Coronary Artery Bypass Grafting (CABG) or Heart Bypass is a type of surgery that improves blood flow to the heart. Surgeons use CABG to treat people who have severe coronary heart disease. Since longer life expectancy has led to an increased incidence of cardiovascular disease and consequently to an increasing number of primary and secondary coronary artery bypass grafting (CABG) operations in the elderly. A secondary Bypass surgery is called a Redo Bypass Surgery. Redo Bypass is a relatively difficult procedure and requires an extensive experience by the heart surgeon an extensive to perform the heart bypass surgery.
Why is it required?
Coronary Heart Disease is a disease in which high cholesterol levels would lead to formation of a waxy substance called plaque inside the coronary arteries. These arteries supply oxygen-rich blood to your heart. Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause chest pain or discomfort called Angina.
If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. This is the most common cause of a heart attack. Over time, ruptured plaque also hardens and narrows the coronary arteries.
A Redo-CABG is required in cases where the Coronary arteries narrow down again due to the existing CHD leading to the formation of plaque again in the Coronary arteries.
What is done during CABG/Redo CABG?
During CABG/Redo CABG, a healthy artery or vein from the body is connected, or grafted, to the blocked coronary artery by the surgeon. The heart surgeon ensures that the grafted artery or vein bypasses (that is, goes around) the blocked portion of the coronary artery. This creates a new path for oxygen-rich blood to flow to the heart muscle.
CABG helps in
Improving your quality of life and reducing angina and other CHD symptoms.
Allowing you to resume a more active lifestyle.
Improving the pumping action of your heart if it has been damaged by a heart attack.
Lowering the risk of a heart attack (in some patients, such as those who have diabetes)
Improving your chance of survival
Eternal Hospital runs a Heart Failure Clinic dedicated to patients with heart failure. Patients are educated about the cause and treatment of heart failure and proper counselling is done to stabilise their symptoms. Our focus is to avoid unnecessary hospitalisations and improve quality of life of heart failure patients. The Centre offers a patient and family-centered approach to care.
Heart Transplantation is an operation to replace a diseased heart with a healthy donor heart. Heart Transplantation is a treatment used for severe heart failure, when medication or surgery is ineffective. Heart Transplant can dramatically improve the survival and quality of life of patients with severe heart failure. However, transplant candidates often have to wait for a long time before a suitable donor heart is available.
Left Ventricular Assist Device (LVAD)
Q. What is a left ventricular assist device (LVAD)?
The left ventricle is the large, muscular chamber of the heart that pumps blood out to the body. A left ventricular assist device (LVAD) is a battery-operated, mechanical pump-type device that's surgically implanted. It helps maintain the pumping ability of a heart that can't effectively work on its own.
Q. When is an LVAD used?
This device is sometimes called a "bridge to transplant," but is now used in longer-term therapy. People awaiting a heart transplant often must wait a long time before a suitable heart becomes available. During this wait, the patient's already-weakened heart may deteriorate and become unable to pump enough blood to sustain life. An LVAD can help a weak heart and "buy time" for the patient or eliminate the need for a heart transplant. Most recently, LVADs are being used longer-term as ‘destination therapy’ in end-stage heart failure patients when heart transplantation is not an option.
Q. How does an LVAD work?
A common type of LVAD has a tube that pulls blood from the left ventricle into a pump. The pump then sends blood into the aorta (the large blood vessel leaving the left ventricle). This effectively helps the weakened ventricle. The pump is placed in the upper part of the abdomen. Another tube attached to the pump is brought out of the abdominal wall to the outside of the body and attached to the pump's battery and control system. LVADs are now portable and are often used for weeks to months. Patients with LVADs can be discharged from the hospital and have an acceptable quality of life while waiting for a donor heart to become available.
Extracorporeal Membrane Oxygenation (ECMO):
A therapy that is used in acute decompensated heart failure resulting in a cardiac arrest. This form of resuscitation is known as E-CPR and is known to salvage these patients much better. It is an invasive form of therapy and involves placing cannulas or tubes in the femoral vessels to help gain access to the circulation and then connecting the patient on to a ECMO machine which is very similar to a heart lung machine. This helps rest the heart and protects all other organ systems. The ECMO is generally used as a last resort when all medical therapies have been exhausted and the patient is heading towards getting an either a artificial heart or a heart transplant. The ECMO works best for a period of 2-3 weeks post which in our experience we see a lot of destruction cells leading to bleeding complications and end organ damage. There two forms of ECMO:
Veno- Arterial ECMO: this form is used to resuscitate cardiac arrest patients and has improved our salvage rates in this subset of patients. It can be used temporarily to tide over the acute phase or as a bridge to definitive therapy like LVAD or heart transplant.
