February 26, 2024

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What You Should Know About Bypass Surgery

Surgery to perform bypass creates an alternate pathway for your blood to flow around a blocked artery. Doctors use blood vessels from your chest, leg or arm as sources for this bypass route.

Your surgeon will temporarily stop your heart using chemicals and cold, while keeping blood and oxygen flowing to keep blood and oxygen circulation going through your body even with no heartbeats taking place. A machine called a heart-lung machine keeps things moving while your heart rests between stops.

The procedure

Under general anesthesia, the surgeon makes an incision (cut) in the center of the chest and separates the breastbone (sternum), creating an opening into the heart. If necessary, they can use medicine to temporarily stop their heart before placing them on a cardiopulmonary bypass machine which pumps oxygen and blood around their body while they perform surgery.

Surgeons harvest blood vessels from legs or arms to provide new grafts that redirect blood away from blocked arteries. One graft usually connects to the aorta, the main vessel carrying blood from the heart; another connects directly to coronary arteries just beyond any blockages.

Your breathing tube that was placed in your throat before surgery will be removed when you awake, allowing you to breathe on its own. Fluids and medications may be administered intravenously (IV). Most people stay in hospital three to seven days.

The grafts

At this procedure, doctors use healthy blood vessels from other areas of your body to reroute blood around a blocked section of your coronary artery and improve oxygen-rich blood supply to your heart muscle. These new blood vessels, or grafts, help increase oxygen intake.

To reach your heart, doctors make a long cut down the center of your chest and spread open your rib cage. They take a section of blood vessel from somewhere else in your body – such as from your leg vein or arm artery – then sew one end to your aorta (the large artery that carries blood out of the heart), while sew-ing another end directly beneath an area with blockages in its path.

Your doctor may take measures such as extracting blood vessels from your wrists or abdomen to use as grafts, in some instances without even stopping your heart (known as off-pump surgery). This process typically takes 4-6 hours.

The surgery

People suffering from coronary artery disease (CAD) can benefit greatly from bypass surgery, which relieves chest pain caused by inadequate oxygen to the heart muscle, reduces risk of heart attacks, slows progression of CAD, and extends life expectancy.

Under general anaesthetic, surgery will take place under general anaesthesia. Before the procedure starts, your doctor will administer medication to make you sleepy before your surgeon cuts through your sternum (breast bone) to spread open your ribcage and cut through its center (sternum). A machine called a heart-lung machine keeps blood circulating while oxygenated oxygen supplies keep the surgeon going about their job.

Your surgeon will start by extracting a blood vessel from either your chest, leg or arm and sew one end to your aorta – the large artery which carries blood away from the heart – while sewing another end directly onto an artery bypassing part of your coronary artery that’s been blocked off.

Recovery

In some instances, doctors employ a newer surgical procedure called TECAB (thoracic endoscopic aortic bypass). This approach may produce better long-term outcomes such as less scarring and faster recovery – however it remains too soon to know for certain how effective this method really works.

Following surgery, you should expect to spend three to seven days in hospital. Most likely you’ll spend your first night in an intensive care unit before transitioning into regular or transitional care rooms for further recovery. Once tubes have been implanted in your chest to drain any fluid accumulation around the heart, nurses will monitor your condition constantly.

Your doctor will prescribe medicines to control your blood pressure, pain and risk of bleeding during recovery. They’ll advise which ones should remain and which should be discontinued or changed; furthermore it is vital to eat a heart-healthy diet, exercise regularly and reduce stress levels so as to allow your body to heal more effectively and lower its chances of another heart attack.