Obesity, cause, treatment and complication

A graft is a blood vessel which is use to bypass a blocked artery. Normally, graft is taken from the internal mammary artery in the chest, or the saphenous veins from the leg, or in rare instances from the radial artery in the arm. The graft is attached above and below the area in the artery where there is a blockage, so that the blood can use the new, unblocked path to flow freely to the heart. Cardiologists take a graft from another part of the body and then attach one end of the graft to the aorta and the other end to the coronary artery below the blockage.

Arteries which carry blood from the heart to the whole body, and while coronary arteries supply blood to the heart muscles. Once coronary artery gets blocked, a new channel is created in order to bypass the artery blockage, calledThe procedure is also known with a name of , CABG or open heart surgeryor commonly just the When artery gets narrowed to about 70% of its normal size, the artery is basically a blocked artery. Due to blockage decrease in the supply of blood and oxygen happen to the heart and over time can lead to chest pain or a heart attack. Sometime blockage can be relieved by angioplasty and stinting; however, in case of severe blockage usually requires bypass surgery. Moreover, in situations when angioplasty do not gets the success, or the blockage is difficult to clear by angioplasty, or in case of severe blockages in multiple major vessels, in such situations Cardiologist suggest coronary artery bypass graft (CABG) surgery. Arteriosclerosis is a common arterial disorder characterized by thickening, loss of elasticity, and calcification of arterial walls, resulting in a decreased blood supply. Atherosclerosis is a common arterial disorder characterized by yellowish plaques of cholesterol, lipids, and cellular debris in the inner layer of the walls of large and medium-sized arteries.

The duration of operation varies from six- to eight-inch cut down the center of the breastbone so the surgeon can get directly at the heart. The body is connected to a heart-lung bypass machine that keeps the blood flowing.  The surgical incision is closed by using special wires. After surgery, the patient is sent to an intensive care unit for a day or two for close monitoring. After which, the patient is transferred to the nursing unit for a week. After leaving the hospital, patient recovers progressively over the next two to four weeks.  There are certain risks of infection and heavy bleeding & also there are risks associated with anaesthesia, breathing problems, Postoperative pneumonia, and wound infection also are common complications from open-. The success rate for bypass surgery is 96 to 98 percent. That means between 2 and 4 percent of the patients can have complications.

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Minimally invasive heart bypass surgery is also known as the minimally invasive direct coronary artery bypass. It is often abbreviated as MIDCAB. As the name suggests, it is a minimally invasive approach to the conventional ‘Coronary Artery Bypass Graft’ (CABG). MIDCAB is basically a beating heart surgery, implying the fact that it is not at all required to stop heart beating in between the surgery which thus eliminates the requirement of heart-lung machine.

For carrying out this surgery, a surgeon is not required to make a large incision or cut at the center of the chest so as to open the rib cage. Instead, he usually makes small incisions in the side of the chest i.e. in-between the ribs. MIDCAB surgery mostly results in fewer complications, faster recovery and less pain after surgery. It is often performed on the patient whose one or two coronary arteries are blocked. If, however, the person has three or more blocked coronary arteries, then surgeons usually perform the conventional CABG surgery.

One of the potential challenges involved in minimally invasive bypass surgeries is the complexity involved in sewing a beating heart. If the surgeon is conducting surgery on the beating heart, then he usually takes the aid of a stabilization system. This stabilization system thus assists him to stabilize the portion of the heart that is under surgery. This system also eliminates the need of a heart-lung machine, thus enabling the surgeon to carry surgery in a precise manner on the heart of patient while the heart continues to beat.

There are in fact numerous benefits offered by the minimally invasive bypass surgery. They include normal supply of the oxygen and other nutrients to the heart as well as an adequate supply of blood to the heart. Besides, it allows the surgeon to carry out surgery on the patient’s heart while it is beating and that too with minimal incisions. Some of the other benefits are highlighted and discussed as under:

Reduced infection rate: Since this type of surgery usually involves minimal cuts or incisions, so this implies the reduction in the exposure level. Reduced exposure of the tissues further minimizes the rate of infection.

Faster recovery: As compared with the conventional CABG surgery, MIDCAB offers faster recovery. Moreover, use of smaller incisions and the avoidance of heart-lung machine minimize the potential risk of heart stroke and failure, thus enabling the patient to return to his normal activities within two weeks.

Minimal bleeding: In this type of surgery, the use of heart-lung machine is not a necessity which leads to a considerable amount of reduction in bleeding as well as prevents the blood cells from any sort of damage.

Cost-effective: A MIDCAB surgery is quite less expensive as compared to the conventional CABG surgery and it involves a shorter stay of the patient in the hospital.

That is all about a minimally invasive heart by pass surgery being carried out on the heart of a patient.

Coronary Artery Bypass Graft Surgery

Coronary artery bypass grafting (CABG) is a type of surgery that improves blood flow to the heart. It’s used for people who have severe coronary heart disease (CHD), also called coronary artery disease.

