What Is Bypass Surgery and what is heart?
The heart is a complex organ of the body made up of cardiac muscles. This tissue is an involuntary muscle found only in the heart organ. The function of the heart is to provide oxygenated blood for all biological functions of the body. It is normally located in the middle of the chest, with its widest part just below the breastbone on the left side. However, this is rarely seen on the right side. The left heart (ventricle) is more powerful.
It pumps all parts of the body. The left lung is smaller than the right lung because the heart takes up more space in the left half of the chest. Blood reaches the heart through the coronary circulation. Friends, veins and arteries work to transport and deliver blood to the heart throughout the body. The heart beats an average of 72 times a minute and pumps 70 milliliters of blood a minute. The average weight of the heart is 250 to 300 grams in women and 300 to 350 grams in men. Apart, the aortic valve and mitral valve are the most commonly replaced valves. Pulmonary and tricuspid valve replacements are quite uncommon in adults. Aortic valve repair is a procedure performed to treat a damaged or diseased aortic valve.
What Is Heart Failure?
If the heart stops beating due to any reason then it is
called cardiac arrest. This is a very serious and emergency condition in which
the continuous supply of oxygen to the brain stops. In such a situation, if
immediate treatment is not received, death occurs.
Before Knowing About Bypass Surgery, It Is
Important To Know What Are Veins And Arteries.
What Are Nerves?
Veins are blood vessels. They carry deoxygenated blood
towards the heart. With the help of muscle contraction, blood flows in the
veins. Blood pressure is 5 mm Hg. The diameter of the veins can vary from 1 mm
to 1.5 cm.
What Are Arteries?
Arteries are also blood vessels. There are 250 arteries in
our body. Apart from the pulmonary and aortic arteries, all arteries carry
oxygenated blood from the heart. Arteries are thick and flexible. Their inner
diameter is less, the color is pink or bright red and when there is excessive
pressure, blood does not flow normally but with a jerk. About 15 percent of the
total blood present in our body is present in the arteries at all times. In
these the blood pressure is 120 mm Hg. There are two types of arteries -
1. Pulmonary arteries
– These arteries carry oxygen-poor blood from the heart to the lungs.
2. Systemic arteries
– These arteries carry oxygenated blood from the heart to other parts of
the body.
The aorta is the largest artery in the body that begins in
the left ventricle of the heart. Oxygenated blood delivers oxygen to tissues
throughout the body. This aorta has 25 branches.
The main artery that supplies blood to the brain is called
the brachiocephalic artery. The main artery supplies blood to the heart. These
areas of the body are called coronary arteries.
The blood vessels that supply blood to the heart are called
coronary arteries.
What Is Bypass Surgery?
Its full name is heart artery bypass surgery. It is also
known by the names bypass surgery, heart bypass etc. Three main arteries supply
blood to the heart. If for some reason there is blockage in any one artery or
all three arteries, then it is called coronary artery disease. Surgery is the
best option for its treatment. Its second and cheaper option is angioplasty.
In surgery, a vein is taken from a particular part of the
body and connected parallel to the blocked area of the heart artery. This
paired vein resumes blood flow into the cardiac artery. This technique of surgery
is called bypass surgery.
What Is Angioplasty?
Angioplasty, known as Vasculoplasty in Hindi, is known as
percutaneous coronary intervention. This is commonly called coronary angioplasty.
It is also a surgical procedure in which narrowed or obstructed heart arteries
are mechanically widened with blood, allowing blood circulation to resume.
In some cases, a coronary artery stent is also inserted.
Angioplasty is the fastest way to get blood flowing again in narrowed or
blocked heart arteries. Angioplasty is considered safer than bypass surgery.
Due to blockage in
the arteries of the heart –
Blockage in the arteries of the heart occurs due to the
following reasons-
1. Fat accumulation causes the arteries to harden, which hinders
the steady flow of blood.
2. High blood pressure.
3. Imbalance in cholesterol level. LDL i.e. “bad”
cholesterol increases and HDL i.e. “bad” cholesterol increases. “Good”
cholesterol is reduced.
4. Problem of diabetes.
5. Obesity means weight gain.
6. Not exercising. There should be some light exercise.
7. Very sedentary lifestyle i.e. little or no physical
activity.
8. Smoking too much.
9. Some type of radiation therapy to the chest.
10. Deterioration of heart valves.
Why Is Bypass Surgery Done?
