A B C D E F G H I J K L M N O P R S T U V W

CORONARY ARTERY BYPASS GRAFTING

Why is Coronary Artery Bypass Grafting performed ?

The coronary arteries supply blood to the heart muscle. Very commonly these arteries become narrowed by deposits of fat. When the patient then exercises and the heart needs more blood, the narrowed arteries are unable to allow enough through. Cramp of the heart muscle, or angina , is then noticed by the patient. The symptoms can often be controlled with tablets such as nitrates and beta-blockers. In some patients, however, angina is resistant to drug treatment.In this situation, an operation to improve the blood supply to the heart is likely to relieve the pain associated with angina. A severely narrowed artery may block suddenly due to a blood clot. In this case a part of the heart muscle would have no blood supply at all and might die. This is called a myocardial infarction , heart attack , or coronary thrombosis . When narrowing of the arteries is severe and there is a high risk of a heart attack, the operation may be advised to reduce this risk.

Preparations needed for Coronary Artery Bypass Grafting

It is vital that you give up smoking completely. Most tablets will continue to be taken right up to the day of operation, but if taking aspirin, this should be stopped one week beforehand. You will usually be admitted theday before surgery. Among the people that you will see is a physiotherapist who will show you the deep breathing and coughing exercises which must continue after the operation to help prevent chest infections. You will normally remain in hospital for about one week after surgery. Your employers should be warned that you will need to be off work for about 3 months in total. The support of family and friends may be needed for the first 2 weeks back home after leaving hospital.

What Happens during Coronary Artery Bypass Grafting

An hour before operation, you will havean injection, or pre-medication . This will cause drowsiness and a dry mouth. In the operating theatre you will be put to sleep completely. The cut will commence at the top of the breastbone and end in the upper part of the abdomen. At the same time, a second surgeon will be making an incision in one or both legs. A vein is removed from the leg for later use as bypass grafts . It is also possible to free up a spare artery from behind the breastbone. This internal mammary artery can also be used as a graft. You will be attached to a heart- lung machine . This takes over the work of the heart and the lungs. It is now possible to stop the heart beat and operate on the coronary arteries. Lengths of vein or internal mammary artery are attached to the coronary beyond the narrowings and blockages. The other ends of the veins are sewn on to the aorta (the large vessel carrying blood from the heart to the body). If an internal mammary artery is used, this is already attached to the aorta. Blood may now flow down the new channels into the coronary arteries, bypassing the narrowed or blocked sections. The heart is allowed to take over from the heart lung machine again.

Possible Complications during Coronary Artery Bypass Grafting

At the end of the operation, the heart may have difficulty in taking over from the heart -lung machine . The problem can usually be overcome with drugs. Sometimes a device to assist the heart to pump is temporarily placed into an artery in the groin. A moderate amount of bleeding from the wound is expected. If too much blood is being lost, the surgeon may decide to take you back to theatre to stop the bleeding. In the first few days after surgery, the heart may beat rapidly and irregularly and you might feel sweaty and uncomfortable. Tablets (usually digoxin) will be given to slow down the heart. Infection of the lungs may occur. Infection of the chest wound should only rarely be a problem, but infection of the leg wound(s) is quite common.This usually needs no more than regular cleaning and dressing. A few patients may suffer a stroke around the time of a heart operation. This usually results in weakness of one side of the body. For many patients the stroke is minor, though some are left with severe disability.

After Coronary Artery Bypass Grafting

After the operation you will be nursed in the intensive care unit (ICU) for one or more days. On awakening you will still be connected to a breathing machine via a tube in themouth. There will be a number of drips , or tubes in thearms and in the neck and a tube in the bladder to drain urine.Two or more tubes or drains will emerge from below thewound. These allow any blood that gathers inside the chest after the operation to be drained away. By the following morning, you should be freed from these attachments and can return to the ordinary ward. The wounds are fortunately not usually too painful, and strong painkillers are rarely required. It is normal to have some ankle swelling associated with the leg wound, and a support stocking may be required. Many patients notice marked mood swings, especially in the early days. Discharge from hospital is about a week after surgery. Activity may increase over 3 months. After 1 month, you should be walking about a mile a day. Driving should be possible after 6 weeks. Strenuous exercise must be avoided for the full 3 months. After that time, there need be no restrictions. Smoking must cease. Changes in diet may be appropriate, avoiding in particular animal (saturated) fats. Bringing the blood fat levels (particularly cholesterol) back to normal may improves the health of your heart after coronary artery surgery. This may require the use of cholesterol-lowering drugs. Regular, moderate exercise is advisable. If your blood pressure is high, this is treated. Many surgeons believe that regular aspirin is helpful in preventing a recurrence of the problem.

If Coronary Artery Bypass Grafting is not performed

Doctors may advise you to undergo surgery because your angina is poorly controlled with drugs. Without operation, there would be little further scope to improve your symptoms. You might also be at risk from having a heart attack if the operation were not performed.