Bypass Surgery: Procedure, Recovery, Cost, Risk & Complication

Bypass surgery refers to a surgical procedure that helps in diverting the blood flow around a blocked or partially blocked artery of the heart. It is done to create a new pathway to the heart and improving the flow of blood to the heart muscle. During this surgery, a healthy, well-functioning blood vessel is taken from the arm, chest or leg and then connected to the other arteries in the heart so that the blood can bypass the blocked or the diseased area.

Problems such as shortness of breath and chest pain, due to poor flow of blood tend to improve after a bypass surgery. It may also improve the heart function and reduce the risk of a heart disease. Heart bypass surgery, or coronary artery bypass graft (CABG) surgery, is utilized to improve blood flow to your heart. A surgeon uses blood vessels taken from another area of your body to bypass the damaged arteries. This surgery is done when coronary arteries become blocked or damaged. These courses supply your heart with oxygenated blood. If these arteries are blocked or blood flow is restricted, the heart doesn’t work properly thus it can prompt heart failure.

One may require a bypass surgery in the following cases:

• Suffering from severe chest pain that is caused due to the narrowing of the arteries that supply blood to the heart muscle
• If more than one coronary artery is diseased, and the left ventricle is not functioning well
• The main coronary artery in the left is narrowed or blocked, as this artery supplies the maximum blood to your left ventricle
• An artery blockage that cannot be cured by angioplasty or a previously done angioplasty or stent placement has been unsuccessful
• Restenosis, which involves the narrowing of the artery even after a stent replacement
• In case of emergency situation such as a heart attack, where the patient does not respond to other treatments

Your doctor will recommend a certain type of bypass surgery depending on how many of your arteries are blocked.

• Single bypass: Only one artery is blocked
• Double bypass: Two arteries are blocked.
• Triple bypass Three arteries are blocked.
• Quadruple bypass Four arteries are blocked.

Your risk of having a heart attack, heart failure, or another cardiac issue depends on the number of arteries blocked. Blockage in arteries also means that the surgery may take longer or become more complex.

Fortunately, recent decades have seen a lofty drop in genuine entanglements. Today, in excess of 95 percent of individuals who experience coronary detour medical procedures don't encounter genuine difficulties, and the danger of death following the strategy is just 1–2 percent.

The danger of genuine inconveniences is higher for crisis coronary detour medical procedures, for example, for patients who are having a respiratory failure when contrasted with the elective medical procedure for the treatment of angina and different manifestations. Furthermore, patients might be at higher hazards on the off chance that they are more than 70 years of age, are female or have just had heart medical procedures. Patients who have different genuine conditions, for example, diabetes, fringe vascular malady, kidney illness or lung ailment, may likewise be at higher hazard.

After a coronary artery bypass graft (CABG), patients normally need to stay in the hospital for around 7 days so that medical professionals may closely monitor their recuperation.

You will probably feel a little groggy and uncomfortable following the procedure, but you will be given medicines to help with that. If the discomfort worsens or you detect significant bleeding, immediately contact your doctor or nurse.

It takes time to recover following a coronary artery bypass graft procedure.

After 5 or 6 days, you should be able to sit in a chair, walk, and walk up and downstairs. Generally, it takes about 12 weeks for a complete recovery. You should schedule a follow-up appointment roughly 6 to 8 weeks after your surgery.

Summary: It might take time of two to three months to recover after the bypass surgery. It depends upon your initial condition after the surgery.

If your doctor recommends heart bypass surgery, they’ll give you complete instructions on how to prepare. If the surgery is scheduled in advance and isn’t an emergency procedure, you’ll most likely have several preoperative appointments where you’ll be asked about your health and family medical history.

You’ll also undergo several tests to help your doctor get an accurate picture of your health. These may include:

• Blood tests
• Chest X-ray
• Electrocardiogram (ECG or EKG)
• Angiogram

• Seek your doctor’s advice about any medication that affects how your blood clots. Many pain relievers and heart medications affect clotting, so you may have to stop taking them.
• Quit smoking: It’s bad for your heart and increases healing time.
• Tell your doctor if you have symptoms of a cold or flu. In particular, the flu can put further strain on the heart and can increase your chances of a heart attack or worsen heart failure. It can likewise cause myocarditis, pericarditis, or both. These are potentially serious heart infections.
• Prepare your home and make arrangements to stay in the hospital for several days.
• To reduce the risk of infection, wash your body with a special soap, like Hibiclens, the night before surgery. It’s made of chlorhexidine, which will help keep your body germ-free until surgery.
• Fast, which includes not drinking water, beginning at midnight before your surgery.
• Take all of the medications your doctor gives you.

