Heart Bypass Surgery

Listed below is the step by step procedure of heart bypass surgery:

  1. What is Heart Bypass Surgery?
  2. Why is Heart Bypass Surgery required?
  3. Pre-operative Preparation
  4. Day Before Surgery
  5. Procedure Day
  6. Methods/ Techniques of Heart Bypass Surgery
  7. Post Procedure
  8. Risks and Complications

What is Heart Bypass Surgery?

Heart bypass surgery is done when arteries supplying blood to the heart muscles are damaged. It is the function of heart to receive blood containing no oxygen from all over the body. This blood is then sent to the lungs where it gets oxygenated. Then the blood is again pumped by the heart to all organs. This is the most crucial of all body functions. Without adequate supply of blood and oxygen, no organ in the body can function. If the heart muscles themselves do not receive adequate blood supply, they cannot function normally and could lead to serious health complications.

heart bypass surgery

The main aim of the surgery is to divert blood supply to the heart through and artificially connected blood vessel taken from the patient's body themselves. Thus the damaged section of the artery is 'bypassed' and heart muscles can function normally.

Why is Heart Bypass Surgery required?

The function of heart and a short description about the heart bypass surgery has been given in the previous section. Every heart disease does not require heart bypass. Following are the indications of heart bypass surgery:

  • Arteriosclerosis:

    Thickening and hardening of the walls of arteries can occur due to various reasons. This is known as arteriosclerosis. The term 'atherosclerosis' is also used synonymous with arteriosclerosis. There may be deposition of plaques on the inside of the arterial walls. The thickened walls narrow the lumen of the arteries considerably. Eventually the lumen is blocked completely which prevents blood flow. A single or all of the branches of coronary artery may be blocked. The block may be partial of complete. Excessively high levels of cholesterol in the blood can lead to this condition.

  • Recurrent Angina Pectoris:

    Angina is the sensation of sudden pain felt in the chest. It is due to lack of adequate supply of oxygenated blood to the heart muscles. The pain may come on suddenly and could be felt in the teeth, jaw, arm, fingers. This could be a symptom of hampered blood supply to the heart muscles. This could be a result of coronary artery damage.

  • Shortness of breathe:

    Another indication of coronary artery damage could be shortness of breathe. If cardiac muscles are not receiving adequate blood supply, they will tire out easily. Physical activity even if it is slight, may cause difficulty in breathing. Intensity of breathlessness is determined by severity of damage to the coronary arteries.

  • Arteritis:

    Arteritis is a condition which may affect any artery in the human body. The walls of the affected artery get damaged due to inflammatory reaction. Coronary artery may get affected by this condition resulting in its damage.

  • Failure of other methods:

    Every blockage of the coronary artery does not need surgical treatment. Some times, the doctor may advise the patient to indulge in physical exercise, follow diet or take medicines. In slightly severe cases, angioplasty may be needed. If all these methods fail, surgery may be performed.

When a patient presents with any of the conditions described above, the doctor will assess the structure and function of the heart by performing certain investigative tests like an ECG, a stress test and angiography. These tests reveal the degree of damage to the coronary arteries. It helps the cardiac surgeon in determining the method of carrying about the surgery.

Pre-operative Preparation

  • Assembling a team:

    Heart being the most important organ in the human body, its surgery requires a great amount of preparation. The team of doctors involved in the preparation includes a cardiologist (heart specialist), a cardiac surgeon, assistant doctors and nurses all of whom have to be highly trained.

  • Discussion with the patient:

    Before taking the decision to proceed with surgery the patient will be informed about the procedure in detail. The preparations, surgical details and post procedure precautions will be explained to the patient. A signed consent has to be obtained from the patient prior to proceeding with the surgery.

  • Investigative tests:

    Certain investigative tests are mandatory to be done prior to most surgeries. Blood group determination is to be done. Blood type matching the patient's group is made available in case transfusion is needed due to heavy blood loss during surgery. Haemogram is done to determine levels of white blood cells. If these are elevated it is a sign of an underlying infection. Hemogram also reveals if the patient is anemic. Anemia will lead to reduced supply of oxygenated blood to the heart. The patient's hemoglobin levels should be normalized prior to surgery. Prothrombin Time is a blood test which will reveal the ability of the blood to clot. Blood tests are also done to determine functioning of kidneys and liver as these are important organs of the human body. Blood sugar tests are done. If the levels are elevated then the surgery is postponed till they return to normal. Heart bypass surgery cannot be performed till the infection is curbed with the help of antibiotics. An ECG and angiogram are done to assess the heart functions. X-Ray of the chest is done to visualize the structure of the heart. Cardiac catheterization is also done. It enables the doctor to directly visualize the coronary arteries and its branches.

