Bypass Surgery

What are the symptoms of needing a heart bypass surgery?

A surgeon will most likely suggest a heart bypass surgery to patients when they see symptoms leading to heart failure or coronary artery disease (CAD), also known as atherosclerosis.  Some patients do not observe any symptoms until they suffer from a heart attack or failure due to prolonged yet invisible coronary artery disease. Your doctor may suggest heart bypass surgery if they observe the following symptoms:

• You may feel severe chest pain (or angina pectoris) because the arteries are blocked or narrowed, resulting in low blood supply to the heart.
• Palpitation, constant feeling of fatigue, irregular heartbeat, breathing problems, swelling, or indigestion are common symptoms of coronary artery disease.
• There is more than one damaged coronary artery, affecting the function of heart pumping.
• The artery to your left heart chamber or ventricle is either narrowed or permanently blocked, reducing the blood supply.
• You may have gone through angioplasty, but either that placement tube didn't go well, or it became narrow again.

What causes heart blockage?

• Our heart is the pumping station that supplies blood to your body. Your heart itself needs a constant supply of healthy blood through the network of arteries. When your body tissues do not get enough blood to function, it affects your heart muscles and starts to deteriorate, called Ischemia.
• Ischemia is one main cause your doctor suggested bypass heart surgery. When the heart arteries start to narrow or block due to the waxy-like substance or plaque, it causes coronary artery disease.

In any condition, bypass heart surgery becomes inevitable when a patient suffers from symptoms of coronary artery disease.

When to call your doctor?

If you or your family members observe any symptoms or may have a previous history of coronary disease, it's immediate time to call your doctor. However, don't worry about where to start, as DoctorFindy exclusively assists you in medical-related queries. DoctorFindy is an online health portal providing access to information to different health facilities from every corner of the country. We provide a list of public and private sector hospitals, lists of certified medical experts and lab test facilities, and help schedule appointments for medical lab tests, regular checkups, and surgical procedures. It also gives patients the facility to book an online video consultation with the best doctors from top cities in Pakistan. Book your appointment online for bypass surgery with the best-renowned surgeon in the comfort of your home. Even after the surgery, You can set up a weekly schedule with the help of DoctorFindy to see your doctor for follow-ups after the bypass surgery. The doctor will check your heart functioning, any remaining stitches, or healing of the incision. Patients should ask questions about medications, recovery phase, cardiac rehabilitation, or lifestyle changes needed.

What to expect before bypass surgery?

• Patients go through a series of lab tests before giving the final call of the bypass surgery. They will be provided with guidelines to follow either week or right before the procedure.
• A doctor may or may not ask for the following lab tests includes; electrocardiogram, exercise stress test, x-ray angiography, CT Scan, CBC, sugar, or cholesterol test.
• Such tests help doctors analyze how properly your body functions and if bypass surgery is feasible to consider or not.
• Another part of pre-procedure guidelines for bypass surgery includes educating the patients about the potential medications, the brief information on the surgical procedure, and possible complications during recovery.
• Healthcare providers will inform you about the diet plan before or after the surgery and what medications to take or not when recovering.

Bypass Surgery Procedure

1. Your surgeon will first check your pulsation rate, blood pressure, heart rate, and oxygenated blood level before putting you on anesthesia. Once anesthetized, they put you on a ventilator with a breathing tube inside your throat.
2. The surgeon then places an intravenous line on the arm and catheters on the neck, wrist, and urinary bladder. Bypass surgery is often completed in three to six hours, depending on how many blockages exist and where they locate in the coronary artery.
3. An incision on either legs or wrists will be marked to attain the vessel to use as a graft for bypassing the blocked vessel.
4. The surgeon will make another incision to cut the breastbone in halves, exposing your heart.

In the on-pump CABG procedure:

• The surgeon put tubes to pump blood through a heart-lung bypass machine. Once the bypass machine starts pumping blood, the surgeon injects a cold solution to stop your heart from pumping. Then the doctor sews the vein with the artery to get done with the graft bypass procedure.
• Once all the blockages mend with the graft bypasses, surgeons first run blood through them to ensure no leakage. Doctors then allow blood to flow from the machine into the heart and remove tubes eventually so the heart can start working on its own.

In the off-pump CABG surgery:

• The doctor first stabilizes the artery section that needs a bypass graft through some instrument, but other cardiac chambers keep pumping. Finally, the doctor sews one end of the vein section over the aorta and the other over the opening in the coronary artery right below the blocked area. The rest of the procedure is the same as on-pump bypass surgery.
• In the final part, the doctor sews the incision made on the breastbone with the help of wires. Any fluid around the heart drains away by inserting tubes in the chest. The doctor sews the skin over the breastbone and inserts tubes into the stomach to drain extra fluid. At last, your surgeon will do the dressing.

What can be done instead of open heart surgery? 

Some common alternatives to heart bypass surgery doctor suggest includes; angioplasty and minimally invasive heart surgery.

• Angioplasty involves attaching a mesh-like tube together with a flattened balloon to your blocked coronary artery. The balloon then inflates to make your narrowed artery wide open. In another procedure for angioplasty, the laser beam removes the waxy plaque narrowing your coronary artery to widen it.
• In minimally invasive heart surgery, your surgeon inserts an instrument through a precise incision and then does the rest of the procedure with the help of video monitoring. Though it attaches veins from the leg or chest to your artery, video monitoring enables consistent heart beating throughout the surgery, unlike bypass surgery.
• Enhanced external counterpulsation is another alternative to bypass surgery, approved in 2002 by FDA for patients with congestive heart failure(CHF). It involves the compression of leg veins leading to increased blood flow to the heart. EECP procedure may go for seven weeks at least with 2-hour treatment daily.

Heart Bypass Surgery Cost In Pakistan

Irrespective of the type of surgical procedure, each one is expensive, and its cost varies depending on the facility in the hospital, quality of treatment, and surgeon credential. The average cost of heart bypass surgery in Pakistan is estimated at Rs. 3 lac to Rs. 5 lac.

What is the recovery time for bypass surgery?

After the surgery, the tube will be there in your mouth until your breathing becomes normal. When your breathing tube removes, your nurse will possibly make you cough hard to avoid mucus penetration in the lungs leading to pneumonia. Some patients often feel pain while breathing heavily or coughing and pain at the incision. Doctors discharge the patient after a week if no severe complications occur after surgery. The recovery time for the bypass heart surgery goes for two months at least and comes with gradual healing. Some patients might feel constipation for a few weeks and have poor sleeping patterns. Do visit your doctor weekly to keep track of overall health, and when can you restart your daily activities like job, workout, driving, home chores, or even sexual activity during the initial days,

• Avoid heavy workout
• Take enough rest to prevent the wound from infection.
• Doctors often suggest cardiac rehabilitation, also called a tailored exercise plan, under the supervision of medical experts.
• In case of any symptoms such as fever, swelling, nausea, increased heart rate, wound infection, or bleeding, ask your doctor for immediate treatment.

Bypass Surgery Risks And Complications

Like any other surgical procedure, bypass heart surgery has low and some high-risk factors. Some potential complications could be;

• Bleeding
• The formation of blood clots could lead to heart attack or stroke.
• The spread of infections on the chest incision can cause sepsis, making the immune system vulnerable to several breathing or heart problems.
• Kidney damage or failure
• Shortness of Breathing
• Abnormal heart rhymes or arrhythmia, though consider a temporary complication.
• The problem of Deliria such as memory loss, agitation, or troubled thinking that may last some month.