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Dr. Andrew Rynne

Family Physician

Exp 50 years

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My 55yrs old father has 3 blocks in his heart, does he need bipass surgery ?

my father 55 years old,has 3 blocks in his heart doctors are suggesting him for bipass surgery ? what is best solution for this engioplasty or bipass surgery, is it risky im worried about my father s health..
Tue, 15 Dec 2009
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My dear, yours father is 55, and I am 61, and has undergone Bypass surgery on 2nd October, 2006. My LAD was totally occluded, and two arteries were having stenosis in them. CABG (Coronary Arteries bypass grafting) or Bypass surgery went smoothly here in Pakistan. Now I am taking a walk of 5 kms comfortably and am driving car, climbing stairs. So ask yours father, that nothing to worry. The risk is only 1%, and benefits are a normal healthy life. Below is teh description of Bypass surgery. Hope it will help yours family in reducing teh tension associated with this surgery. Plz dont hestitate to contact me if you and yours family need further information on this topic. ABOUT CORONARY BYPASS The goal of coronary artery bypass graft surgery (CABG) is not to repair or remove any blocked arteries, but to detour blood around a blockage in a coronary artery and reestablish the flow of oxygen-rich blood to the heart. To create the detour, a segment of a blood vessel is taken from another part of the body. The segment may be taken from one of the following: •The saphenous vein from the leg is commonly used. •The internal mammary artery from the chest is usually preferred for key artery branches because it tends to remain open longer. Some call it the internal thoracic artery. •The radial artery from the arm and sometimes arteries from the stomach (gastroepiploic artery) may also be used as bypass grafts. Depending on which blood vessel is used, one end is either sewn to the aorta or may remain connected to the larger artery where it originated. The other end is attached (grafted) beyond the blockage in the coronary artery. As a result, blood can flow around the blocked area, increasing the supply of oxygen and nutrients to the heart muscle. Bypass surgery may be recommended for individuals with a history of any of the following: •Narrowing in several coronary artery branches (common in people with diabetes) •Severe narrowing in the left main coronary artery •Blockage in the coronary artery or another condition that may not or has not responded to other treatments (e.g., angioplasty) •Severe angina Bypass surgery carries some risks, including a less than 5 percent chance of heart damage and a less than 2 percent chance of death. Studies show that women have a slightly higher risk during or immediately after bypass surgery. This may relate to the fact that women who undergo the surgery are generally older and in poorer health, and their smaller body size makes the surgery technically more difficult. However, the overall risks are relatively low when compared to the fact that many of these bypass operations significantly lengthen and improve the quality of the patient’s life. In some cases, the grafted arteries may also become blocked and require a second bypass surgery. Second bypass has slightly higher risks than the initial surgery, because patients are older and other, less optimal blood vessels must be used for the new grafts. However, bypassed arteries can remain functioning for many years, especially when the patient makes diet and exercise adjustments for cardiac health. Therefore, bypass surgery remains a popular choice for physicians treating severe coronary artery disease. During coronary bypass surgery For several weeks before bypass surgery, patients who smoke will be advised to stop smoking. Many surgeons also advise their patients to stop taking aspirin to minimize the risks of excessive bleeding during and immediately after surgery. They will also be asked not to eat or drink anything after midnight before surgery. Certain medications, especially those that affect blood clotting, may be reduced or stopped. Patients should discuss their medication schedules with their physician. The patient is usually admitted the morning of surgery. A few days before surgery, the patient undergoes a number of tests, which include an x-ray, blood tests, urinalysis and an electrocardiogram (EKG). The patient’s blood is typed and cross–matched with units of donor blood, according to the surgeon’s wishes. Blood transfusions may not be needed. Patients should know, however, that blood banks test blood to screen donor blood for most major diseases, such as hepatitis or AIDS. The patient will be given specific pre-operative medications and is then prepared for surgery. The chest, groin and leg areas are shaved, and a bacteria-killing (bactericidal) solution is applied to the operative site and surrounding area. The patient is then sedated with medication given through an intravenous (I.V.) line in the arm or hand. As soon as the patient is asleep, an anesthetic inhalation gas (general anesthesia) is continuously administered through an endotracheal tube (breathing tube) and constantly monitored by the anesthesiologist. After the patient is asleep, a device called a Swan-Ganz catheter is often inserted through a needle stick into the jugular vein (in the neck) and threaded to the pulmonary artery (which goes from the heart to the lungs). The catheter is used to measure heart function, measure the pressures in both the heart and lungs, and to give any necessary medications. The endotracheal tube, which was inserted into the mouth and down the windpipe (trachea), is used to maintain an airway. A urinary catheter is also inserted and connected to a collection bag to measure the patient’s urine output. An incision is then made in the chest, through the breastbone (sternum), and the two halves of the breastbone are divided (median sternotomy). A medical device called a retractor is used to pull back the two halves of the breastbone to give the surgeon plenty of room to work. The ribs are not divided, reducing discomfort during recovery. The functions of the heart, including blood flow and oxygenation, are rerouted through a heart-lung machine. While the machine takes care of the heart’s functions, the heartbeat can be carefully stopped by administering a cardioplegic solution. In total, the heart will remain stopped for about 30 to 90 minutes during the four to five hours (on average) of surgery. Before the heart is stopped, the blood vessel(s) to be used as grafts are removed from their source location. If they are located in the chest, one end of the blood vessel(s) may remain connected to the larger artery it originated from, or it will be sewn to the aorta, depending on which blood vessel is used for the graft. The other end is sewn into place below the blockage in the coronary artery. After the graft(s) are completed, and blood is successfully flowing around the blockage, the heart is restarted and the patient is removed from the heart-lung machine. Finally, when normal blood flow and heartbeat are re-established, the surgical site is carefully closed layer by layer. The sternum is usually closed with wire and the surface incision is closed with staples or sutures, depending on the surgeon’s preference. Although coronary bypass is a relatively safe surgery with an extensive history in patients, researchers are still looking for ways to improve it. For instance, studies are underway to investigate new ways of grafting blood vessels. One method involves a “sewing” device consisting of two sets of hooks. One set holds the graft; the other makes the attachment to the aorta. In the small group of individuals having undergone the procedure, the graft was connected in less than two minutes (versus up to seven minutes with current methods). Researchers also noted a better quality of connection. Moreover, it resulted in less time required on the heart-lung machine. Another technique, still in the animal testing stages, involves connecting grafts with an adhesive. Researchers think that either procedure may someday find use in minimally invasive bypass surgery and may make the heart-lung machine unnecessary in standard coronary bypass surgery.
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