  • Selection of the graft:

    Heart bypass surgery involves using another blood vessel from the patient's body itself to be used as a diversion for the blood so that the damaged section of the coronary artery is 'bypassed'. This blood vessel which will be used is known as a graft. The vessel which will be used as a graft has to be decided prior to the surgery. Usually a segment of a vein from the leg or a segment of an artery from the chest or the arm are used as grafts.

  • Informing the doctor about medications:

    If the patient is taking medicines for any other health conditions, the doctor should know about it. If the patient is on blood thinners the doctor might stop these for a while.

    Preparation for the surgery must begin well in advance so that any obstacles or complications in the course of surgery can be diagnosed and dealt with efficiently.

Day Before Surgery

  • Admission to the hospital:

    It is advised to the patient to be present in the hospital where the surgery will be performed one night in advance. The investigative tests which have been mentioned in the previous section are usually performed a day prior to the surgery.

  • Food intake:

    The patient will be advised to preclude from eating or drinking the night before surgery. Heart bypass surgery is done under the influence of general anesthesia. The central nervous system is completely numb. If the stomach is full during surgery, the contents may get aspirated into the lungs which can cause further complications.

  • Physical examination:

    Blood pressure, breathing rate, pulse rate and body temperature (also known as vitals) are monitored at regular intervals. A detailed physical examination is done for the patient and its report is sent to the surgeon.

  • Medicines:

    Antacids are prescribed before surgery to prevent development of acidity. This can cause reflux of stomach contents into the lungs which will lead to complications. Laxatives may be given to clear the bowels. Heart bypass surgery is an invasive process. The chances of developing infection is high. Therefore antibiotics may be administered before hand to the patient to combat the infection.

Procedure Day

The day of surgery is filled with anticipation for the patient. The patient is draped in sterile surgical clothes and wheeled into the operating room. The operating room is sterilized to get rid of all microorganisms. General anesthesia is used for heart bypass surgery. The anesthesia will be administered by a qualified anesthetist. It could be in the form of respiratory fumes or it could be injected directly into the veins.

The anesthesia takes sometime to set in. The patient's vitals are monitored continuously. Once the anesthetist confirms that the patient is completely under the influence of anesthesia, the surgery begins.

The skin over which the surgical incision will be made is cleaned by shaving all hair from it. It is cleaned with Betadine which is an antiseptic solution. Any other antisepctic solution may also be used.

The surgeon, the anesthetist and all the members of the surgical team wear sterilized surgical clothes and gloves. Their mouths and nose are covered in a face mask. They use a surgical cap to cover their heads.

Methods/ Techniques of Heart Bypass Surgery

Heart bypass surgery has to be performed with great caution. The surgeon operates needs to be very well versed with the procedure. There are several types by which the surgery can be performed. Some steps of the surgery however remain the same.

The surgeon will administer a single surgical incision at the center of the chest just above the sternum bone. The sternum is then cut and removed. The surgeon takes a graft from the patient's body which will be used to bypass the diseased coronary artery. The graft is sutured to the coronary artery in such a manner that it will form an alternate path for the blood to flow unobstructed. The diseased segment of the artery is no longer used for blood to reach the heart muscles. The sternum is replaced to its original position and the skin incision is sutured. This is the traditional method used to perform bypass surgery and is also known as open heart surgery.

The process can also be done without removing the sternum and exposing the heart completely. This is known as minimally invasive direct coronary artery bypass grafting. The process differs from the traditional one in that the incisions given on the patient's chest are multiple and small. The sternum does not need to be removed. This procedure however has limitations . It can be used effectively only if branches of coronary artery in the front are blocked. Multiple blockages cannot be treated well.

heart bypass surgery method

The heart supplies blood to all the organs and systems in the human body. If it stops, instant death results. During heart bypass surgery also, its functions cannot stop. Therefore a heart-lung machine is used. This machine performs the function of pumping oxygenated blood to all body parts and collected deoxygenated blood from the body, through the duration of heart bypass surgery. Newer techniques have developed by which surgery can be performed without using this machine. The normal functions of heart are also preserved during the surgery. This procedure is known as off-pump coronary artery bypass.

With slight variations as described above, heart bypass surgery is performed. A single coronary artery may be blocked or there may be multiple blockages. Depending on the number of arteries which have to be operated upon the coronary artery bypass grafting process may be associated with prefixes single (one artery), double (two arteries). Triple (three arteries), quadruple (four arteries) or quintuple (all arteries).

