Heart diseases affect approximately 15% of the population in India, Coronary heart disease (CAD) being one of them. CAD is a condition that causes blockages in the arteries due to accumulation of fat and calcium. This reduces blood supply to the heart, causing chest pain (angina), breathelessness and palpitations. In its severest form, it can lead to a sudden heart attack or a decrease in heart function (heart failure). One of the treatment modalities for Coronary Heart Disease - CAD is Coronary Artery Bypass Surgery (the other being stenting). Bypass surgery is usually recommended for people with blockages in all three arteries or a blockage in the main artery to the heart (left main artery) or two blockages in one or two arteries.
When is bypass surgery preferred to stenting?
CABG is preferred to stenting in patients with blockages in all three arteries especially if the patient is diabetic or has a decreased heart function. By pass surgery may be recommended in left artery blockages or if stenting is not possible.
How is it done?
Under anesthesia, the surgeon opens front of chest (the surgery can be done by making a cut in the left side of chest also). The arteries from the chest, forearm or vein are used for creating new channels to supply blood to the arteries. The surgery is commonly completed within 5- 6 hours.
What are the risks of bypass surgery?
Though the exact probability of risk depends on individual patient’s profile but on an average it is approximately 1-2%. Some of the risks include:
- Bleeding during or after surgery,
- Heart attack or failure,
- Kidney problems,
- Stroke or infection which can rarely be life threatening also.
However, you are far better off getting the surgery done when recommended as the benefits outweigh the risks.
What are the benefits and how long do they last?
Bypass surgery can relieve the symptoms of angina and can improve the functioning of heart. It also reduces the chance of heart attacks, thereby increasing a patient’s life expectancy. The success of bypass surgery depends on whether the patient is regularly taking prescribed medicines, contolling diabetes and hypertension, reducing weight (if obese), not smoking and maintaining a healthy lifestyle. With appropriate care, the benefits of bypass surgery can lasts for 10-15 years.
How long is the hospital stay?
The patient can be removed from the ventilator within few hours. The ICU stay is usually two days and the patients are allowed to have a normal diet. Also, the patient is allowed to walk slowly from 2nd day onwards, but the recovery takes around 3-4 weeks after which the patients can return to work.
How is beating heart surgery different? Is it safe?
In this surgery, the patient was connected to a heart lung machine to stop the heartbeat during the surgery. However, in the 1980s and 90s, due to latest technological advancements, a bypass surgery could be done while the heart continued to beat . This did not require the patient to be connected to a heart lung machine. This procedure caused less blood transfusions, reduced chances of stroke or kidney damage and helped in quick recovery. It is possible to use this technique in 98-99% cases, despite that traditional method is a safe procedure.