CHD is a condition in which a substance called plaque (plak) builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood…

Grafts used for bypass
Internal mammary arteries [also called IMA grafts or internal thoracic arteries (ITA)] are the most common bypass grafts used, as they have shown the best long-term results. In most cases, these arteries can be kept intact at their origin because they have their own oxygen-rich blood supply, and then sewn to the coronary artery below the site of the blockage. If the surgeon removes the mammary artery from its origin, it is called a “free” mammary artery. Over the last decade, more than 90% of all patients received at least one internal artery graft.
The radial (arm) artery is another common type of arterial graft. There are two arteries in the arm, the ulnar and radial arteries. Most people receive blood to their arm from the ulnar artery and will not have any side effects if the radial artery is used. Careful preoperative and intraoperative tests determine if the radial artery can be used. If the radial artery is used as the graft, the patient may be required to take a calcium channel blocker medication for several months after surgery. This medication helps keep the artery open. Some people report numbness in the wrist after surgery. However, long-term sensory loss or numbness is uncommon…

After surgery, there will be a short stay (1 to 2 days if there are no complications) in the intensive care unit (ICU).

In the ICU, you will likely have : -
Continuous monitoring of your heart activity.
A tube to temporarily help with breathing.
A central line, which is a thin plastic tube inserted into a vein in the neck and threaded down into the heart and pulmonary artery. It is used to monitor pressures and blood flow within the heart.
A tube to remove stomach secretions until you start eating again.
A tube (catheter) to drain the bladder and measure urine output.
Tubes connected to veins in the arms (intravenous, or IV, lines) through which fluids, nutrition, and medicine can be given.
An arterial line to measure blood pressure. An arterial line is a short, soft, plastic tube (a catheter) that is placed directly into an artery. The arterial line leads to a monitor, which continuously displays your blood pressure.
Chest tubes to drain the chest cavity of fluid and blood (which is temporary and normal) after surgery…

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An open surgical procedure used to treat moderate to severe coronary artery disease. Clogged arteries are bypassed with grafts to provide alternate routes of blood flow to the heart. Although other grafts may be used, this surgical procedure most commonly involves a saphenous vein graft from the leg to route blood around areas of vessel blockage in the heart.

Sometimes after the chest is closed and sutured, the underlying tissues are not fully healed.

Most surgeons will recommend their patient’s follow sternal precautions.

* No pushing, pulling, lifting more than 10 pounds for 6 weeks post-operative.
* No pulling or pushing up in bed with the arms.
* Walk with hand held assistance rather than using canes or other assistive devices.
* Take small steps when turning in standing, avoid twisting the body.
* No driving for 4 weeks post-operative.
* If a sternectomy is involved and a skin or muscle flap is present, shoulder elevation may be limited to 90 degrees.
* Avoid holding hands/arms overhead for long periods of time.

Recovery From Open Heart Surgery
In many surgeries, drugs are given to wake the patient immediately after the incision is closed. Most surgeons opt to allow CABG patients to wake slowly, to prevent any stress on the heart that might happen when waking abruptly.

The patient will be taken to the recovery area, usually a cardiac or surgical intensive care unit, for care while coming out of anesthesia. The critical care environment is necessary to provide the patient with one on one nursing care and constant monitoring. At this time the ventilator will remain in use, providing breathing support while the patient remains sedated.

One or more chest tubes, large tubes that are inserted around the surgical site, help remove any blood that may have collected around the heart. A large IV called a Swan-Ganz will also be in place, allowing staff to monitor critical heart functions and infuse medications.

Once the anesthesia drugs wear off and the patient is awake, the breathing tube is removed (a process called extubation) and the patient is able to breathe on their own. Immediately after extubation supplemental oxygen may be given by nose, to assist with breathing. Oxygen levels and breathing will be closely monitored and if a patient cannot breathe adequately without the ventilator, the breathing tube will be reinserted.

Once awake and breathing on their own, the patient will begin rigorous rehabilitation, starting with sitting on the edge of the bed or standing and walking a few steps to a chair. The patient will be instructed in ways to move that minimize pain and how to protect the surgical wound. At this time, pain medication is available to allow the patient to move without intense pain.

A CABG patient will typically stay in the intensive care environment for at least twenty four hours. The chest tubes are usually removed within forty eight hours of surgery, before transferring to a step-down unit. Many CABG patients indicate a significant improvement in pain level when the chest tubes are removed.

Life After Open Heart Bypass Surgery : -
CABG is not a cure for heart disease; it is a highly effective treatment. A CABG patient who does not follow their doctor’s instructions to change their diet, quit smoking, exercise, lose weight or control their blood sugar may find that their coronary artery disease has returned, and is blocking the new grafts.