Bypass surgery is done in the following circumstances –
1. When sudden chest pain occurs. This pain should also be
felt in the teeth, jaw, fingers, and hands. This means that the heart is not
getting adequate blood supply. There may be blockage in the arteries.
2. There is difficulty in breathing and shortness of breath.
Feeling weakness in the body and difficulty in breathing is even with light
activity. This may be due to damage to the heart artery.
3. Several tests can detect blockage in the arteries even
when there are no symptoms of angina. Chest pain is called angina. It is also
called angina pectoris and ischemic chest pain.
4. When angiography shows that the patient may have a heart
attack at any time, then in such a situation bypass surgery should be done at
least six hours before the patient has chest pain.
5. In case, chest pain persists even after recovering from
heart attack.
6. When the artery becomes swollen. Inflammation causes
damage to the artery walls. Thick swelling can affect any artery in the body; can
also damage the coronary artery.
7. When there is blockage in one or more arteries, the
sub-branches of the arteries become narrowed. In such a situation, bypass
surgery is the only option.
8. In case of heart valve damage. Surgery is required to
correct these.
9. Decrease in the heart's ability to pump blood.
10. In case of failure of angioplasty or some complications
after angioplasty.
Tests to Be Done Before Bypass Surgery
To know the condition of the heart and heart arteries,
doctors can conduct the following tests and only then the decision about bypass
surgery is taken –
1. Electrocardiogram (ECG or EKG)
2. Echocardiogram (Echo)
3. Stress Test
4. Nuclear Heart Scan
5. Electron Beam Computerized Tomography (EBCT)
6. Magnetic Resonance Angiography (MRA)
7. Angiography
8. Intravascular Ultrasound (IVUS)
9. X-ray
10. Blood test
11. CT Angiography
Information Given By the Doctor Before
Bypass Surgery
1. The following facts are kept in mind before surgery –
(i) The age and general health of the patient.
(ii) The medicines the patient is currently taking.
(iii) Allergy to any particular medicine.
(iv) Any previous
surgery.
(v) Any previous treatment for heart disease.
(vi) Someone in the
family having heart disease.
2. Doctor gives information about anesthesia.
3. Precautions to be taken after operation.
4. It is forbidden to take medications that affect the blood
clotting process.
5. A special type of soap is given for use before surgery.
6. Smoking is strictly prohibited.
7. It is prohibited to eat or drink anything immediately
before surgery.
8. Drinking water is also prohibited. If your mouth is dry
due to thirst, you can gargle with water, but do not drink the water. There
should be no water at all in the stomach.
How Is Bypass Surgery Performed?
·
Heart surgeon for bypass surgery,
·
Anesthesiologist (anesthesia specialist),
·
Perfusionist (heart-lung machine specialist),
Others have a whole team of surgeons and nurses.
1. General process
After the patient is given anesthesia, the middle bone of
the patient's chest, called the sternum, is cut to gain access to the heart. It
is connected to a heart-lung machine to maintain oxygen and blood flow
throughout the body. This machine starts working for the heart and lungs. The
heart is washed with a solution which reduces its temperature and also stops
beating. Then grafting work is done. For grafting, the graft of artery/vein
(which will be mentioned later) of the body parts is prepared in advance, which
is bypass grafted as per the requirement.
That is, a new artery/vein is added to the blocked artery in
front of the blockage. The heart and lungs are reconnected to the circulatory
system, the heart-lung machine is removed, and two pacemaker wires are placed
on the surface of the heart. These wires are connected to a temporary
pacemaker, which regulates the heartbeat if it becomes irregular. Then finally
the chest bone is stitched with wires and stitches are placed in the skin. The
operation takes three to four hours and requires four to six units of blood.
Artery/vein taken for graft –
(i) Artery graft – Usually the internal artery of the left
breast is used. Or the artery of the arm can also be used for the graft. It is
called radial artery.
(ii) Vein graft- The saphenous vein is a long vein located
inside the leg. This vein is commonly used for grafts. As time passes, it
becomes more likely to get blocked.
2. Non-Traditional Artery Bypass Surgery (Beating Heart Surgery) –
Beating heart surgery is completely successful in the new
modern technique of bypass surgery. Even a six-month-old baby can undergo
bypass surgery. Would like to tell you that for the first time in the world,
using this technique, successful bypass surgery of a six-month-old girl named
Sharon D'Souza was done in Mumbai, India in January 2009. Friends, you will be
shocked. , To learn that the girl's left coronary artery was abnormal due to
pulmonary artery disease, a rare congenital heart disorder that occurs in one
in 5 lakh children.
