Vein Heart Bypass

Heart Bypass is a surgical procedure to restore normal blood flow to an obstructed coronary artery. In Coronary Artery Bypass Grafting (CABG), popularly called “Heart Bypass”, healthy veins or arteries from the patient’s body are grafted to create a bypass channel that ensures proper blood & oxygen flow to the heart. When blood flow reduces due to coronary heart disease (CHD), these arteries or veins, often taken from your leg or forearm, are grafted (attached) to the coronary artery to let blood “detour” past a narrowing or blockage in this artery.

Depending on the patient’s heart condition, the doctor will recommend one of the following types of bypass surgeries:

• Single bypass: Recommended when only one artery is blocked.
• Double bypass: Recommended when two arteries are blocked.
• Triple bypass: Recommended when three arteries are blocked.
• Quadruple bypass: Recommended when all four arteries are blocked.

Based on technique, there are two types of Coronary Artery Bypass Surgeries (CABGs):

• On Pump CABG (Traditional Bypass Surgery): The pumping and oxygenation functions of the heart are supported by a heart-lung machine, while medications are given to induce cardioplegia (temporary paralysis of the heart muscle). This ensures that the heart is completely at rest while the surgeon performs the bypass surgery.
• Off Pump CABG (Beating Heart Bypass Surgery): Here the heart continues to perform its pumping and oxygenation functions without inducing cardioplegia. The section of the heart where the bypass is needed is stabilized and operated on while the rest of the heart keeps beating. It is as safe as the other procedure with reduced risk of stroke, bleeding and renal failure.
• Off-Pump LIMA-RIMA Y CABG (Arterial Beating Heart Bypass Surgery): This procedure is done on beating heart using only arteries as grafts and not veins (total arterial bypass grafts). It uses the 2 mammary arteries of the chest to construct a “Y” shaped graft and hence, no cuts are required to be made on the patient’s legs or arms. Arterial Bypass helps you live longer as it lasts for 25 years.
• Minimally Invasive Direct CABG: It is similar to an off-pump CABG, but instead of a large incision (cut) to open the chest bone, few small incisions of 5 to 10 cm are made in the chest area between the ribs. This procedure is used when the blockage is in the front portion of the heart. However, it is not done for triple or quadruple bypass.

In a Heart Bypass, the graft creates a new route for blood to travel to the heart. If the patient has multiple blockages, the surgeon may conduct one or more bypass procedures during the same surgery. The usual flow of the procedure is:

• Patient is put under general anesthesia for the surgery and vitals are stabilized.
• A breathing tube is placed in your lungs through your throat and is connected to a ventilator.
• An incision is made on the chest followed by cutting open the patient’s ribcage to access the heart.
• An artery or vein is taken from your body to create the bypass passage. Depending on the procedure it can be done in the following ways:Vein Harvesting :  In case of vein based Heart Bypass surgery, veins from the leg called the Saphenous Veins are used. These veins are harvested from an incision on the leg from the groin to the ankle. It is then used to connect the aorta to the coronary artery below the site of blockage. Minimally invasive procedures lead to less scarring and a faster recovery.

  Artery Harvesting : In case of Arterial Bypass (RIMA LIMA Y), these arteries for graft are accessed through the same chest incision used to access the heart. Based on the patient’s condition, the radial (arm) or gastroepiploic (stomach) arteries may also be used.

• Post grafting, blood flow to the heart is restored. Usually, heart starts beating voluntarily. If not, then mild electric shocks are used to trigger the process.
• The surgeon uses wires to close up the previously opened chest cage, similar to a broken bone repair. Finally the incision is closed and the breathing tube removed when the patient is able to breathe normally.

CABG is a commonly prescribed course of action for people diagnosed with CHD. This procedure is only done when Angioplasty is ruled out due to excessive blockage or weak and narrow passage of the arteries. The common factors to be considered are:

• Complaints of severe chest pain, caused by shortage of blood flow to the heart due to narrowing of the arteries supplying blood to the heart muscle, during light exercise or even at rest.
• The patient has more than one plaque blocked coronary artery, and the heart’s main pumping chamber — the left ventricle — isn’t functioning well.
• The left main coronary artery is severely narrowed restricting supply of blood and oxygen to the left ventricle.
• Isolated artery blockages do not allow space for temporarily inserting and inflating a tiny balloon to widen the artery (angioplasty). This applies especially when there is a history of angioplasty and the artery has narrowed again (restenosis).
• In the unlikely event of a heart attack, where the patient is not responding to other treatments.

Bypass surgery is advised by cardiac surgeons to restore healthy heart functioning. This procedure will ensure:

• Improved pumping action to restore blood flow to the heart muscle.
• Reduced symptoms of CHD, such as angina.
• Reduced risk of further heart problems and longer survival.
• Improved quality of life to resume an active lifestyle.

Even with coronary bypass surgery, the patient will need to make lifestyle changes after surgery. Medications are prescribed routinely after coronary bypass surgery to lower the blood cholesterol levels, reduce the risk of developing a blood clot and help the heart.

In the event of a heart attack, time is of essence. Therefore, early diagnosis and treatment reduces chances of complications in surgical treatment and increases possibility of survival.

Patient’s age, health, and the severity of angina decides this treatment. If unattended it may lead to a life-threatening heart attack due to blood clots caused from rising angina pain.

This surgery is done when coronary arteries become blocked or damaged. These arteries supply the heart with oxygenated blood. If blocked or blood flow restricted, it may gradually lead to complete heart failure.

CABG is prescribed to patients with CHD. During CABG, a healthy artery or vein from the body is connected, to the blocked coronary artery by passing it around the blocked portion of the coronary artery and creating a new unobstructed passage for healthy blood circulation.

Majority of beating heart bypass surgery or off pump coronary artery bypass surgery patients experience improvement or complete relief of their symptoms and remains symptom-free for several years.

In this type of heart bypass surgery veins from the leg is used called the Saphenous Veins. These veins are removed from your leg, and then sewn from the aorta to the coronary artery below the site of blockage. Minimally invasive saphenous vein removal may be performed and results in less scarring and a faster recovery.

Bypass surgery will improve blood flow to your heart muscle and reduce your symptoms of CHD, such as angina. In time, you may feel healthier and active than you were before the surgery. Your risk of further heart problems will also be reduced to a great extent.

The things that you do and the choices you make can greatly reduce your risk of more heart problems in future, including heart attack.

The most important things you can do to reduce your risk of more heart problems are to:

Take the prescribed medicines properly by your doctor.
Be smoke- free
Enjoy a healthy eating
Be physically active
Keep a check on your blood pressure and cholesterol
Maintain a healthy body weight
Be smoke- free
People with diabetes should generally aim to maintain their blood glucose levels within the normal non-diabetic range and follow individual advice from their doctor.

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