What is Coronary Bypass Surgery?
Coronary bypass surgery is a surgery to bypass the coronary veins that has blockage from the accumulation of plaque (fats, cholesterol, cell debris) using patient’s artery or vein. The goal of this surgery is to fix the flow of coronary vein so that an oxygen supply to heart muscle is back to normal, which will reduce chest pain and reduce the rate of mortality that is caused by heart attack. Until now, coronary bypass surgery is the most performed surgery in the whole world ( > 1 million).
Where does the material for bypass is taken from?
The material for coronaty bypass generally is taken from leg vein (safena magna vein) or from the back of chest wall (mamaria interna artery). The material for coronary bypass could be taken from arm vein (radialis artery) and abdomen (epigastrica inferior and gastro epiploica artery) alternatively. Generally, a patient needs 2 – 4 bypass channels.
Coronary Bypass Surgery Indication
Internationally, indications for coronary bypass surgery are:
- Coronary cardiac diseases that reaches the base of major blood vessel or the left side of heart.
- Reach 3 coronary veins
- Involves many locations and diffuse, which is inappropriate for rings
- Patient with impaired ventricles function
How is the treatment post-op surgery?
Generally, the length of treatment in intensive care unit is 1 – 2 days. Patient is allowed to fully mobilize on second post op day. The healing of surgical incision takes about 7 – 14 days, while the sternum / breastbone will be reconnected after 6 weeks. Patient is recommended to avoid sudden movement such as getting up from bed / chair, avoid lifting heavy item, avoid lifting arms exceeding from the head limit.
The extraction of leg vein will cause the return of blood flow from leg back to heart disturbed, and swelling of legs will result which generally will be diminished after 6 – 8 weeks stocking usage could reduce the swelling of the legs.
Patient could return to light activity within 1 week after surgery, driving a vehicle after 4 weeks and return to work after 6 weeks.
Patient is suggested to change his life style, such as exercise regularly, avoid stress, reduce fatty meal, stop smoking, control blood pressure / blood sugar and blood cholesterol.
What is the rate of failure in Coronary Bypass Surgery?
Death rate of coronary bypass surgery range between 1 – 2 %. Death rate could be pressed down below 1 % in the particular heart center. Risk of failure in the surgery will be increased if patient is above 70 years old, cardiac function declines, blockage of the base of left coronary artery, diabetic, chronic pulmonary disease and chronic renal disease.
What could be the complication of Coronary Bypass Surgery?
Complication that might occur is post perfusion syndrome, which is the temporary neuro cognitive impairment that relates with lungs – heart machine. The impairment of wound and breastbone healing, cardiac infarct due to lack of blood flow or emboli, early blockage of bypass channel, kidney function impairment, stroke, viral infection of wound or blood, thrombus of internal veins and abnormal heart rhythm. These complications usually could be prevented or resolved.
How long will the bypass channel function well?
Ten years after surgery. About 60 % of bypass channel that originates from leg vein still function well. When using mamaria interna artery, 90 % of bypass channel could function well up to 20 years.
How is the comparison between coronary bypass surgery with ring placement?
The result of research in various countries show consistently that coronary bypass surgery is more favorable for patients who have significant blockage of the major blood vessel of the left side of heart, blockage that involves many coronary blood vessel, diabetic patient and patient with reduction of heart pumping and young age. In the developed countries, coronary bypass surgery is more economic compared to ring placement.