This surgery is also similar to heart artery bypass surgery. In this process, the chest bone also has to be cut to reach the heart. But in this process the heartbeat is not stopped nor is the heart-lung machine used. It is also known as beating heart bypass grafting. With this modern technology bleeding is stopped only in the particular area of the heart where the surgery is to be performed. This surgery requires only one to two units of blood and the patient is discharged from the hospital in just a week.
3. Minimally invasive direct coronary artery bypass grafting (minimal invasive technique)
In modern technology, bypass surgery is done by making a cut
as small as three inches with the help of modern stabilizer equipment. There is
no need for heart-lung machine in this. Because of this technique there is no
need to make a big incision. The breastbone is opened by making a small
incision on the left side of the chest. This is done for grafting into the
blood vessels present in the front. Through minimally invasive technique, the
heart can be rotated as per the need, which makes it easier to see the back and
side parts of the heart. The patient can be discharged from the hospital in
three to four days. After this the possibility of re-operation is next to nil.
Want to clarify here that this procedure is not normal but completely new and
two or more coronary arteries cannot be bypassed by this procedure.
Condition after operation –
1. After the operation, the patient is kept in the Intensive
Care Unit (ICU) for 24 to 48 hours.
2. The cardiac monitor consists of wires connected to the
patient's chest through electrodes, providing continuous monitoring of the ECG
and heart rhythm status.
3. A cannula is attached to an artery through which the
patient's blood pressure is checked.
4. There are two tubes installed in the patient's chest
through which fluid keeps coming out from inside the chest. These tubes are
removed one day after the operation.
5. An endotracheal tube is placed in the patient's windpipe
for 16 to 24 hours, connected to an artificial respirator. This helps the
patient to breathe. It is removed when the patient starts breathing well on his
own. As long as this tube remains connected to the patient's windpipe, he
cannot eat, drink or talk.
6. Oxygen mask is also placed on the patient's mouth and
nose so that he continues to get proper oxygen.
7. The patient is discharged in a week or two. During this
time, the wounds on his chest and leg (if the vein has been removed from the
leg) or the wounds on the part of the body from where the vein has been removed
also dry up. If a vein has been removed from the leg, there may be swelling in
the leg. Therefore, it is advisable to rest by raising the legs up i.e. the
legs should not hang downwards. It is advisable to tie a crepe bandage on the
foot while walking, this will prevent the swelling from increasing.
Home Care
Taking care of the patient at home after being discharged
from the hospital is a big responsibility. For this, keep the following things
in mind-
1. The patient's room should be very clean, neat and
ventilated. Dettol mixed with water should be mopped in that room every day so
that there is no infection.
2. The patient's bed sheet and pillow cover should be
changed daily. The patient's clothes should also be changed daily.
3. After surgery, the body becomes weak, hence reduce your
physical activities.
4. Keep in mind that there is an incision on the chest, so
do not make the mistake of lifting/pulling any heavy items.
5. You will feel chest pain while coughing and sneezing, do
not panic about it. This type of pain will continue until complete recovery.
6. Keep taking the medicines prescribed by the doctor
properly and regularly.
7. Take care of the surgery site, if there is even the
slightest redness, or pus or any infection, contact the doctor immediately.
8. Keep getting your blood pressure checked regularly.
9. Whenever the doctor asks for a test, take an appointment
and get the test done, this will save time for both you and the doctor.
10. Take special care of your eating habits. Eat clean and
fresh fruits and vegetables. Do not consume foods high in saturated fat like
cakes, pastries, dairy products, pizza, burgers etc. It would be better if you
get a diet chart made from a dietitian.
11. Do not smoke at all. Consult a doctor about alcohol.
12. Keep in mind that it may take 6 to 12 weeks for complete recovery at home, so keep your mind and brain calm and follow the doctor's instructions sincerely.
Success Rate of Coronary Artery Bypass Surgery
(CABG) Treatment in India
The Success Rate of Coronary Artery Bypass Surgery (CABG)Treatment in India has many factors depending on it, like the stage of the
condition, the age of the patient, and the complication of the procedure.
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