Pre Procedure

The following preparation needs to be taken in before undergoing a bypass surgery:

• Your doctor will provide you with the initial instructions regarding restrictions in any particular activity or changes in your diet and medicine.
• Pre-surgical tests such as x-ray of the chest, blood tests, coronary angiogram and electrocardiogram will be conducted.
• In most cases, a patient is admitted to the hospital in the morning of the surgery. It may also be performed in emergency conditions like just after a heart attack.

During Procedure

The procedure of a bypass surgery involves the following steps:

• The time taken is normally 3-6 hours, and the surgery can be performed with general anaesthesia
• An incision is made in the chest, while diverting the blood flow with the help of a heart-lung machine. The rib cage is spread opened by the surgeon, exposing the heart. The heart is made to stop working for the time being, while the heart-lung machine circulates the blood in the body.
• The healthy blood vessel is then attached above and below the blocked artery, making sure that blood flow will bypass the narrowed part of your diseased artery.
• A breathing tube, inserted in your mouth helps you to breathe during and post-surgery.

Post Procedure

Since bypass surgery is a major operation, you may be admitted in the ICU for one or two days while your blood pressure, breathing, heart and other vital signs will be monitored. The breathing tube remains in the throat till the time you gain consciousness and can breathe on your own. If you do not have any complications, you are likely to be discharged within a week. Initially, simple tasks like walking or your daily jobs may become difficult to perform. Consult your doctor if you face any of the following symptoms that indicate an infection of your wound:

• Fever
• Rapid heart rate
• Pain around the wound in the chest
• Reddening, bleeding or other discharge from the area of the wound

In this process, the doctor takes the healthy blood vessels either from the legs or hands and connects them around the blocked arteries, for improving the blood flow.

It doesn’t help with the cardiac disease that causes a blockage, such as atherosclerosis or coronary artery disease. It helps to relieve chest pain and breathing problems.

According to the surgeons, there is no such age limit for bypass surgery. But, anyone above the age of 65 is in greater danger.

Summary: There is no age limit for bypass surgery but people of older age groups can be at risk of further consequences.

The surgery enables blood to make a reroute, or bypass, around at least one, limited or blocked coronary supply routes. You will feel drained and sore for an initial couple of weeks after surgery. You may have some concise, sharp agonies on either side of your chest. Your chest, shoulders, and upper back may ache.

Bypass is accepted to yield better long haul results in individuals with 3-vessel CAD. It is thought to likewise give preferred outcomes over stenting in the vast majority with disease of the left fundamental coronary supply route. Notwithstanding, in the individuals who have ACS because of blockage in the left fundamental corridor, stenting might be the more secure decision since it very well may be done significantly more rapidly. Bypass is a superior choice than stenting in individuals with 2-vessel CAD who additionally have diabetes.

Your doctor will give you medications to help manage your pain, such as ibuprofen (Advil) or acetaminophen (Tylenol). You may also receive a narcotic for extreme pain. These medications will help you throughout your recovery process. These will include antiplatelet drugs and other drugs prescribed by your doctor. This is especially important if you have existing conditions such as diabetes or conditions affecting the stomach or liver.

1. Antiplatelet drugs( such as aspirin) It helps to prevent the formation of blood clots. Side effects of this medication can be stroke caused by bleeding rather than clotting, stomach ulcers, serious allergy-related issues if you’re allergic to aspirin, etc.
2. Beta-blockers It blocks your body’s production of adrenaline and lowers your blood pressure. Side effects of this medication can be drowsiness, dizziness, weakness, etc.
3. Nitrates It helps to reduce chest pain by opening up your arteries to let blood flow through more easily. Side effects of this medication can be headaches.
4. ACE inhibitors It avoids your body's generation of angiotensin II, a hormone that can make your circulatory strain rise and influence your veins to limit. Side effects of this medication can be headaches, dry cough, fatigue, etc.
5. Lipid-lowering medicines( such as statins) It can help lower LDL (bad) cholesterol and help prevent strokes or heart attacks. Side effects of this medication can be headache, liver damage, myopathy, etc.

