Coronary artery bypass surgery is the most common type of heart surgery. Coronary arteries, which are the vessels that feed the heart, can be affected by various risk factors (see coronary heart disease) over time, and may become narrowed or completely occluded.
This blockage of arteries is called coronary artery disease. A new vessel is added to the clogged vessel with coronary artery bypass surgery and a new pathway is opened for blood flow. Thus, the heart can continue to work properly by receiving the blood it needs through this new vessel.
WHAT IS BYPASS SURGERY?
Bypass, which is applied in the occlusion of the coronary vessels that feed the heart, is the first among the surgeries performed in cardiac surgery in adults. In fact, approximately 70-80% of the heart surgeries performed consist of coronary bypass surgeries. Moreover, the age of patients who have undergone bypass surgeries has been decreasing in recent years. Bypass was generally known as an operation that was necessary for patients in their 50s and 60s. Today, there has been a noticeable increase in the number of patients in their 40s and even 30s who have undergone coronary bypass surgery.
The most important reason for the decrease in the age of surgery is the changing habits due to modern life. In recent years, the age of incidence of coronary artery disease has decreased significantly due to reasons such as the increase in smoking rates and the decrease in the age of starting smoking, malnutrition and sedentary lifestyle that are the result of modern life. In parallel with this, bypass surgeries are now performed not only on elderly patients, but also on young adults.
Bypass surgery; It creates the bridging process made through new vessels taken from the body (leg or chest) to the vein that is clogged in the heart vessels. In other words, a new path is created by using the body's own veins to the clogged veins. It ensures that sufficient amount of blood is delivered to the heart muscles, whose nutrition is impaired due to occlusions in the coronary vessels. In this way, complications such as insufficiency of the heart valves, ballooning of the heart muscle, heart attack and sudden death can be prevented.
IN WHICH DISEASES IS BYPASS SURGERY PERFORMED ?
In the cardiological examinations, it is decided that the treatment of the problem detected in the heart with methods such as drugs or angioplasty will not be sufficient or possible, therefore bypass is performed. Bypass can be performed in patients with multi-vessel diseases, severe narrowing of the vessels supplying the left ventricle of the heart, in the presence of a significant stenosis in the main coronary artery feeding the left heart, in people with insufficient balloon or stent procedures, in cases where there is a stenosis in the vessels feeding the heart and another heart condition that needs to be corrected with surgery.
HOW IS BYPASS SURGERY PERFORMED?
The most classical way to reach the heart is the method in which the breastbone (sternum) is opened in the middle. In some special methods, the size and location of these incisions change. Some valve and ASD surgeries can be performed with 5-6 cm incision (window). In the mamaria internana taken from the chest, the blood is coming from the vein going to the arm, while the upper ends of the other free veins (radial artery and saphenous vein) are sutured to the aorta. Thus, with a new vessel (bypass graft), the flow of blood that carries energy and oxygen to the heart muscle in the area of stenosis or obstruction is provided. The number of bypass vessels made during the operation ranges from 1 to 6. Generally, 2-4 vessels are bypassed. The veins used by the surgeon during the operation are the veins in the patient's own body, which do not leave a shortage when removed. In these surgeries, we prefer the mammary interna vein taken from the chest, then the radial artery taken from the arm and finally the saphenous vein taken from the leg. However, the vessel to be used may change depending on the location and severity of the stenosis in the vessel to be bypassed. Sometimes the saphenous vein may be the best option for that target vein. Sometimes mammary interna may not be used in elderly, chronic lung disease and very overweight patients. The arm vein is also not used unless it is necessary in advanced age, diabetes patients using insulin and chronic kidney patients. The final selection of the vessels to be used will be made by the surgeon during the operation. Two mamaria intermeas are not preferred in patients with advanced age, COPD, diabetes and in female patients. The first step in heart surgery is to stop the heart by connecting the blood flow between the heart and lungs to a machine (heart-lung machine) during the surgery. Some of the coronary bypass surgeries (in special cases such as COPD, Chronic kidney disease) can be performed on the working heart (beating heart, offpump).
Bypass surgery is an application that treats the consequences, not the causes, of vascular occlusion. Before bypass surgery, people with risk factors should create their lifestyles to protect their heart health and not disrupt their routine controls. Otherwise, an infarction problem, known as a heart attack, may occur and the patient's life is at risk.
Before the bypass surgery, it is necessary to consult an experienced doctor and to perform all the necessary examinations. At the same time, the list of drugs used should be reported to the doctor and maximum precautions should be taken against any risk of infection during the surgery.
After the bypass surgery, radical changes should be applied in the patient's life. It is necessary to pay attention to nutrition together with changing the lifestyle, quitting alcohol and smoking, creating a stress-free lifestyle. It is recommended that most of these activities be performed under the supervision of a doctor.
