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Health Corners
Cardiac Surgery

Open Heart Surgery

Coronary Artery Bypass Graft

What is Open Heart Surgery?

Open heart surgery refers to a group of surgical procedures where the surgeon cuts open the chest to work on the defective area of the heart. An incision is made in the patient’s chest, skin and fat layers are cut through, the breastbone is sawn and the heart is exposed. The surgeon now works on the heart (either repairing a valve, closing a hole or grafting an artery to bypass a blocked one) _ sometimes actually requiring to cut the heart open.

While an Open Heart Surgery is performed, the heart is stopped from beating. A heart lung machine is used to perform the functions of the patient’s heart during the surgery. The impure blood that normally reaches the patient’s heart is now directed to the machine which purifies it and returns it to the arteries that carry it to the rest of the body.

Once the surgeon corrects defect, the heart lung machine is detached and the heart resumes pumping.

Open heart surgery is an invasive procedure. It is a major surgery requiring skill and expertise. It is performed under general anaesthesia. Depending on the nature of the problem it can take anything from two to six hours. The patient will require good post operative care.

Who is likely to undergo Open Heart Surgery?

Open-heart surgery is usually performed on patients with:

Coronary Artery Disease (where one or more coronary arteries are blocked)Heart Valve Disease (where one or more heart valves are not working properly) Other defects in the heart.

Coronary Artery Bypass Surgery

What is Coronary Artery Bypass Surgery?

Coronary Artery Bypass Surgery is an operation where the surgeon takes a blood vessel from another part of the body and grafts it on to the blocked blood vessel in the heart so that the blood is routed through the graft, bypassing the block. Surgery does not remove the block or the artery but simply provides blood an alternate path of flow. This is just like providing a detour road if there is a block on a highway. Traffic continues to flow on the highway, avoids the road block by taking the new road provided, gets back on the highway beyond the block.

The procedure is also called a Coronary Artery Bypass Graft (CABG).

Who is likely to undergo a CABG?

The patient may be required to undergo the following tests:

This surgery is one of the options for patients with Coronary Artery Disease (CAD). CABG is advised when patients of CAD do not benefit from medication and cannot undergo less invasive procedures like an angioplasty. Usually CABG is advised for patients with:

  • Block in the left main coronary artery
  • Blocks in multiple coronary arteries
  • Blocks in all three major arteries.

How is CABG performed?

CABG is an Open Heart Procedure.

While the cardiac surgeon exposes the heart, another team harvests the blood vessel that is going to be grafted on to the blocked artery. This could be the Greater Saphenous Vein or the Internal Mammary Artery.

The Saphenous Vein is found in the leg and it runs from the groin to the ankle. It is found suitable because it is a long vessel, lies close to the skin, its size is almost the same as that of the coronary arteries and if removed, the distribution of blood can be taken over by other veins in the leg.

The team that is harvesting this vein makes incisions at suitable points in the leg and takes a required length of this vein. One end of the vein is sewn to the a vehicle of pure blood like the aorta and the other end to the blocked artery, beyond the block.

The Internal Mammary Artery is a blood vessel that runs on the inside of the chest cavity. It is an artery, not a vein and has same blood pressure as that seen in the aorta or the coronary arteries. This vessel is less prone to cholesterol build up, though the reasons for this are not known. While these reasons make it good graft material, the vessel is also small and delicate and may not be the best option in all patients. The surgeon can transfer the lower end of the internal mammary artery to the heart surface and use it as a bypass graft to the coronary vessels. ( It does not have to be cut at both ends and removed as with the saphenous vein graft.)

After the vessel is harvested for the graft, anticoagulants are given to stop the blood from clotting when connecting to the heart lung machine. Body temperature is lowered. The heart stops beating and is relaxed.

Each blocked vessel is identified and the graft is sewn on with suture material thinner than a human hair. The other end of the graft is sewn on to the aorta. If the graft is the internal mammary artery, one end is already connected to an artery.

After this is done, blood is re routed through the heart and the heart lung machine is slowly withdrawn. The effects of anti coagulant is reversed with the help of medication.

The pericardium is closed, the sternum wired together and the incision closed. Anaesthesia is reversed and the patient is sent to the intensive care unit for monitoring.

The post operative period

Initially, the patient may have an endotracheal tube put in to assist breathing. A urinary catheter will also be put in to drain urine. Intravenous medication will be given.

The patient is required to stay at least a week to 10 days in the hospital. It may take him 4-6 weeks of rest to return to normal activity. He will be advised not to lift heavy things for a few months..

The patient is advised to keep to an exercise routine and adopt a low fat diet.

Coronary Artery Bypass Graft helps improve blood circulation and relieve angina, which many patients with Coronary Artery Disease exhibit. But it cannot prevent blocks forming again.

Risks involved in CABG

  • In a very small percentage of cases, the patient might suffer a heart attack
  • In patients over 70 there is a slight risk of stroke.
  • Blood clots may form.
  • Wound infection can occur in diabetic patients.

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