Bypass surgery

Recently Prime Minister Dr. Manmohan Singh underwent beating heart bypass. Archana Darshan talks to Dr O.P. Yadava, CEO and Chief Cardiac Surgeon at Delhi-based National Heart Institute, who explains the nuances of a bypass surgery.

The name itself tells all. Bypass surgery, sometimes called CABG pronounced as Cabbage reroutes or bypasses the blood around the clogged arteries to improve the blood flow and oxygen around the heart. The arteries that bring blood supply to the heart can get clogged by the buildup of cholesterol (plaque), which narrows the arteries and reduces the blood supply to the heart.

What happens in bypass?

Surgeons leave the blocked segments alone and graft a healthy segment of the blood vessel by making a detour around the blocked part of the artery.

Where does the healthy blood vessel come from?

An artery may be detached from the chest wall and the lower open end attached to the coronary artery below the blocked area an artery may be taken from the forearm – usually the one which is felt as pulse (Radial artery).

A piece of a long vein in your leg may be taken. One end is sewn to the Aorta i.e. above the block and the other end of the vein is attached or “grafted” to the coronary artery below the blocked area. An aorta is the largest artery in the body, originates from the left ventricle of the heart and brings oxygenated blood to all parts of the body.
Either way, blood can use this new path to flow freely to the heart muscles.

A patient may undergo one, two, three or more bypass grafts, depending on how many coronary arteries are blocked.

Which conduits are better – Arterial or Venous?

Arterial conduits are better, while venous grafts degenerate much faster and only 50% are open at 10 years. So one must make all efforts to use at least 2 arterial grafts and if feasible go for Total Arterial Grafting.

What does the heart do while all this action is taking place?

Earlier while the surgeon was busy sewing the new vessels in place for the blood to flow uninterrupted, the function of heart, which means pumping blood would be done by a machine pump oxygenator (heart-lung machine) to be precise. Once the surgeon was through, electric shock was given to revive the heart and it would begin beating.

But the process involved more trauma. And if the surgery took longer than designed obstructing the natural pattern of blood flow could inflict damage to the tissues and heart cells.

What PM underwent was beating heart surgery, in which his heart continued to beat amidst all the action and only a small part of it was stilled so that the surgeon could carry with his sewing.

Advantages of beating heart bypass

The beating-heart bypass surgery is especially beneficial for patients with severe diabetes, kidney problems or smokers having bad lungs.
This process avoids many of the complications that can arise from the use of the heart-lung machine, such as stroke, increased need for blood transfusion, kidney and lung complications.

Another benefit of the beating heart procedure is faster recovery time — about three to six weeks compared to 10 to 12 weeks with traditional bypass surgery.

Costs involved are essentially the same in both procedures (Around 1.6 lacs), but because beating heart surgery is user and patient friendly, with quicker convalescence , it turns out cost effective because of earlier return to gainful employment.

Many of us have often heard the term Open Heart Surgery and fear what it involves. Dr. Yadava clarifies, “ Open Heart Surgery is any surgery in which heart is stopped and the body is supported on a heart lung machine. Open heart surgery can be used to perform bypass surgery or to change a valve of the heart or to close a hole in the heart.

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