
What Are Stat Categories
STAT categories classify heart surgeries into groups based on how risky or complex they are. The STAT 1 category indicates surgeries with the lowest risk of death, while the STAT 5 category indicates the surgeries with the highest risk of death. A hospital that has a high survival rate for STAT 5 cases indicates success at handling unpredictable situations during the operation and during recovery.
What we measure:
STAT 5 neonatal survival measures the percentage of babies with the most complex heart defects who survive their surgery and have been discharged from the hospital.
What it means:
At Childrens Colorado, our surgical team specializes in some of the most complex cardiovascular procedures, with special expertise in surgical repair during the newborn period. Having a high STAT 5 survival rate means that the newborn babies we treat are more likely to survive their operation than the national average, even though we accept many more complex patients.
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What Is The Survival Rate Of Heart Surgery
Heart surgery survival rates vary based on the type of surgery and how many problems are repaired during the operation. Survival rates are:
- Mitral valve repair for mitral valve prolapse: 100%.
- Aortic valve replacement: 98.1%.
- Coronary artery bypass surgery : 97.8%.
Heart surgery is generally riskier for people who are very ill or have other medical conditions.
Heart Surgery Survival Rates By Type Of Procedure
The Cardiac Center team performs more than 850 pediatric heart surgeries a year, including open heart and closed heart procedures and heart transplants. Open heart procedures, which represent a major portion of our volume, require cardiopulmonary bypass and are usually the most complicated and complex procedures.
Pediatric heart surgery survival rates reflect the number of patients who survived within 30 days of the surgery or until the time they were discharged, whichever period is longer.
We track outcomes from common procedures as Quality Indicators for congenital heart surgery. The following data shows CHOP’s outcomes for these procedures.
The cardiac surgery indicators are included in the Society of Thoracic Surgeons Congenital Heart Surgery Database and in the National Quality Forum standards for pediatric heart surgery. The STS Congenital Heart Surgery Database contains data from over 100 congenital heart surgery centers in North America. The NQF is a nonprofit organization that sets or endorses standards to measure quality in healthcare.
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What Do We Do If The Bypasses Close Off
So far we have said that while LIMA-LAD grafts are an excellent option with great long term results, vein grafts are unfortunately no so good, and have an almost 1 in 2 chance of going down within several years of surgery. The good news is that the LIMA-LAD graft is the most important. And although the vein grafts may go down more frequently, if they do go down the chance of needing another heart operation is very, very low. If required, treatment can typically be undertaken using minimally invasive methods such as using stents.
The decision to treat blocked bypasses depends on many factors. Often the blockage may be silent and without symptoms, in which case no specific treatment is needed. Some bypass graft blockages will present with symptoms such as chest pain, shortness of breath or heart failure, in which case further evaluation can be undertaken and the decision made on the best treatment depending on the results of tests such as stress tests and angiograms. Finally some of these bypass blockages may present as a heart attack in which case often the blockages can be treated through the use of stents and medicines.