If you or your family member has been diagnosed with coronary artery disease and recommended for coronary artery bypass surgery by your doctor, We at Wockhardt take this opportunity to educate you on coronary artery bypass surgery.
Ageing and other complex factors cause the blood vessels to become hard. In addition, cholesterol and minerals from the blood are deposited on the inner surface of the coronary arteries. When this material builds up, they form a plaque. A raised plaque may restrict the blood ﬂow through the coronary artery.A raised plaque may also change the surface of the artery from smooth to rough, and these rough surfaces may stimulate the formation of a blood clot, which may lead to narrowed artery. A blood clot can also build up quickly and abruptly close of the artery.
Coronary artery bypass graft surgery is an open-heart operation in which arteries or veins are taken from another part of the body to channel needed blood flow to the coronary arteries. During surgery these arteries or veins are connected directly to the coronary arteries on the sur face of the heart beyond the blockages. This way, blood can flow through them to bypass the narrowed or closed points.
Coronary artery bypass graft operations usually last from three to six hours, their duration depending on the number of vessels to be grafted. Each operation varies in complexity, so its duration can only be estimated.
The 1990's witnessed significant advances in Bypass surgery like
- Elimination of heart lung machine
- Smaller incisions
- Endoscopic approaches
- Arterial grafts
Awake bypass surgery is the latest advance where a patient undergoes bypass surgery while actually awake and can converse with the operating surgeon and his team.
A new type of beating heart surgery which is performed with epidural anesthesia, eliminating the need and risks of general anesthesia. The technique is a highly precision- based methodology, which involves injection of micro doses of local anesthetizes only the chest region while the rest of the system is fully awake. This enables a painless bypass surgery and makes the surgery sage for patients who are at high risk for general anesthesia.
High thoracic epidural anesthesia is given instead of general anesthesia
- Which works like cardiac sympathectomy
- Causes vasodilatation of internal mammary arteries & coronary arthritis
- Produces severe heart rate without hemodynamic compromise
- Leads to attenuation of stress response
- Gives favorable blood/oxygen supply/demand ratio for myocardium
- Provides effective pain control
Patient Selection for awake CABG & procedure Thoracic epidural anesthesia eliminates the need & risks of general anesthesia. With this technique anesthetic medicine is steadily delivered to the epidural space of the spine. The patient thus feels no pain in the chest area. Minimal medication is given to reduce anxiety and the patient remains awake the entire surgery.
Advantages of awake bypass surgery
- Avoidance of tracheal intubation
- Avoidance of Ventilation.
- Avoidance of cardiac depression due to general anesthesia and premedication drugs
- Avoidance of ischemic events related to intubation• No ventilator related problems
- No hoarness of voice due to intubation
- No dizziness
- No nausea.
- Reduced ICU stay
- Reduced Hospital stay
Specially good for patients with
- Severe lung disease
- Severe liver disease
- Past history of stroke/ unconsciousness
- High risk for general anesthesia
- Emergency CABG
- Bleeding disorders
- Large heart
- Poor ventricular function (<25%)
- Diffuse coronary disease.
- Spinal deformity
- No general anesthesia
- Can be performed for high-risk group of patients who were earlier termed in-operable because of risk of general anesthesia
- No post-operative ventilator support required which reduces post-operative intensive care to less than 24 hours
- Overall hospitalization can be reduced by 3 days
Typically a patient is admitted to the hospital with enough time before the operation date to allow diagnostic tests to be done. These routinely include blood and urine tests, electrocardiograms (ECGs), chest x - rays and so on. Cardiac catheterization with coronary angiograms is done during the pre-operative hospital stay.
Before the operation, members of the cardiac surgery team will visit to examine you, discuss the details of the operation and answer your questions. The nursing staff will also evaluate your needs; make you as comfortable as possible. In addition, the anesthesiologist will evaluate you and discuss plans for the care of vital body functions during the operation. Other members of the technical staff may come to draw blood, instruct you about how to breathe and care for your lungs after the operation. You will also be told when the operation will occur.
