Frequently asked questions
Heart bypass surgery involves the use of blood vessel grafts to bypass blocked coronary arteries. Heart bypass surgery is also referred to as Coronary Artery Bypass Graft surgery (CABG).
During this surgery, a small length of an artery or vein is sourced from another part of the body, usually from the hands or the legs. This portion is then stitched on to the aorta, the main blood vessel originating from the heart, at one end and below the blocked portion of the coronary artery at the other end. Before doing the bypass surgery the surgical team evaluates the patient’s health status. Certain health conditions may preclude the possibility of bypass surgery. If the patient is deemed fit for surgery, consent from the patient is obtained. The benefits and the potential risks involved are explained to the patient.
During the surgery:
The surgery team harvests the graft from the veins of the calf or forearm as the case may be. If the graft is taken from the internal mammary artery, the graft incision is made in the chest. A long incision is made in the centre of the chest. The breastbone is cut through and the ribs are retracted to expose the heart. The patient is then connected to a heart-lung machine also called a cardio-pulmonary bypass pump. This machine carries out the function of the heart and the lungs during surgery.
If a venous graft is used one end of it is attached to the aorta and sewn into place. The other end is then attached to the area of the coronary artery below the block. If an internal mammary artery graft is used, the detached end is connected to the coronary artery while the other end remains attached to its point of origin in the aorta.
After this, the surgeon slowly starts reverting the functioning of the heart-lung machine. The circulation is then completely restored to the heart. Mild electric shocks are given to heart muscles to stimulate it to start beating again. Tubes are placed in the surgical sites to drain out the fluids that may accumulate. The chest cavity is then closed, and soft tissues and skin are sutured. Ventilator support is provided to assist in breathing. The patient is then shifted to a post-operative intensive care unit for observation. A heart monitor is attached to evaluate the functioning of the heart. A urinary catheter is placed to evacuate urine.
The heart bypass surgery would cost between 5,500-7,000 USD in the top hospitals in India. Factors that determine the cost of surgery,
· The choice of hospital-A super-specialty heart hospital with high reputation will obviously cost more.
· The choice of surgeon-A highly reputed surgeon with huge experience will cost more
· The condition of the patient-The cost of the surgery goes up in proportion to the risks associated with surgery. An otherwise healthy patient without any other systemic diseases, falls in a low risk category. A patient with pre-existing systemic diseases that could aggravate the heart disease falls into a high risk category. The cost of surgery for high risk types will be higher, since the surgical team will have to take additional precautions to prevent the occurrence of any surgical complications.
· The duration of hospital stay-Longer the duration of stay, higher the overall cost of surgery
For those coming to India for heart bypass surgery, there are certain additional costs involved apart from the cost of heart surgery. They include the cost of air tickets, medical visa and cost of stay outside the hospital.
Those coming to India for heart bypass surgery will have to come prepared for a stay of two to three weeks. This include
· the time for pre-surgical consultations and assessment – about two to three days.
· stay in the hospital- about ten to twelve days
· observation period after discharge from the hospital- about five to seven days.
The main treatment for a heart attack is the restoration of blood supply to the affected areas. This is referred to as revascularisation. There are two modes of restoration of blood supply. They are ‘angioplasty with stents’ and coronary artery bypass surgery or’ bypass surgery’ in common parley. There is a lot of confusion among people about, which treatment is better for them, stents or bypass surgery. The best treatment is of course decided by the doctor depending on the condition of the patient.
The differences between these two treatments are:
· Angioplasty with stents is a minimally invasive procedure while bypass surgery is a major surgery.
· Angioplasty with stents cannot be done if there are multiple blocks in coronary arteries. Bypass surgery is the only option in such situations.
· The success rate of angioplasty in preventing a future heart attack is less as compared to bypass surgery.
· Being a minimally invasive surgery the recovery from an angioplasty is faster. In comparison, bypass surgery, being a major surgery takes a substantially longer recovery time.
· If the overall health of a patient is poor, a bypass surgery cannot be carried out even if the patient’s condition warrants it. In such situations the surgeon will have to wait till the general health of the patient improves rendering him fit for a bypass surgery. The surgeon may do an angioplasty with stenting as a temporary procedure.
· A bypass surgery is much costlier than an angioplasty and stenting for obvious reasons.
A heart bypass surgery is a major surgery. It involves two steps -the sourcing of the grafts from blood vessels elsewhere in the body and attachment of the grafts to the coronary arteries. To reach the coronary arteries the surgeon has to access the heart. This can only be done by cutting open the ribs and chest muscles. Once this is done, the surgeon has to attach the grafts on either ends of the blocked coronary arteries. This requires a high degree of precision and skill. All of these makes the heart bypass surgery a major one. Hence the recovery from the surgery will take a considerable period of time. The duration of surgery will be about four to five hours. Soon after surgery the patient will be shifted to the post-operative intensive care unit. Breathing support will be provided there with the help of a ventilator. The condition of the heart will be monitored thoroughly. The patient will remain in the intensive-care unit for a period of three to four days.
Soon after the patient will be shifted to the hospital room where they will remain for the rest of the hospital stay. The patient will have to stay in the hospital for a period of ten to twelve days. The patient will be encouraged to walk a short distance periodically while staying in the hospital room. He will also be made to do certain chest exercises and physiotherapy to improve the flow of blood through the grafted arteries. Once discharged from the hospital the patient will be given strict instructions regarding post-operative home care. The patient can start doing mild jobs about four weeks after the surgery. Lifting of weights above 8kgs is not allowed. Activities that exert pressure in the chest should be avoided. Driving may be permitted after five or six weeks.
In general, recovery from heart bypass surgery will take about three months to four months. Even then the patient should take proper care of the heart to prevent the recurrence of the heart disease.
Though a major surgery, heart bypass surgery offers excellent results. More than 95% of the patients report significant benefits from undergoing surgery. More than 90% of those undergoing the surgery remain symptom free even after 5 years while 85% remain symptom free even after 10-12 years. Surgical morbidity and mortality rates is about 1-2%.
Around 60-70% remain healthy even after a period of 15-20 years. In a small minority, the symptoms may recur after 3-5 years and might need further surgeries. Those who fall into this category are usually the ones who fail to make the necessary lifestyle adjustments as suggested by the doctor.
The rate of success is much higher in younger people and diminishes with advancing age. The surgery has a poor prognosis for those who are above the age of 70. Poor left ventricular function is also a major reason for the failure of the graft. Smoking, undesirable dietary habits, sedentary lifestyle etc are some of the factors that affect the long term success of the surgery.