About Bypass Surgery

Bypass surgery is performed on patients who have advanced coronary artery disease and serious narrowing of the vessels. The surgery is meant to provide the cardiovascular system with an alternative route for the pumping and flowing of blood, thus improving heart performance.

Instructions

History

• 1

  Coronary artery bypass surgery is one of the newest types of surgery developed. The first, performed at the Albert Einstein College of Medicine-Bronx Municipal Hospital Center, was performed in 1960. Prior to this, heart surgeries were, at best, mildly successful, with fewer than 50 percent of patients surviving. Before the 1940s, the use of anticoagulants (blood thinners) was not widespread, which made survival improbable. Once Gordon Murray, a Canadian surgeon, introduced the use of this chemical component into vascular surgery, things improved. By the time Dr. Robert Goetz and Dr. Michael Rohman performed that first successful surgery, the concept was no longer new.

Types

• 2

  There are basically five types of bypass surgery, ranging from single bypass to quintuple bypass. Single bypass surgery skips a single artery, which is replaced in order to avoid atherosclerotic narrowings that block the flow of blood to the heart. The number of bypasses is directly connected to the available replacement vessels, rather than to the overall cardiopulmonary health of the patient.

Warning

• 3

  To be performed successfully, a bypass surgical procedure requires that the heart be stopped. This is usually done through cardioplegia, a method that uses cold crystalloids to freeze the heart without causing damage. Mechanical ventilation is provided to avoid lack of oxygen supply to the body and brain. Coronary grafts and vessel replacement happen during this period, which lasts about an hour, after which the heart is restarted. Off-pump surgery, in which the heart is stabilized through mechanical means, is used less often because it is relatively new.

Features

• 4

  To replace the obstructed artery, surgeons first must graft a vein from somewhere else in the body. Traditionally, this meant the greater Saphenous vein, which runs along the leg, all the way up to the groin. The vein is not only one of the largest and longest veins in the body, but also one that can be removed without major consequences. Over the past few years, doctors have experimented with the use of the left internal mammary artery, which is stronger and requires a less invasive procedure, as it already runs under the breastbone and needs only to be reattached.

Time Frame

• 5

  Most patients can expect a full recovery from bypass surgery within four to six weeks. During the first 10 to 15 days, there may be changes in sleep patterns or bowel movements, which will eventually return to normal. Patients who were on medication for heart problems may need to keep taking it, depending on the type of problem and extent of the damage. After a few months of post-operative care, 90 percent of patients are able to return to normal levels of exercise and physical activity.