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CABG (Heart Bypass)
Patients having blockage in one or more coronary arteries need to undergo a heart bypass, in order to restore normal blood flow to the heart. Coronary artery bypass graft surgery is performed by taking the patient's own arteries and veins located in the leg, arm, or chest and bypassed by a blood vessel graft and thereby reducing the risk of death and angina.
An account of patients with heart failure can be seen in the Ebers Papyrus, one of the oldest preserved medical documents written around1600 BC. As per AHA data, 448,000 CABG surgeries were performed in the year 2006 in America and the first coronary artery bypass surgery was performed at Albert Einstein college of Medicine-Bronx Municipal Hospital Center by a team of surgeons led by Dr. Robert Goetz in 1960.
Necessity of heart bypass:
CABG is recommended for the following conditions:
- Patient having angina or chest pain
- Left ventricular function is hindered
- No response to conservative treatments
- Two or three major coronary arteries are confirmed to have coronary artery disease with blockage
Some symptoms pertaining to coronary artery diseases include:
- Chest pain and palpitations
- Breathing difficulties
- Persistent tiredness and weakness
- Swelling of leg combined with weight gain
- Easy fatigue
Benefits of heart bypass surgery:
- Distinct improvement in the symptoms of chest pain and ischemia.
- About 90% of patients get satisfaction with the resultant improvement after CABG
- Successful surgery reduces the risk of heart attack and extends the life span of the patient.
- The surgery is highly beneficial to resume a normal life by the patient
Risk and complication associated with CABG includes:
- CABG does not guarantee the recurrence of the coronary artery blockage
- Blockage or total closing of graft
- Damage to adjacent arteries and veins
- Abnormal heart rates- arrhythmia
- Low or high blood pressure
- Pulmonary embolism
- Increase the risk of heart attack due to blood clot
- Kidney failure is possible
- Anesthetic reaction
- Infection and bleeding
- 4-5 % mortality rate is possible with CABG
- Increased risk of chest infection and lung complications
- A short memory loss is probably possible, which may subside within 6 months after the surgery
- The risk of developing coronary artery disease is common to both genders and the risk increases at the age of 40 and above.
- Women develop coronary artery disease about 10years later than men, hence the mortality rate is more in women
Preparations before heart bypass surgery:
- A patient can undergo surgery after medically stability is attained after the heart attack
- Follow your surgeon’s advice and evade dental treatments before the CABG and avoid taking antibiotics
- A comprehensive physical examination will be conducted
- Diagnostic test like ECG, stress tests, cardiac catheterization, x-rays will be analyzed
- Blood and urinalysis may be performed
- After consulting the surgeon prior to the surgery, note down the list of medicines which is to be taken or stopped.
- Report the surgeon if you experience cold, fever or sore throat a few days before surgery
- Get the support of family and friends to help you with emotional backing during the post-operative rehabilitation
- Make necessary arrangements and assistants at home, as per your requirement for recovery after the surgery
- The night before surgery, do not eat or drink anything after midnight
- Quit smoking and inform the surgeon about habit of smoking and alcohol
Bypass surgery after- care:
- During the initial post-operative period, the patient needs to stay at hospital for 7-10 days and will be hosted in the intensive care unit (ICU) for the first few days, when the patient’s vital statistics will be monitored periodically
- The drainage tube will be detached 1-3 days after the surgery
- Discomfort may be experienced in the chest during activity for about 2 months
- Within a few days of the surgery, the cardiac rehabilitation will be started as patient becomes stable
Special precautions to be followed after the bypass surgery:
- Always try to keep the incision clean and dry
- Keep the feet elevated if the saphenous vein(vein of the leg) is used for the graft and take care not to cross the legs
- Walk daily as per the instruction of the surgeon
- Follow strict and habitual lifestyle changes to have maximum benefit from the surgery
- Follow a proper diet and exercise regime and maintain a healthy weight
- Make a point to participate in post cardiac rehabilitation program
- Do take the prescribed medication meticulously
- Follow up visits with surgeon and physician are mandatory
- Quit smoking immediately
Generally, the grafts placed during surgery works well for several years, and the patient can expect a full recovery after 3-6 months of the surgery.
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