Heart bypass surgery is an action to overcome the blockage or narrowing of the coronary arteries in patients with coronary heart disease. This procedure is performed to replace the function of damaged coronary arteries, using grafts of new blood vessels from other organs of the body.
The heart is a vital organ that pumps blood throughout the body, including the heart muscle itself. The blood supply to the heart muscle is supplied by the coronary arteries which are divided into two main branches, namely the right and left coronary arteries.
These coronary arteries can become blocked or narrowed due to the buildup of plaque on the walls of blood vessels (atherosclerosis). Blocked heart arteries can cause damage to the heart muscle which can end in a heart attack or heart failure.
Therefore, heart bypass surgery is performed to restore the supply of oxygen-rich blood to the heart muscle.
Indications for Heart Bypass Surgery
Heart bypass surgery is usually recommended in patients with coronary heart disease with the following conditions:
- Having narrowing of more than one heart blood vessel, so that the left heart chamber which is in charge of pumping blood throughout the body does not function normally
- Have severe narrowing or blockage of the left main coronary artery, which supplies blood to the left heart chamber
- Having blocked arteries that cannot be treated by widening the blood vessels using a small balloon (angioplasty) or placing a ring
- Suffering from severe chest pain
Heart bypass surgery may also be performed to treat emergency conditions, such as a heart attack that has failed to be treated with other types of treatment.
Heart Bypass Surgery Warning
There are several things to know before undergoing heart bypass surgery, namely:
- Heart bypass surgery is not recommended for patients with coronary heart disease who have no symptoms and are at low risk of having a heart attack.
- The risk of complications after surgery is higher in the elderly, especially those over 85 years of age.
- In addition to the elderly, the risk of complications is also high in patients who have recently had a heart attack or stroke, have had radiotherapy or surgery in the chest area, have certain health conditions, such as blood clotting disorders, COPD, kidney disease, diabetes, infections, or electrolyte disturbances.
The risks above will be evaluated and controlled as much as possible by the doctor and the team performing the surgery. So, it is important for patients to report all of the above conditions if they have them.
For patients who smoke, it is recommended to stop smoking as soon as possible. The reason is, smoking can slow down the healing process after surgery, and worsen overall health conditions.
Before Heart Bypass Surgery
In preparation for heart bypass surgery, the doctor will give advice to the patient about what things should not be done, the types of foods that should be consumed or avoided, and drugs that need to be taken or stopped for some time before surgery.
The doctor will also carry out a series of examinations to evaluate the patient's readiness and risk for surgery. The examination includes questions and answers related to medical history, physical examination, as well as several supporting examinations, such as chest X-ray, blood test, urine test, electrocardiography, and cardiac angiography.
Prior to surgery, the patient will be asked to fast for 8 hours. Generally, fasting begins at midnight on the day of surgery.
Heart Bypass Surgery Procedure
Before the operation begins, the patient needs to remove all jewelry and other objects that may interfere with the operation. Patients will also be asked to change into hospital clothes that have been prepared
Heart bypass surgery generally lasts 3–6 hours, depending on the number of new blood vessels needed. During this procedure, the patient will receive general anesthesia so that he is in an unconscious state.
After the patient is sedated, the doctor will check the patient's heart rate, blood pressure, oxygen levels, and respiratory system function. After the examination is complete, a ventilator tube or breathing apparatus will be placed in the patient's respiratory tract through the throat.
After the ventilator is installed, the skin to be operated on is cleaned with an antiseptic solution. The cardiac surgeon (Sp. BTKV) will then make an incision along the center of the chest cavity and split open the breastbone, so that the heart can be seen.
At the same time, another surgeon on the operating team will take a vein that will be used as a graft from another part of the body, usually a vein in the calf or arm.
After that, the doctor will give special drugs to stop the heart from working. The function of the heart to supply blood throughout the body will be replaced by a heart-lung machine.heart lung machine) which is connected to the great arteries of the heart.
When the heart has stopped and the heart-lung machine function is confirmed to be working properly, the transplantation of blood vessels that have been taken from other parts of the body can be started.
These new blood vessels will be grafted into coronary arteries that are narrowed or blocked. One end will be connected to the section before the blockage and the other end to the section after the blockage. In this way, a shortcut or bypass which blood can pass through.
After the new blood vessel transplant is complete, the doctor will make the heart beat again. Sometimes, an electric shock is used to make the heart beat again.
The next process, the doctor will reunite the breastbone with a special wire that will be permanently attached to the breastbone. After the bones are joined, the incision in the skin will be sutured and covered with a bandage.
The pre-installed breathing tube will remain in use until the patient can breathe normally on his own.
In addition to the techniques mentioned above, or the so-called conventional techniques, there are also non-conventional techniques, including techniques without stopping the heart rate and techniques with the help of robots that allow surgery without splitting the breastbone.
After Heart Bypass Surgery
Since the breathing tube cannot be removed, the patient will be placed in the intensive care unit (ICU), usually for 1-2 days of treatment.
While in the ICU, doctors and nurses will periodically monitor the patient's vital signs, such as heart rate, blood pressure, breathing, and oxygen levels. The recovery period after surgery can be short or long, depending on the patient's overall health condition.
After the patient is conscious of the anesthetic effect, the breathing apparatus may not be able to be removed immediately. However, the doctor will adjust the ventilator settings, so that the patient can breathe more comfortably. The ventilator will be removed when the patient is able to breathe properly, indicated by the ability to cough.
After the breathing tube is removed, the nurse will help the patient to cough and take deep breaths every 1 hour. This process may be painful, but it is very important to prevent the accumulation of phlegm in the lungs which can cause pneumonia.
The wound from the surgical incision may be painful for a few days. The doctor will consider giving pain medication. However, avoid using over-the-counter pain relievers, as some types of pain relievers, such as aspirin, can increase the risk of bleeding.
If the patient's condition has improved, the patient will be transferred to the usual treatment room. While in the treatment room, the patient may be allowed to return to eating and drinking normally, as well as being allowed to get out of bed and walk.
Cardiac rehabilitation usually starts from the first day of treatment in a regular inpatient room. This rehabilitation is done to strengthen the heart organ.
Patients will be allowed to go home at least 7 days after surgery. However, the patient is still unable to function normally. The reason is, the time it takes to completely recover is 6 weeks to 3 months.
During the recovery period at home, the patient will be asked to have regular checkups according to the schedule determined by the doctor. Patients are also advised to avoid strenuous activities and lead a healthy lifestyle, such as eating nutritious foods and quitting smoking.
Complications of Heart Bypass Surgery
Although the risk is low, heart bypass surgery can also cause complications, such as:
- Bleeding or infection of the surgical site
- Arrhythmias or heart rhythm disturbances
- Memory loss or difficulty thinking
- Kidney disorders
- Blood clotting
- Pneumonia
- Fluid buildup in the lungs (pleural effusion)
- Heart attack
- stroke
- Chest pain
- Kidney failure
- Drug allergic reaction