Understand Bypass Surgery & it’s Questions.

Author : Bhadresh Bundela

What is bypass surgery ?

This is a surgery in which a healthy blood vessel (artery) is used to form a detour (bypass) around a blockage in a coronary (heart) artery. The new blood vessel used is called a ‘graft’ and therefore the procedure is correctly termed as ‘Coronary Artery Bypass Graft’ surgery. The original blockage in the artery remains as it is, but now there is adequate blood supply to the heart muscle beyond the blockage. Today coronary artery bypass is one of the most frequently performed surgical procedures.

How is it done?
The ‘graft’ used can be either an artery or a vein. However, these days most advanced heart centers such as the Asian Heart Institute prefer to use ‘arterial grafts’ since they have been shown to have a longer life. Studies performed at the Cleveland Clinic by Dr. Floyd Loop and others have shown that arterial grafts remain open even after 20 years of surgery. When surgery is done only using arteries as grafts (also called ‘Total Arterial Revascularization’), the chances of getting recurrence of angina are very slim, and in most cases the patient does not need a second bypass surgery. In the past ‘venous grafts’, usually from a vein in the leg called saphenous vein were used often, but they have a higher rate of developing fresh blockages.The most common artery used is an artery from your chest called the Left Internal Mammary Artery (LIMA). This artery is detached from the chest wall and the open end attached to the coronary artery below the blockage. The RIMA can also be used in select cases. The radial artery is another very commonly used conduit vessel in bypass surgeries. It’s typically taken from the non-dominant hand.
Frequently Asked Question – After Bypass Surgery

» When can I drive on my own?
It is wise to wait for 2 months after your surgery, before driving on your own. Before starting please consult with your surgical team. This is the amount of time it takes for the healing of your sternum (breast bone), which was cut open during surgery. Any chance injury, with the steering wheel can cause damage if driving is started too early.

» Can I travel by car?
Yes. You may travel by car as soon as you are discharged. However, for the first few weeks, it is advisable to restrict the driving time, to less than two hours. If the drive is going to be longer, then you should take a break every two hours and walk around for a few minutes.

» Should I be ‘speaking less’ during my recovery period?
There is no reason for you to ‘speak less’ after surgery. However, during the first few days of your recovery, you might feel short of breath on speaking for a long period of time. If so, your body is telling you to rest, and you may keep silent for some time.

» When can I go back to work?
We generally advise patients to wait for at least 1-2 months after surgery before returning to work. However, each individual is different and some people may be able to return sooner. Please consult with your doctor before returning to work.

» What about the old blockages in the arteries, will they remain?
The blockages which are present in the arteries remain as they were. The ‘graft’ which provides the ‘new blood supply’ is connected below your old blockages, thereby providing adequate blood to the heart muscle.

» After my surgery, why do I still get a pain in my chest?
To perform your surgery, your chest-bone was cut open and stitched together after surgery. It is quite normal to feel some pain or altered sensations in your chest region for a few months after surgery. However, this pain will be different from the pain of ‘angina’ which you might have experienced before surgery.


Questions to Ask a Before By-pass Surgery
Bypass surgery is a major procedure and it is extremely important for you to understand what it entails. Here are some questions which you ought to discuss with your surgeon prior to the surgery.
» Will the surgery be done by using arterial grafts or venous grafts?
» Will the surgery be done off-pump, also called ‘beating heart surgery’ or will a cardio-pulmonary bypass machine be used?
» What is the risk involved in the surgery?
» If I do not choose to do surgery, what options do I have, and what are the pros and cons of the alternative options?
» How long will I have to stay in the ICU? How long will my hospital stay be?
» Will I have to be given a blood transfusion during or after the surgery?

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