KNOW YOUR BYPASS SURGERY (DO YOU NEED THIS MUTILATION?)

HOW THE BYPASS SURGERY IS DONE        

As soon as a patient is diagnosed of having angina or heart attack, the doctor knows that minimal 70% blockage is atleast present. Now the patient is asked to go for Angiography to know the location and extent of the blockages. After this, he is asked for surgery i.e. either bypass or angioplasty. The patient who agrees for CABG has to give his consent and the surgery follows. The basic steps of bypass surgery are:

Patient is first prepared i.e. the chest is shaved and cleaned and so is the leg or arms from where another tube for replacement has to be removed. The tube can also be removed from the chest.

After anaesthesia with surgical knife skin and muscles in front of the chest are cut open. Then with a surgical saw, anterior chest bone is also cut. The distance between two ribs over the heart is increased with the help of a retractor (acts like a Jack used in car) In some cases, one of the ribs might be required to cut and removed.

Heart is now exposed by cutting the safety shealth around it. The main blood tube (the aorta), which comes out of the heart is now connected to the heart lung machine. The machine is already filled with around 5 bottles of blood and now it does the function of the heart, i.e. of pumping blood and its purification in artificial lungs. The beating of the heart is reduced by hypothermia so that surgery can be easily performed.

The next step is to plant new blood tube taken from aorta and other to the coronary tube distal to the blockage(s).

After completing this replacement which can be to a number of tubes. The heart lung machine is removed and the heart is restarted. Finally the muscles and skin are stitched.

These stitches on the skin are allowed to heal for around 7 days and then removed.

During surgery, the patient is given fluids by the blood route and if there is blood loss, blood is also given. Few bottles of blood is required to fill up the heart lung machine.

THE COMPLICATIONS OF BYPASS SURGERY                                

You may be surprised by the number of complications which can result from bypass surgery. It is doubtful that most patients who are asked to have surgery are really given enough information before giving consent for surgery. It is a mutilating surgery which takes hours to be performed.

The most important complication of surgery is the immediate as well as the delayed death rate from the operation. Other diseases associated with CAD can also influence the death rate. For e.g. high blood sugar (diabetes), high blood pressure (hypertension), kidney disease and previous heart attacks can cause complications and death.

Second major complication of bypass surgery is a heart attack. There is always an injury to the heart muscle due to the surgical procedure. This can result in reduced function of the heart.

Next most serious complication that occurs after bypass surgery, is disorder of clotting mechanism resulting in stroke (paralysis). Major strokes or paralysis, such as those leading to a complete loss of function of an arm or leg and loss of speech may be seen in patients who have undergone surgery. The frequency of minor strokes causing weakness of only one arm or a slight loss of speech is also high. The disturbance of clotting mechanism can also result in bleeding.

Another major complication to mention is the damage to the brain, which can take place during the surgery. The reason is the heart lung machine on which the patient is put during the surgery. This machine is responsible for the supply of blood to the brain during the surgery and any failure to meet the blood demand of the brain can lead to its damage. The machine is only a mechanical management and will not understand the blood requirement of the brain. Personality changes after surgery are not uncommon and so is memory loss. Disturbance is sexual function can also result due to brain damage.

Other systems of the body can also be damaged by the surgery. These are:

A.      Respiratory System

i.                     Infection in the chest cavity

ii.                   Haemorrhage in the lungs or collection of fluid in lungs.

iii.                  Injury to major nerves passing through the chest cavity.

iv.                 Air in chest cavity.

         

B.      Gastro-intestinal System

i.                     Bleeding in stomach, intestines.

ii.                   Damage to liver

 

C.      Renal System: Kidney Failure

 

Other complications of surgery on the heart itself can result in altered rhythm of heart (Arrhythmias). There can be cardiac arrest or cardiogenic shock. Also, the weakened muscles of the heart can finally result in heart failure.

The blood given during surgery if already infected and not properly checked before can result in diseases like hepatitis (infection of the liver), HIV and other infections being transferred to the patient.

There can be high blood pressure i.e. hypertension after surgery. The healing of the surgical would may be delayed and can cause infections. And not to forget, the danger of reblockages (the chances of which are increased due to stitches on the blood tubes) is always present.

Hope you liked this blog!

This article is written by Dr. Bimal Chhajer (India’s best Heart doctor)