Coronary Bypass Surgery

What is coronary artery bypass surgery?

Coronary artery bypass surgery is often the best solution for patients suffering from severe coronary artery disease, Atherosclerosis. Atherosclerosis is a disease that is the result of fatty build-up on the inner walls of the arteries that nourish the heart and allows less room for blood to flow. These build-ups can narrow the arteries and thus restrict the normal flow of oxygen-rich blood, or can actually block the flow of blood altogether. If your doctor has recommended coronary bypass surgery to "detour" your blocked artery, the following information can help answer your questions about this procedure.

Symptoms

In it's early stages, CAD has no obvious symptoms. As Atherosclerosis worsens, it may cause one or more of the following:

a.) Dull, crampy pain in you buttock, thigh and calf muscles during exertion.

b.) Sudden onset of localized paralysis, tingling or numbness in a limb; partial vision or speech loss.These symptoms may indicate cerebral atherosclerosis, which can lead to stroke.

c.) A feeling of tightness or heavy pressure in the chest.

How is coronary bypass done?

During bypass surgery, surgeons take a blood vessel from another part of the body and construct a detour around the blocked part of the coronary artery. The breastbone is broken and opened to gain access to the heart; however, the heart itself is not opened. There are two common procedures:

a.) An artery may be detached from the chest wall and the open end attached to the coronary artery below the blocked area.

b.) A piece from a long vein in your leg may be removed and one end sewn onto the large artery leaving your heart.The other end of the vein is grafted to the coronary artery below the.blocked area.

Either way, blood can then use this new path to once again flow freely to the heart.

What is minimally invasive bypass surgery?

This is a new technique that is being evaluated as alternative to traditional coronary artery bypass surgery. It involves the use of special tools to perform a coronary artery bypass procedure without breaking the breastbone and without the use of a heart-lung machine. Benefits to this procedure are less pain and shorter hospitalization. This is a new technique and many medical centers do not yet perform. Your doctor will help you decide which treatment is best for you.

What to expect

Prior to your surgery you will have a full medical and cardiac evaluation that usually includes cardiac catheterization (an examination of the inside of your heart), a coronary angiogram ventriculogram (an x-ray picture of the pumping action of the lower left part of your heart). The procedure is performed under general anesthesia. You will recover in the intensive care unit of the hospital and monitored closely for 2 - 3 days. You will have several tubes to help you breathe, empty your bladder and provide medications. Once your condition is stable and the tubes are removed, you will be moved to a regular hospital room where you will spend 7 - 10 days. You will then receive physical, respiratory and occupational therapy. Bypass surgery is a major surgical procedure, so it is important that you speak with your doctor in advance about possible complications, as it does carry some risks.

After surgery care

Your recovery time at home will be approximately one to two months. You will have follow-up visits during that time to monitor your progress and the success of the surgery and your doctor will place you on a specialized post-operative rehabilitation and prevention program. It is imperative that you follow your physician's instructions about reducing your risk of the progress of further Atherosclerosis by stopping smoking (if you smoke), reduce your consumption of high fat and cholesterol foods, follow your doctor's recommended exercise program and learn how to control your blood pressure. Sexual activities may be resumed 3-4 weeks after surgery. You should be somewhat careful in protecting the area around the leg from which the vein was removed; this may take a few months to return to normal. Most people who have sedentary office jobs can return to work in four to six weeks. Those who have physically demanding jobs will need to wait longer. In some cases, they may need to find other employment with less physical activity.

Hope for the future

Without coronary artery bypass surgery, for many people there would be no hope for tomorrow. By providing your heart with life-giving oxygen, coronary artery bypass surgery can help ensure a longer healthier life.

Nagender A. Reddy, M.D.