Heart bypass surgeries have a duration ranging from 3-6 hours. It is a complicated procedure. Higher the number of arteries involved, more is the duration. After the surgery, certain restrictions are to be followed by the patient for some days or weeks to follow. There are other parameters of care to be followed as well which increase the efficacy of the surgical procedure.

Post Procedure

Successful completion of heart bypass surgery does not mean end of the treatment. The doctor as well the patient have to take equal part in the post-operative care. This begins right after the surgery is over. The detailed post-operative care has been described below.

  • Immediately after surgery:

    After surgery, the patient is immediately transferred to the ICU. Vitals are monitored continuously. An intravenous needle is inserted prior to surgery to fulfill nutritional requirements. This is retained for sometime after surgery. After gaining consciousness the patient may feel soreness in the chest at the site of surgical incision. The person will remain in ICU for 1-2 days. Fluid may tend to get accumulated in the heart. To drain this, tubes are placed inside the patient's chest. These are monitored regularly and removed after all the fluid has been drained. The patient is kept under observation and given discharge from the hospital in 4-5 days.

  • Swelling at the site of graft:

    The area from where graft for heart bypass is taken may show some swelling. This should subside in a span of 7-10 days. If the graft is taken from leg veins, the patient is advised to wear elastic stockings to control the swelling.

  • Suture removal:

    The sutures at the site of surgical incision are inspected daily for healing. The patient is advised to meet the surgeon for removal of sutures at the given date.

  • Physical activity:

    The patient's sternum is separated from the ribcage during open heart surgery. After the surgery it takes a few weeks for the sternum to reattach properly. The surgical incisions also take time to heal. It is not advisable to over exert the heart muscles for a few weeks post surgery. Hence it is advisable not to indulge into excessive physical activity. Activities like running, heavy exercises, lifting heavy weights are to be strictly avoided for about a month after surgery. Later, simple physical exercises may be started after consulting with the doctor.

  • Diet:

    The patient may be advised by their doctor to consult with a dietician. After the surgery, diet has to planned keeping in mind that the cholesterol levels should remain normal. Food which is high in fat content should be avoided. It is also essential to maintain normal range of blood pressure. So the diet should include less amounts of salt and pickles. It is important to keep weight at optimum levels. Increased weight will put more load on the patient's heart. They may be advised to avoid eating fried food, cheese, butter, sweets.

  • Lifestyle modification:

    The patient will recover from heart surgery slowly over a span of 6-8 weeks. In this period the patient should follow diet regimen as has been described above. Earlier it has also been mentioned that it is unwise to perform heavy physical exercises. But the patient should not be absolutely sedentary. They should move around the house to their capacity. After a few weeks, they can start going for walks outside the house too. The walking speed should however not be too fast. Patients are advised not to drive a car till 4 weeks after surgery. Smoking tobacco and drinking alcohol are strictly prohibited during the period of recovery. Later also, the patient is advised to preclude from smoking and drinking.

If these care instructions are followed well, the patient recovers fast and easily after surgery. However, despite of all the care that can be taken, there are some complications and risks which could be possible after surgery. However, with adequate care these complications can treated as well.

Risks And Complications

  • Bleeding: Heart bypass involves manipulating several blood vessels. Tis increases the risk of bleeding during the surgery. Excessive bleeding can be dealt with by providing blood via transfusion.
  • Infection: Heart bypass is an invasive procedure which needs a big surgical incision. Open heart surgery involves accessing the full depth of thoracic cavity. These factors provide a high scope for infection to develop infections internally or at the site of incision. Antibiotics are prescribed before or after surgery
  • Pain: Like infection, pain can also be felt at the site of incision which can be reduced with pain killers.
  • Blood clots: Blood clots can block arteries and cause damage to heart, lungs or other organs. Blood thinners can be used to dissolve these clots.
  • Embolism: Embolism is a condition in which blood supply to a certain organ is suddenly ceased or reduced due to obstruction of blood flow from the artery supplying that organ. Studies have revealed that the heart-lung machine which is used during bypass surgery tends to dislodge the plaques formed inside the artery. These plaques comprise of cholesterol or calcium. They travel through the blood stream and may lead to embolism of brain by blocking its blood supply. This could cause memory loss or deficiency of other brain functions in long run. Opting for off pump coronary artery bypass is known to reduce the risk of embolism.
Heart bypass surgery is a life saving procedure for many people with blocked coronaries. Despite of the risks associated with it, it is still one of the best methods to treat blockages of heart. New methods and techniques are being developed with which heart bypass surgery can give better results.

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