Coronary Bypass Surgery

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Coronary Bypass Surgery

What is coronary bypass surgery? 

Coronary bypass surgery is an operation to bypass the coronary arteries that are blocked due to the accumulation of plaque (fat, cholesterol & cell impurities) by using arteries or veins from the patient's own body. The purpose of this operation is to improve the flow of coronary arteries so that the supply of oxygen to the heart muscles becomes normal again so that it can eliminate the symptoms of chest pain and reduce the risk of death resulting from a heart attack. Until now, coronary bypass surgery is the most widely performed operation in the world (> 1 million)

Where is the bypass material taken from?

Material for the coronary bypass is generally taken from a vein in the leg (vein safena magna) or from behind the chest wall (internal mammary artery). As an alternative, material for coronary bypass surgery can be taken from blood vessels in the hands (radial arteries) and in the abdomen (inferior epigastric arteries & gastro-epiploic arteries). Typically, a patient needs two to four bypass channels.

What are the indications for coronary bypass surgery? 

Internationally, indications for coronary bypass surgery are coronary heart disease affecting the base of the main left heart arteries, regarding three coronary arteries, involving many locations and areas (diffuse) that are not suitable for treatment with rings, patients with impaired ventricular function, diabetes and young age.

What is the process of coronary bypass surgery? 

After general anaesthesia, a heart surgeon performs a skin incision in the centre of the chest and splitting the breast bone. During surgery, the heart rate is stopped temporarily and the heart-lung function is taken over by the heart-lung machine. The operation can also be done with a technique without using a heart-lung machine. Coronary bypass surgery involves connecting by sewing the bypass channel to the coronary arteries through areas that are narrowed or blocked. The other end will be sutured to the aortic artery, except for the internal mammary artery and the gastroepiploic artery, where the other end has been connected from the beginning. Generally, the operation lasts for approximately three hours. If all the bypass channels have been installed and there is no more bleeding, the chest wall is closed again using some fine wire. Patients are then treated in the Cardiac Intensive Care Unit (CICU).

What is the treatment after coronary bypass surgery?

Generally, the length of treatment at ICCU is one to two days. Patients have been allowed full mobilization on the second day after surgery. Healing surgery wound takes 7-14 days, while the sternum will reconnect after 6 weeks. Patients are advised to avoid sudden movements such as getting out of bed or sitting, avoiding lifting heavy objects, not raising their hands beyond the head limit. Intake of veins from the legs will cause blood flow back from the legs back to the heart to become less smooth, causing the feet to become swollen, which generally will decrease or disappear after 6-8 weeks. The use of stocking socks can reduce swelling in the legs. Patients can return to mild activity within one week after surgery, drive the vehicle after 4 weeks and return to work after 6 weeks. Patients are also advised to change lifestyles such as: getting used to exercising regularly, avoiding stress, reducing fatty foods, stopping smoking, controlling blood pressure, blood sugar levels and blood cholesterol.

What is the failure rate for coronary bypass surgery?

The death rate for coronary bypass surgery ranges between 1-2 per cent. At certain heart centres, death rates can be reduced to below 1 per cent. The risk of failure of surgery will increase if the patient is elderly (more than 70 years), heart function decreases, blockage at the base of the left coronary artery, diabetes, chronic lung disease and chronic kidney failure.

What are the possible complications of coronary bypass surgery?

A possible complication is posted perfusion syndrome, a transient neurocognitive disorder associated with the heart-lung machine. Impaired healing of wounds and sternum, heart infarction due to embolization or lack of blood flow, early blockage of the bypass channel. impaired kidney function, stroke, germ infection in wounds or blood, thrombus in deep veins and heart rhythm disorders. These complications can generally be prevented or overcome.

How long does the bypass channel function properly?

Ten years after surgery. about 60% of the bypass channels that come from veins in the legs are still functioning properly. If using an internal mammary artery, 90% of the bypass can function well for up to 20 years.

How does coronary bypass surgery compare to ring placement?

Research results in various countries have shown consistently that coronary bypass surgery is more beneficial for patients who experience significant blockages in the main left heart arteries, blockages that involve many coronary arteries, diabetes sufferers and sufferers with decreased heart pump function and young age. In developing countries, coronary bypass surgery is even more economical compared to ring placement.

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