If you are found to be fit, one or two bottles of your own blood may be drawn before surgery which will be used for blood transfusion, during or after surgery. It is the safest blood transfusion, and eliminates or reduces the need for donor blood transfusion. This may be done before or after your admission, on the decision of your cardiovascular surgeon.
Before the operation, most of your body hair will be shaved off, especially from your chest and legs. You will probably be asked to shower and wash with to remove bacteria from the skin to reduce the chance of infection. You should remove personal items such as glasses or contact lenses, dentures or detachable bridge work, watches and jewellery and give it to your family members for safe keeping.
Usually medicines are taken on schedule, but consult your Doctor before taking any medicines. Medications that will make you relaxed and drowsy will be given about an hour before the operation.
Attendants will wheel you to the operating room on a rolling bed. After you are in the operating room, the anesthesiologist will give you an anesthetic that brings sleep and freedom from pain during the operation. Then the operation will be performed.
Your family can wait in front of the operation theatre during the surgery or at the reception. Be sure your surgeon knows where your family will be waiting
Patient is taken to recovery area or an intensive care unit (ICU). A member of the family may visit brieﬂy in the recovery or intensive care unit after a few hours of the operation when the patient is awake.
The usual hospital stay after an operation is from normally 5 to 7 days. However Patients who undergo the minimally invasive coronary bypass surgery (MICAS) can return home within 3-4days. During that period and beyond, most patients have "goods days" and "bad days" with overall progress and a gain in strength.
There will be some discomfort in the incision made to reach the heart it is usually made along the midline of the chest through the breastbone. The incisions may hurt. Medication will be given to relieve the pain.
Sometimes it causes heavy perspiration during the night or even the day. Taking medicines usually brings relief, but the fever may continue for three to four days after the surgery.
Deep breathing exercises and coughing are impor tant ways to speed recover y. Coughing reduces the chances of pneumonia and fever and will not harm the incision or bypass grafts. Most patients will have fear of pain, discomfor t and don't like to cough after an operation, still coughing is essential. Some patients find it easier to cough if a pillow suppor ts their chest. You can help you own recover y by changing positions in bed often.
Once your breathing tube is removed, you will be able to swallow liquids. How quickly you will be able to progress from liquids to regular diet is an individual matter.
It depends on your digestive system. It is possible you may have a depressed appetite for some days due to mild indigestion caused by stress. It will return to normally on your return to normal activities.
Patients may get out of bed and sit in a chair or walk around the room as soon as they are able - usually within a day or two. Later they can take short walks in the hall. Eventually they can climb stairs and take brisk, longer walks to prepare for going home.
Sponge baths are given right away. It will be a few days however before you are allowed to shower and shampoo.
This book let has talked about other people will do to make sure your operation is successful and that you have smooth and happy recovery period. There is also a lot you can do, both before and after your operation, to help yourself.
- If you smoke, give up smoking
- Watch your weight
- Watch your cholesterol level
- Be positive
- Keep physically active
- You should only take the medicines prescribed by your doctor
It depends up on a patient's need and the wishes of your cardiovascular surgeon. Patients usually are advised about future surgical appointment when they are discharged from the hospital. You should see cardiologist regularly and have lipid profile, TMT, Echo tests at reqular intervals to assess progress. You should make an appointment with your personal or family doctor soon after returning home.
If you per form a sedentary job, the average is between three to six weeks. If your job involves heavy work, the time is six weeks or longer. Your Doctor is the best guide to help you return to work.
Typically patients may resume sexual relations when they feel like it. If you have questions, talk to your Doctor.
You may begin driving any time you feel physically able to operate the vehicle safely. It is usually best to wait a few weeks after leaving the hospital to begin driving a car.
At Wockhardt, we care for your well being. We strongly recommend practicing prevention and securing health. In a world where lifestyle evolves by the day, it is essential to stay in the best of health. Wishing you and your family good health and happiness always.
The information in the booklet is not intended as a substitute for medical advice but is to be used as an aid in understanding ailment. Always consult your doctor about your medical condition.