Veno-Venous ECMO: This form of ecmo is used mainly in patients who have severe lung related pathology such as H1N1 infection, viral pneumonias and ARDS. It is excellent form of therapy with good salvage rates. It is best used early in the disease when the lungs are soft and compliant for maximum benefit. It is greatly under utilized in India due to lack of knowledge and cost factors.
It is a well-known fact that Cardiac Surgery has excellent long-term benefits. However, with Midline Sternotomy and Cardiopulmonary Bypass, there’s high morbidity during the postoperative period. Opening the chest by Sternotomy is not only very traumatic, but also the most invasive part of Cardiac Surgery. With advancements in the field of Minimally Access Surgery, it is now possible to use this technique in most Cardiac Operations. Cardiac Surgeries can be performed through small thoracotomy incisions either on the right or left chest. This avoids both Midline Sternotomy and the morbidity associated with it.
At Eternal, we perform almost all types of adult Cardiac Operations using Minimally Invasive Cardiac Surgery (MICS). In fact, the Minimally Invasive approach is not only restricted to adults but has also been used in pediatric cases as well.
The advantages of MICS include:
Small thoracotomy incision
Less risk of infection
Reduced ICE and shorter hospital stay
Improved postoperative pulmonary function
Improved cosmetic results
Improved quality of life
Aortic Aneurysm Surgery: An aortic aneurysm is a bulge in a section of the aorta, the body’s main artery. The aorta carries oxygen-rich blood from the heart to the rest of the body. An aneurysm occurs when the pressure of blood passing through part of a weakened artery forces the vessel to bulge outward, forming what you might think of as a blister. Because the section with the aneurysm is overstretched and weak, it can burst. If the aorta bursts, it can cause serious bleeding that can quickly lead to death. An aneurysm that bleeds into the brain can lead to stroke or death
Where do aneurysms occur in the body?
In the tiny arteries that supply blood to the brain (the cerebral arteries).
In parts of the large vessel that carries blood from the heart to other parts of the body (the aorta). Aortic aneurysms can occur in the area below the stomach (abdominal aneurysms) or in the chest (thoracic aneurysms). An abdominal aortic aneurysm (AAA) is usually located below the kidneys.
In the heart's main pumping chamber (the left ventricle).
Why do I need surgery?
Different operations treat the different kinds of aneurysms. Surgery to treat aortic aneurysms, those that occur in the body's main artery, depends on the size and location of the aneurysm and your overall health. Aortic aneurysms in the upper chest (the ascending aorta) are usually operated on right away. Aneurysms in the lower chest and the area below your stomach (the descending thoracic and abdominal parts of the aorta) may not be as life threatening. Aneurysms in these locations are watched for varying periods, depending on their size. If they become about 5 centimeters (almost 2 inches) in diameter, continue to grow, or begin to cause symptoms, you may need surgery to repair the artery before the aneurysm bursts.
What does the surgery involve?
Surgery involves replacing the weakened section of the vessel with an artificial tube, called a graft. This means that surgeons will have to open either the stomach area (for abdominal aneurysms) or the chest (for thoracic aneurysms).
The cardiovascular surgeon leads the surgical team, which includes other assisting surgeons, an anesthesiologist, and surgical nurses. When the operation begins, the surgeon will make a cut (called an incision) either in the abdomen or the chest. The incision depends on where the aneurysm is located.
The bulging section of the aorta is cut out (excised). The surgeon will then replace the missing piece with a fabric tube called a graft. The clamps are then removed slowly to allow blood to flow through the vessel again.
Sometimes surgeons do not cut out the bulging section of the aorta. In these cases, the operation is the same except that surgeons place the fabric graft inside the vessel, like a lining, to decrease the pressure on the wall of the artery. This procedure is called endoaneurysmorrhaphy.
If the aneurysm is located in the ascending aorta just above the heart, the heart-lung machine will be used. The surgery takes about 2 to 4 hours.
You can expect to stay in the hospital for 5 to 7 days, including at least 1 to 2 days in the Intensive Care Unit (ICU).