Coronary Bypass Surgery

Coronary bypass surgery is a popularly performed surgery that is also known as bypass surgery. It is the most common bypass surgery performed in the body. This surgery is performed to provide new channels to supply blood to the heart and is performed when the heart's own blood supply gets restricted due to narrowing or blockage in the coronary arteries.
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Coronary Bypass Surgery

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Coronary Bypass Surgery

Introduction:

Since most people understand a road bypass, that corollary is apt. When a road gets blocked by construction, encroachment, or any other reason that normal traffic can’t flow, authorities construct a new bypass road.

This new road starts from before the traffic hold-up and takes traffic beyond the hold-up. This ensures a smooth flow of traffic.

Coronary arteries are the blood vessels that supply the heart with energy, nutrients, and oxygen. A critical narrowing/blockage in these arteries may lead to a heart attack or other problems. Hence it is essential to keep the heart well supplied with blood.

When an artery of the heart, Coronary artery, develops obstruction or blockage such that blood can’t flow smoothly, surgeons can create a bypass route for smooth flow of blood. Bypass surgery is performed when the coronary arteries are fully or partially blocked.

Procedure:

The basic idea is to create an alternate pathway for the blood to flow through, ensuring adequate blood supply to the heart. This is done by bypassing the coronary arteries using other blood vessels from the patient’s body. The vessels are generally taken from within the chest (LIMA, RIMA), arms (radial artery), or legs and thighs (saphenous vein). These can be safely removed for use in the heart. How the operation will be performed depends on the specific case, and the surgeon only determines that after a detailed evaluation.

Patients Frequently Asked Concerns:

Risk Associated with Surgery

Over the past 3 decades, bypass surgery has become very efficient and pain-free. Today we have better instruments, better grafts, better surgery and anesthesia techniques, better control of risk factors, and more efficient drugs. Statistically, bypass grafts show excellent results even 15 years after surgery.

However, most people remain concerned about the risks of bypass surgery. About 40 years ago, when techniques were not as refined, many centers around the world would have been satisfied if 60-65% bypass patients survived.

Today we are all aiming that we should have almost 100% survival after bypass surgery. Most centers in India are indeed operating at over 99% success rate, and better hospitals are witnessing a 99.6-99.8% early survival. In essence, this is relatively a safe operation.

Pain after Surgery

All patients suffer pain after the surgery. This is well known for all types of operations. The truth is that chest surgery causes slightly less pain than a belly operation. Pain will make a patient eat less, walk less, talk less, exercise less, sleepless, and some can also become depressed. And I know this very well by closely observing patients over 35 years.

I insist that my patient should not suffer pain after surgery. A pain-free patient (or nearly pain-free patient) is more active from early after surgery and able to enjoy life fully since they start behaving and exercising normally very soon after they don’t suffer complications of inactivity.

Recovery and rehabilitation after surgery

These follow a normal pattern of recovery as after any open chest procedure, and most patients are discharged within 4-6 days after surgery.

  • First 2 days

All patients are cared for in an intensive care unit for the first two days after surgery. A dedicated specialist cardiac surgery postop care nurse is with the patient 24×7. Monitoring each and every vital parameter and looking after Pulse, BP, variety of pressures from within the heart chambers, lung function whether the patient is breathing by a machine or by their own. Kidney, liver, brain functions, need for blood transfusion and intravenous fluids, etc., are also checked. There is a dedicated Cardiac Surgery and a Cardiac Anesthesia Doctor in the hospital only for Cardiac Surgery patients to supervise the nurses. I am also available around the clock for any issues for which doctors or nurses might seek advice.

  • Next 3-5 days

Most patients start to walk to the bathroom before this stage, food progressively becomes more interesting, and they are shifted to the SICU or ward depending upon many clinical factors. While nurses and doctors are always around, this time is spent making patients more and more independent for their daily needs.

  • Day of discharge

The patient and their relatives are educated in a rehabilitation class by a rehabilitation expert. All patients learn to get in and out of bed unsupported. Patients are expected to travel home by car, sitting in the front seat with a towel between the chest and seat belt. All patients are asked to climb stairs and not be carried in chairs as makeshift palanquin. (once we make the video link here)

  • First Review after a week

Some blood tests, an ECG, and CXR are required at this clinic attendance. Most patients can start short walks in the local parks and increase exercise.

  • A month after surgery

Most self-employed people who can control their timings are back to work by this time; people in employment need about 2 months to regain strength.












Copyright by Dr. Sujay Shad 2020-2021. All rights reserved.



Copyright by Dr. Sujay Shad 2020-2021. All rights reserved.



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