Heart bypass medical procedures are serious yet generally safe. Specialists perform a huge number of heart bypass tasks every year and huge numbers of the individuals who have the surgery get alleviation from their side effects without requiring long haul medicine. The more serious heart disease, the higher the danger of intricacies. Nevertheless, the passing rate is low, and according to one report, only 2–3 percent of people who experience heart sidestep medical procedure bite the dust because of the activity.

An individual will have a tube down their throat that makes them relax after waking up. It will feel abnormal and awkward, however, it is essential. Typically, a specialist will evacuate the tube following 24 hours. By and large, an individual will stay in the hospital for about seven days after surgery. It isn't unexpected to encounter soreness and night sweats, and there is probably going to be some liquid in the lungs, so individuals ought to anticipate a good bit of coughing.

Individuals more often than not begin to eat and move around not long after the specialist has evacuated the breathing tube carefully. Normal post-surgery meds ordinarily incorporate medications called platelet inhibitors, which help anticipate blood clusters.

Life expectancy after surgery has not. 90% of a group of 1,324 patients worked on somewhere in the range of 1972 and 1984 endure five years after surgery, as indicated by one investigation, and 74 percent endure 10 years. That number has remained generally stable from that point onward. In any case, more seasoned and more broken down patients are getting sidestep medical procedure nowadays, which may influence survival rates.

The cost of a bypass surgery would be approximately Rs. 1,50,000 – Rs. 3,50,000.

The risk of a complication is generally low in a bypass surgery, though it depends on your overall general health before the surgery. The risk factor will be higher if the surgery was done in an emergency basis, or if you have serious health conditions like kidney disease, diabetes, blocked arteries in the legs or emphysema (lung disease).

The possible risk and complications associated with a bypass surgery are:

• Bleeding
• Arrhythmias, improper beating of the heart
• Infection of the wound in the chest
• Stroke
• Problems in the kidney
• Memory loss or facing trouble when thinking clearly that generally improves in 6 months
• Heart attack, in case a blood clot breaks loose just after the surgery

In the past decade, more alternatives to heart bypass surgery have become available. These include:

• Balloon angioplasty:

  Balloon angioplasty is the alternative that’s most likely to be recommended by doctors. During this treatment, a tube is threaded through your blocked artery. Afterward, a small balloon is inflated to widen the artery.The doctor then removes the tube and the balloon. A small metal scaffold, also known as a stent, will be left in place. A stent keeps the artery from contracting back to its original size. Balloon angioplasty may not be as effective as heart bypass surgery, but it’s less risky.

• Enhanced external counterpulsation (EECP)

  Enhanced external counterpulsation (EECP) is known as an outpatient procedure which can be performed as an alternative to heart bypass surgery, according to multiple studies. In 2002, it was approved by the Food and Drug Administration (FDA) for use in people with congestive heart failure (CHF).

EECP involves compressing blood vessels in the lower limbs. This increases blood flow to the heart and extra blood is delivered to the heart with every heartbeat. Over time, some blood vessels may develop extra “branches” that will deliver blood to the heart, becoming a sort of natural bypass. EECP is administered daily for a period of one to two hours over the course of seven weeks.

• Medications

  There are some medications you can consider before resorting to methods such as heart bypass surgery. Beta-blockers can relieve stable angina. You can use cholesterol-reducing drugs to slow plaque buildup in your arteries.

  Your specialist may likewise prescribe a daily dose of low-portion aspirin (infant headache medicine) to help prevent heart attacks. Aspirin therapy is very effective in people with a prior history of atherosclerotic cardiovascular disease (such as heart attack or stroke).

  Those without a prior history should only use aspirin as a preventive drug if they are at high risk of heart attack and other atherosclerotic cardiovascular diseases also, have a low risk for bleeding.