It is common for the patient to experience psychological problems after bypass surgery. In this case, professional help may be required. At the same time, it is recommended to apply a supportive nutrition program to protect heart health after surgery.
FREQUENTLY ASKED QUESTIONS
What Are the Risks of Bypass Surgery
Risk factors vary according to the patient's pre-operative condition, age, gender, and the presence of other comorbidities. Risk factors are higher in women and in patient groups over 70 years of age. In addition, diabetes, obesity, presence of any other organ disease (such as kidney or lung diseases), previous heart attack or stroke, accompanying heart valve and / or rhythm disorders, previous heart surgery are among the most important risk factors. .
What is the duration of bypass surgery?
It varies according to the type of surgery performed, the number of bypasses to be performed, whether there is another surgical intervention for the heart in the same session, and whether he has had any previous heart surgery. For example; While the operation may take 2.5-3 hours in a patient who will undergo bypass to two or three vessels, it may take 4-5 hours in cases where the valve needs to be changed during the session.
How long is the hospital stay after the bypass surgery?
The hospital stay of patients in the low risk group is 4-6 days. Patients with high risk factors are referred to the cardiology department and the time to return to daily life varies between 2-4 weeks.
How can anesthesia be applied in bypass surgery?
General anesthesia is generally applied to patients who will have bypass and heart valve surgery. Heart failure, previous heart attack, high blood pressure, diabetes, smoking and advanced age-related lung disease and kidney function disorders are seen at a higher rate in most patients who need heart surgery. Therefore, anesthesia of these patients requires a different approach. The patients to be operated are evaluated by the anesthesiologist at least one day in advance and the most appropriate anesthesia method is planned.
What is the EVH method used in bypass surgery?
The endoscopic method, which has been used in recent years in the vein to be removed from the leg in bypass surgery, also draws attention. The EVH (Endoscopic Vessel Preparation) method, which allows vessel preparation with a 2-3 cm incision made from the knee region instead of long incisions made along the entire leg, is considered one of the techniques that accelerates the recovery process after coronary bypass surgeries. Thanks to this technique, the risk of complications such as wound infection, bleeding, bruising and swelling in the leg that may occur after surgery is reduced. The patient suffers less pain and recovers in a shorter time. It can return to daily life in a much shorter time.
What are the advantages of Coronary Bypass?
When the narrowings in the coronary arteries rise above a certain level, they prevent blood flow, which prevents the heart from fulfilling its task. In this context, coronary bypass eliminates chest pains and prevents possible heart attack. Negative habits are abandoned with coronary bypass, and taking a step towards a healthier and higher quality life is one of the advantages of surgery. One of the advantages of coronary bypass is the elimination of existing arteriosclerosis. Coronary bypass makes the blood that is not fed from the narrowed or occluded vessel feeding the heart muscle.
What are the disadvantages of Coronary Bypass?
Coronary heart diseases are one of the most common causes of death. However, with the development of technology, equipment and the experience of the surgical teams, the disadvantages of coronary bypass have disappeared. Coronary bypass surgeries can be performed with or without stopping the heart. Both techniques have different advantages and disadvantages. All the advantages and disadvantages are explained by the doctor. Since the same technique is not applied to each patient, the disadvantages and advantages vary from patient to patient.
How long is the life of the bypassed vessel?
The answer to this question is also related to how the patient looks at his heart after surgery. As long as the lifestyle is regulated, diet programs are applied and the doctor's recommendations are followed, the lifespan of the new vessels is up to 30 years.
Does Bypass Affect Sexual Life Negatively?
Bypass affects sexual life. The fact that patients with this condition are in the advanced age group alleviates the effects of this condition, while younger patients should definitely avoid drugs that will exacerbate this condition.
Can Coronary Bypass be repeated?
Patients who have undergone coronary bypass may need a repeat bypass operation. However, with the advancement of PTCA (Balloon and stenting) techniques in our time, the need for reoperation in the early period has decreased, while the possibility of reoperation due to more widespread disease in the later period has decreased. The first operation is at a very early age: the coronary vessels or the grafts used may be blocked due to the progressive nature of the disease after the operation. Therefore, it is important that risk factors are kept under control (such as close monitoring of blood sugar and fats, blood pressure, smoking cessation) not only in young patients, but also in all patients who have had bypass surgery. Progression of stenosis in vessels that were not bypassed because there was no critical stenosis during the first surgery. A patient who had a bypass in the previous surgery may need valve surgery later.
Is Heart Valve Surgery Also Performed During Coronary Bypass?
Yes. In the elderly, surgery for aortic valve stenosis and repair of mitral valve insufficiency due to crisis is the most common "joint" heart surgery performed during coronary bypass. Apart from this, if there is a heart surgery that needs to be done, it is also performed simultaneously.