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Coronary artery bypass surgery

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Coronary artery bypass surgery is caused when the arteries near the heart become constricted or blocked. In order to increase blood flow back into the heart, surgeons must take a blood vessel from another part of the body and go around the blocked area. There are many steps doctors must follow to properly complete the surgery as well as steps to take in order to recover from the surgery. There are also several risks and complications that can result from the surgery, which will be discussed later.[1]

The Steps of the Procedure

Blocked Arteries

There are several reasons that someone would need to undergo coronary bypass surgery. The first reason is because someone experiences severe chest pain due to the constriction of arteries leading to one’s heart. [2] This blockage of the arteries can be a result of a buildup of cholesterol and fatty deposits. [3]. In this instance, because the artery narrows, the heart does not receive enough blood to function properly. This can occur with slight exercise or even just at rest. There are several other procedures that can aid narrowed arteries. However, coronary bypass surgery serves as the best option if the others do not work. Another reason one would need coronary bypass surgery would be because the left ventricle is not working properly along with other coronary arteries not functioning well. The left main coronary artery provides the bulk of the blood that goes through the left ventricle, and if that is blocked, one would need coronary bypass surgery. The lack of blood would inhibit the left ventricle. Emergency situations may also call for the need of coronary bypass surgery. If someone has a heart attack, surgeons may need to utilize this procedure in order to save the patient. However, in this instance, the doctors only use coronary bypass surgery if other techniques have failed. [2]

How the Procedure is Done

Doctor preparing anesthesia

There are several procedures and steps doctors must follow in order to properly perform a coronary bypass surgery. First, an anesthesiologist will give the patient general anesthesia so that the patient will sleep through the entire procedure. This allows the patient to undergo the procedure pain-free. Once the anesthesia puts the patient to sleep, the surgeon will begin the surgery. The surgery begins with a 8-10 in cut down the center of the patient’s chest. Next, the doctors will separate the breastbone so that they can have a clear view of the heart and blood vessels surrounding the heart. Depending on the patient, doctors will hook the patient up to a heart-lung bypass machine and stop the patient’s heart during the procedure. This machine acts as the heart and continues to pump oxygenated blood throughout the rest of the body. However, doctors do not always use this machine. If they think that a patient will not respond well to the machine or other problems arise, surgeons can now do the surgery while the heart is still beating. This type of surgery is called off-pump coronary bypass surgery.


The next step in the surgery is to locate the trouble arteries and go around (graft) the arteries that are blocked or narrowed. In order to go around the trouble arteries, surgeons must use another blood vessel from another portion of the body. This blood vessel can come from several areas, but the most common areas are the saphenous veins in the leg, the internal mammary artery in the chest, and the radial artery in the wrist. For the saphenous vein, doctors will make a cut in the inside of the leg and remove the vein. The vein has to be sewn into the coronary artery and be connected to the aorta in order to properly complete the graft. In the case of the internal mammary artery, one end of the artery is already connected to the aorta and the other end would need to be attached to the coronary artery. After doctors successfully re-route the blood around the trouble area and everything seems to function properly, the surgery is completed. Doctors close the separated breastbone with wires that are not removed later. The surgery takes about 4-6 hours to complete. After the patient is done with the surgery, doctors place the patient in the intensive care unit where they can be closely monitored by the hospital. [4]

Recovery

After coronary bypass surgery, there are many different steps to recovery and precautions to help the patient’s heart. After the surgery, the hospital will keep the patient for up to a week in order to monitor them and make sure the patient reacts correctly to the medicines and surgery. During this period of time at the hospital, there are several tubes that drain fluid away from the heart. The hospital will also help the patient with how to recover from the surgery and precautions they should take. [4]

There are several different types of medication that doctors prescribe in order to help patients recovering from coronary bypass surgery. Some medications help prevent further clotting in the arteries near the heart, which is the original cause of the procedure. Also, the doctor might prescribe medication that lowers blood pressure and the heart rate. Lowering blood pressure and heart rate relieves some pressure of the new graft to reduce the risk of another incident. Some patients might be given nitrates if there were several blocked arteries and not all of them were able to be cleared. Nitrates open the blood vessels around the heart and bring more blood into the heart. If a vessel is partially clogged, the opening of the vessel and increased blood flow can compensate for the partial closure. Another medication used reduces the amount of cholesterol in the body. This helps prevent buildup in the new grafts so that they do not become blocked. Patients that undergo coronary bypass surgery need to be also careful of the large wound that is required in order to reach the heart and blood vessels.

Doctors recommend that patients avoid strenuous physical activity for a few months to allow the wound to fully heal. Patients should seek medical help if they get a fever, chest pain persists after the surgery, heart rate increases, and if there are abnormalities around the incision. After several months of healing, patients need to begin to exercise their heart. Physical exercise can help improve heart health and reduce risks associated with heart disease. However, some patients should not exercise because their exercise could potentially lead to further complications. Also, after coronary bypass surgery, there are several steps that should be followed by every patient. To reduce the risk of further complications, the patient should maintain a healthy diet. The diet should be low in cholesterol so that more buildup does not occur in the blood vessels. If the patient is a smoker, they should try to quit immediately. Smoking greatly increases the risk of further heart issues. Seeking help can be very important for patients after coronary bypass surgery. Depression is a very large problem for people that have just undergone coronary bypass surgery. Sometimes those people need to seek help in order to come out of their depression. Another step to help reduce the risk of more complications is reducing stress, as stress can lead to further heart problems. [1]

Complications and Risks

A blood transfusion may be necessary if too much blood is lost

There are several risk factors and possible complications as a result of coronary artery bypass surgery. There are several issues that can arise with the heart as a result of the surgery. Sometimes after surgery, the heart cannot pump as much blood as before. Also, surgery might cause irregular heartbeat which includes rapid beating or beating out of rhythm. Irregular heart beat can cause blood to clot near the heart, causing further problems. If the clot breaks free, it can travel to other parts of the body, causing damage. For instance, if the clot enters the brain, it can cause a stroke. Also, there are several devices that can help correct a slow or fast heart beat such as a pacemaker. A very small percentage of patients show signs of a heart attack right after surgery, which are usually not severe in nature. Another complication of coronary bypass surgery is the inflammation of the sac that surrounds the heart. This fluid pushes against the heart and needs to be removed. This pressure can cause chest pain and should be taken care of if the pressure persists. Coronary artery bypass surgery can cause heavy bleeding in some patients, which requires a blood transfusion. Also, the patients need to be careful where the incisions are made. The wound areas can become infected and the severity of the infection can vary greatly. Some are slightly harmful and will go away with little treatment, while others must be treated immediately. There are many more possible complications such as nerve damage around the surgery site. [5]

Video

Coronary Artery Bypass Surgery Description

References

  1. 1.0 1.1 Aroesty, Julian.Patient Information. UpToDate. Web. January 23, 2014(Updated). Author Unknown.
  2. 2.0 2.1 Coronary bypass surgery. Mayo Clinic. Web. October 23, 2012 (Created). Author Unknown
  3. Reasons for Coronary Artery Bypass Surgery Graft. ThirdAge.com. Web. March 15,2014 (Accessed). Author Unknown
  4. 4.0 4.1 Bhimji, Shabir. Heart bypass surgery. MedlinePlus. Web. May, 14, 2012 (Updated)
  5. Aroesty, Julian. Patient Information. “UpToDate”. Web. March 24, 2014 (Updated).

Cardiovascular diseases