Heart bypass surgery: procedures, risks and treatments

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Definition of heart bypass surgery

What is heart bypass surgery?

Heart bypass surgery or Coronary Artery Bypass Grafting (CABG) is a surgical procedure performed to increase blood flow to the heart. Usually, this treatment is intended for people who have severe coronary heart disease.

Coronary heart disease causes plaque to build up in the coronary arteries. In fact, the arteries are responsible for supplying oxygen-rich blood to the heart. The plaque that builds up causes a narrowing of the blood pathways, so that blood flow to the heart muscle can be reduced or even blocked.

When blockage occurs, people with this condition will experience symptoms of heart disease, such as chest pain, shortness of breath, and in some cases a heart attack can occur.

With heart bypass surgery, the surgeon will create new avenues for oxygen-rich blood to flow smoothly to the heart muscle. This procedure involves taking a healthy blood vessel from your leg, arm or chest and connecting it to the outside of the blocked artery in your heart.

Although this treatment does not aim to cure heart disease, you can relieve the symptoms of heart disease. For some people, this surgery can improve heart function and reduce the risk of dying from heart disease.

When is heart bypass surgery necessary?

Heart bypass surgery is usually done when the doctor considers the following:

• You experience symptoms of severe coronary heart disease, the effects of which cause the heart muscle to lack blood even during moderate exercise or rest.
• You have more than one coronary artery that is problematic and a left ventricle that's not working properly.
• The left main coronary artery is narrowed or blocked, so that blood flow in the left ventricle is interrupted.
• You have a blockage in your left artery and an improper angioplasty procedure was performed. Or when you have had an angioplasty but have not managed to treat the condition or the heart ring has been installed, but the arteries have narrowed again (restenosis).

In conclusion, CABG surgery is performed when the patient is in an emergency situation, that is, has a heart attack or does not respond to other heart disease treatments.

Types of heart bypass surgery

Reporting from the Department of Surgery from the University of California San Francisco, heart bypass surgery consists of several types, including:

Traditional Coronary Artery Bypass Grafting

This type of surgery is most commonly performed, when at least one main artery is affected. During the operation, the sternum will be opened to make it easier for the surgeon to access the heart.

Then, the surgeon will administer a special medication to stop the heart organs from working and a heart-lung bypass machine will be used to keep blood and oxygen moving throughout the body during the operation. This is done so that the surgeon can operate on the heart in silence.

Off-Pump Coronary Artery Bypass Grafting

This type of surgery is similar to traditional CABG in that there is a breastbone opening procedure. However, the heart is not stagnated and does not require a heart-lung bypass machine.

Minimally Invasive Direct Coronary Artery Bypass Grafting

This type of operation is similar to the CABG off-pump. However, instead of making a large incision in the sternum, the surgeon will make a small incision on the left side of the chest between the ribs. Usually the surgeon will use robotic assistance and video imaging.

This medical procedure is not suitable for all people with heart disease. This is done when more than one coronary artery is blocked.

Risks and side effects of heart bypass surgery

In addition to seeing the patient's condition, the doctor will consider the risk of side effects that may occur after heart bypass surgery is performed.

The following are the possible side effects of heart bypass surgery:

• Bleeding from the wound from the operation.
• Heart rhythm disturbances (arrhythmias) so that they become abnormal; to be faster or slower than it should be.
• Bacterial infection of open scars.
• Experiencing kidney problems or stroke.
• There was a heart attack after surgery due to a blood clot.
• Loss of memory or difficulty thinking clearly, which usually improves within 6-12 months after surgery.

The risks of surgical side effects, mentioned above, are generally quite low. However, this depends on the patient's overall health condition before the operation is performed.

The risk of surgical complications is very high if the patient has other health problems, such as diabetes, kidney disease, emphysema, and clogged arteries in the legs.

Preparation before undergoing heart bypass surgery

Before CABG surgery, the doctor will ask you to take a series of medical tests. The goal is to check your cardiovascular system, lung condition and pulse.

The doctor will also observe the symptoms of heart disease that you feel, namely how often, how severe, and how long the symptoms last.

Health tests that need to be done

Here are some medical tests that need to be done before heart bypass surgery:

• An electrocardiography (EKG) test which aims to detect electrical activity in the heart.
• Stress testing at the same time includes imaging tests, such as PET scans of the heart and MRI. This test aims to find out problems with the heart while you are on the move.
• Echocardiography test, which is a test to check the size and shape of the heart as well as to find out poor blood flow in the heart.
• Coronary angiography aims to determine areas of blockage in blood vessels.

In addition to the medical tests above, you will also be asked to follow a variety of pre-surgery recommendations, including:

• Obey the rules of eating and drinking recommended by the doctor.
• Quit smoking and drinking alcohol.

Heart bypass surgery procedure

Heart bypass surgery usually takes about 3-6 hours. The patient will be given general anesthesia through a tube that is inserted into the mouth. The hose is also connected to a ventilator which helps the patient breathe during and after the operation.

Most operations are done through a long incision in the chest; some are in the form of a large incision, some are small. This depends on which type of bypass operation you are having.

After surgery, the heart organ returns to work on its own. Sometimes, to stimulate the heart to beat again, the doctor will send a light electric shock. Next, the surgeon will close the incision with a special wire. The wire will be removed when your bone has healed.

Postoperative heart bypass care

After the surgery, you will be placed in an intensive care unit for a few days until your condition stabilizes.

After that, you will undergo cardiac rehabilitation in order to speed up the recovery process in the hospital. This process is then followed by a recovery program that you can do yourself at home.

Like any other type of surgery, surgery bypass the heart can also cause side effects. Some of these include muscle and back pain, fatigue, difficulty sleeping, changes in appetite, and swelling in the area of ​​the operation.

These side effects usually disappear after 4-6 weeks after surgery. Most of the patients are even able to continue their activities as before.

However, you still need to consult your doctor if you want to do certain activities because the entire recovery process generally takes 6-12 weeks. After leaving the hospital, you will undergo the recovery process at home.

Matters that need to be considered during the recovery process at home

Here are a number of things that patients and caring relatives need to pay attention to so that recovery after heart bypass surgery is fast:

• Watch for signs of infection such as fever, pain that is getting worse, and bleeding in the wound area.
• Routinely clean the surgical wound according to the doctor's direction.
• Routinely see a doctor and consume the drugs given.
• Eat a balanced nutritious diet.
• Maintain ideal body weight.
• Only go through the recommended activities during recovery.

Patients who have recently undergone surgery bypass the heart is usually only allowed to do light activities such as walking, cooking, and lifting light objects.

After 6 weeks, then you can do more strenuous activities such as doing housework, driving, carrying children, and having sex.