Some patients may require rehabilitation after returning home to help with strength and stamina. Some facilities have a specialized heart rehabilitation program while others use the services of physical therapists.

Open Heart Bypass Surgery

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Having the industry’s most elaborate and exclusive Patient Care and Clinical Coordination teams stationed at each partner hospital, we provide you the smoothest and seamless care ever imagined. With a ratio of one Patient Care Manager to five patients our patient care standards are unmatched across the sub continent.

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Coronary Artery Bypass Graft, the most commonly performed heart surgery is done as both conventional Open Heart Surgery as well as a minimally invasive surgery.In Comparison to the conventional Open Heart Surgery, the advanced treatment technique – minimally invasive Cardiac Surgery is on a rise for treating various heart ailments.

Coronary Artery Bypass Graft is performed in conditions such as Arteriosclerosis (atherosclerosis), Coronary Artery Disease (CAD), any occlusion (obstruction) or for any diseased arteries. CABG involves bypassing blockages in coronary arteries with a blood vessel taken from another part of the patient’s body. The bypass reroutes the blood flow by bypassing the diseased tissue and providing uninterrupted blood flow to the heart.

Open Heart Bypass Surgery which is the conventional involves performing an incision or cut over the sternum and dividing it to reach the heart. The graft is taken from Great Saphenous Vein from the patient’s leg for the bypass procedure. Now-a-days Internal Mammary Arteries are the treatment of choice for the graft because it remains far longer unobstructed as compared to Greater Saphenous vein. The salient feature involved in this surgery is the use of a Heart-Lung Machine which provides an uninterrupted circulation and oxygenation to the blood while the heart is stopped during the surgery. On completion of the bypass surgery the heart is restarted and the chest wall is closed. The patient is removed from the heart-lung machine. The total hospital stay of 7-10 days is expected with an Open Heart Surgery.

Minimally Invasive Cardiac Bypass Surgery, the latest treatment technique for performing Coronary Artery Bypass Graft is the advanced treatment technique which involves invasion onto the chest wall through a small incision. The procedure is commonly known as Key-hole Heart Surgery. The peculiar feature of this surgery is that a very small incision is made on the chest wall and within the confined space the heart is beating without the use of a lung-heart machine. The technique is used for the pathologies involved in the Left Anterior Descending Artery and Right Coronary Artery. For bypass, Internal Mammary Artery is used. This technique has a fewer complications and the recovery period is around 12-24 hours and the hospital stay is usually about 3-4 days.

On – Pump Vs Off – Pump Cardiac Surgery

While performing a CABG, when the surgeons use Heart-Lung Machine, then it is called On-Pump CABG. The rationale for using this machine is providing blood supply to the rest of the body when heart is stopped. This machine does the work of a heart and lung. The cannulas are placed in the heart to drain the impure blood to the pump where it is purified and pumped back into the patient. This works even when the heart is stopped with specialized medications and is still nourished. During this time the grafts are constructed and at the end of the procedure the heart is restarted. When the adequate function has been resumed, the bypass machine is disconnected and the pipes are withdrawn from the heart.

An Off Pump CABG is the newer method of performing CABG. It is performed so as to keep heart beating and without the use of heart-lung machine. The technique involves attaching new grafts to the heart while it is constantly moving and filled with the blood. Special devices are used to stabilize the heart. This technique is a newly evolved technique to reduce the risks involved with an Open heart surgery such as stroke and decrease in higher mental functions.

Open Heart Surgery Vs Minimally Invasive Cardiac Surgery – The differences

• Whereas the conventional CABG surgery requires a 10″-12″ incision to separate the sternum, MIDCAB surgery requires either a 3″-5″ incision placed between the ribs, or may be done with several small incisions.

• The CABG is an on pump procedure thus requires a heart lung machine, while the MIDCAB is a beating heart surgery does not require the heart lung machine.

• MICAB surgery is more economical, results in a faster recovery, has fewer complications, and causes less pain after surgery.

• The procedure is mostly indicated when only 1-2 arteries are involved, unlike the conventional CABG, which is generally indicated when 3 or more coronary arteries have occlusion.

It is important to note that although MICAB procedure has many advantages over conventional open heart CABG, not everyone is a candidate for MICAB. Whether a patient will benefit more from MICAB or Open heart surgery can be decided after the cardiac surgeon reviews the medical details of the patient.

Indicure is the leading healthcare services company in India providing heart surgery in India with the most established cardiac surgeons at best heart hospital at low cost. The patients come from US, UK, Australia, Canada, New Zealand, Zimbabwe, Kenya, Tanzania, Nigeria and many other countries for quality and affordable . For more information, log onto http://www.indicure.com/treatments/cardiac-procedure/cardiac-surgery/open-heart-bypass-surgery-cabg.htm and http://indicure.com/treatments/cardiac-procedure/cardiac-surgery/minimally-invasive-heart-bypass-surgery.htm

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