Bypass Surgery

What is Bypass Surgery?

Bypass Surgery is also called Heart Bypass Surgery or Coronary Artery Bypass (CABG)
Surgery. Bypass surgery is done to treat a medical condition called Coronary Heart Disease
(CAD) in which arteries get blocked due to the accumulation of fat and calcium. This reduces
the blood supply from the heart. To accomplish optimum blood supply, a graft conduit is
implanted as an alternative path for blood supply from the heart at the site of the blockage.
Since the original blood supply path/artery is bypassed, this kind of surgery is generally
called Bypass Surgery.

What is Coronary Heart Disease (CAD)?

Coronary Heart Disease is a medical complication of the heart which involves the buildup of
plaque in the wall of arteries supplying blood to the heart. These arteries are called coronary
arteries. The plaque that causes blockage in coronary arteries is made up of cholesterol
deposits. Over time, the buildup of plaque makes the interior of arteries narrow resulting in
lower or reduced blood supply. This process of narrowing is called atherosclerosis.

Who needs bypass surgery?

As mentioned above, this surgery is done to treat patients suffering from Coronary Heart
Disease. Patients with the following symptoms need to undergo bypass surgery:

• Severe Chest Pain caused by narrowing of coronary arteries. It is commonly called
  Angina. This kind of pain occurs on the left side of the chest. You will not be able to
  carry out any kind of cardio exercises. It feels like someone is standing on your chest.
• Body Mass Index of 35-40: This condition also makes the patient eligible for bypass
  surgery.
• Type 2 diabetes: If you’re a patient with type 2 diabetes, you might need to
  undergo bypass surgery.
• Heart Attack: A completely blocked coronary artery causes a heart attack. In this case,
  it is necessary to get a bypass surgery done.
• Emphysema: It is a medical condition in which lung size increases abnormally
  resulting in heavy breathing.
• Kidney disease: If you’re suffering from any kind of kidney disease, there are more
  chances of developing heart disease.
• Peripheral Arterial Disease (PAD): The condition in which narrowed or blocked
  arteries reduce the blood flow to your limbs.
• Shortness of breath: If you are unable to breathe properly, it is a sign of a
  blocked coronary artery and you may be needing a bypass surgery if this symptom is accompanied by the above-mentioned signs.

Stenting and Bypass Surgery

What is stenting and when is bypass surgery preferred over it?

Stenting is a medical procedure in which a stent (a tiny tube) is inserted into a blocked
coronary artery to keep it open and to ensure proper blood flow. Stents may be metallic or
made of plastic.
Bypass surgery or CABG Surgery is preferred over stenting when a patient with CAD has all
three arteries blocked and he is suffering from type 2 diabetes. CABG surgery may also be
recommended when stenting is not possible.

Bypass Surgery Procedure

How is the bypass surgery performed?

The procedure of bypass or CABG Surgery involves multiple steps and takes around 5 to 6
hours to complete. The process may be summarized as the following:

• • The beginning step
    Your surgeon will give you general anesthesia and make an incision in the middle of
    your chest to open and spread apart the rib cage so that the heart is exposed.
    Your surgeon may also opt for minimally invasive surgery which doesn’t require the
    above process and only smaller incisions are made so that specialized robotic
    instruments are inserted into your body to perform the surgery.
  • Open heart or with a cardiopulmonary bypass machine
    Your surgeon may either opt for off-pump or open heart bypass surgery wherein
    your heart keeps beating while the operation is done
    Or
    He may use a cardiopulmonary (heart-lung) machine to replace the operative arteries
    in order to ensure proper blood supply during the procedure.
  • Grafting
    Your surgeon obtains a graft conduit from your limb, possibly and preferably your
    thigh, using a technique called Endoscopic Vessel Harvesting (EVH). The graft thus obtained will be attached above and below the blocked part of the artery.
  • The final steps
    After finishing the grafting of all the blocked arteries, the surgeon will
    double-check the functioning of the bypass and if everything is going well, your
    wounds will be stitched up and bandaged and you’ll then be shifted to the
    intensive care unit (ICU) for further monitoring and care.

Risk factors

What are the risks involved in a bypass surgery?

Like every other surgery, bypass surgery also involves your risk of developing certain
complications after the surgery. Chronic obstructive pulmonary disease (COPD), diabetes,
old age, and other chronic diseases increase the chances of developing more complications
after the surgery.
Some of the complications that may occur after the bypass surgery may include bleeding,
arrhythmia, blood clots, chest pain, infection, kidney failure, and heart attack.
Post Surgery care and precautions

What to expect after undergoing a bypass surgery?

After the bypass surgery, you’re shifted to an intensive care unit for monitoring of your
improvement and care.
You may feel pain while coughing and breathing. The site of incision may also be painful.
You are likely to stay at the hospital for several days before you are allowed to leave. Our
medical team at Yashoda Hospital and research center will give you proper instructions
before discharge. You may be instructed as follows:

• • • Proper cleaning, dressing, and caring of your incision wounds.
    • Avoiding any kind of heavy exercises
    • Getting a lot of rest for a quick recovery

Besides, your doctor may recommend cardiac rehabilitation such as occasional stress
tests and carefully monitored physical activity to see how well your heart is doing while
recovering. The recovery from CABG surgery or bypass surgery takes around 6 to 12
weeks.

Treatment

What kind of medication is given after a heart bypass surgery?

Your doctor at Yashoda Hospital and Research Center, Nehru Nagar, Ghaziabad, will give you
several medications to help manage your pain and ensure a quick recovery.

Ibuprofen or acetaminophen or narcotic may be given in case of unmanageable pain. Some
antiplatelet drugs like aspirin may also be prescribed throughout the recovery process to
prevent the formation of blood clots.

Drugs like nitrates, ACE inhibitors, and beta-blockers may also be prescribed to reduce
chest pain, prevent your body’s production of angiotensin II hormone, block your body’s
production of adrenaline and lower your blood pressure respectively.

Expert doctors at Yashoda hospital and Research Center, Nehru Nagar, Ghaziabad
The surgery improves blood flow to the heart by redirecting blood around the section of
the blocked artery in the heart. This procedure involves taking a healthy blood vessel from
a patient’s leg, arm, or chest and connecting it beyond the heart’s blocked arteries. This
intricate treatment is given with perfection at Yashoda Hospital and Research Center, Nehru
Nagar, Ghaziabad.

Dr. Amit Rai
He is a senior consultant and Cardiologist at Yashoda Hospital and Research Center, Nehru Nagar, Ghaziabad. He has a vast experience from Government Medical College, Jabalpur. Hea lso worked as Chief Senior Resident, at M.C.K.R hospital, New Delhi. He has been providing his expert services for 34 years after completing his M.B.B.S degree from Rani Durgavati Vishwavidyalaya, Jabalpur, Madhya Pradesh. He has done his fellowship in non-invasive cardiology from Navin C . Nanda National Institute of EchoCardiography and Cardiac Research, New Delhi.

Dr. Alok Sehgal
He is a chief consultant in cardiology at Yashoda Hospital. He has completed his D.M. from
the reputed institute of India, CMC Vellore. He has been providing his expert services for 20
years. He specializes in all kinds of diagnostic peripheral vascular diseases, cardiac
catheterisation, and angiographic studies on adults and children. He also specializes in
balloon angioplasty (a procedure used to open blocked arteries), intracoronary stenting,
bifurcation stenting, pericardiocentesis (a procedure to remove fluid that built up in the sac
around the heart), and coil embolization, a minimally-invasive procedure to treat the
weakened area in the artery by filling it with material which helps in reducing bleeding.