Bypass surgery, also known as coronary artery bypass grafting (CABG), is a surgical procedure used to treat coronary artery disease (CAD). CAD occurs when the blood vessels that supply blood to the heart muscle become narrowed or blocked by a buildup of plaque (atherosclerosis). Bypass surgery is performed to create new pathways for blood to flow around the blocked or narrowed arteries, improving blood flow to the heart muscle.
Who would benefit from bypass surgery?
Bypass surgery is recommended when the CAD is severe, and the blockages in the coronary arteries are significant. Dr.Nikhil says, “ Typically when a patient has 2 or more major blocked vessels, bypass surgery is the preferred treatment”. Bypass surgery can relieve symptoms, such as chest pain (angina), improve heart function, and reduce the risk of heart attacks.
How is bypass done?
During bypass surgery, the surgeon takes a healthy blood vessel, typically from the patient’s leg (saphenous vein) or chest wall (internal mammary artery), and grafts it to the coronary arteries that are blocked or narrowed. These grafts “bypass” the blocked areas, creating new routes for blood to reach the heart muscle. Dr.Nikhil says, “ Unlike what many patients think, we do not remove the blockages from the blood vessels, we just make pathways for blood to flow around the blocks”.
Types of Bypass Surgery
– Traditional Bypass Surgery or On Pump:
This involves open-heart surgery, where the chest is opened via middle of chest incision, and the patient is connected to a heart-lung machine to maintain circulation during the procedure. Dr.Nikhil says, “This is the Gold Standard for CABG!”.
– Off-Pump Bypass Surgery:
In this variation, the heart-lung machine is not used, and the surgery is performed on a beating heart. This approach can be performed safely and may be considered for certain patients who are at higher risk for complications with traditional bypass surgery. As it is slightly cheaper than “on pump” surgery, Off pump CABG is performed more frequently in India.
– MICS (Minimally Invasive Cardiac Surgery)
Also known as Keyhole Cardiac Surgery, this approach is to prevent a Midline chest incision. In selected patients this can be employed. They will benefit from Less duration of pain, less bleeding, less blood transfusion, faster recovery and quicker return to work.
– Robotic Assisted CABG
This is a type of MICS that uses robotic systems to assist surgeons in performing various surgical procedures with enhanced precision, dexterity, and control. The Robots arms are placed inside the patient’s chest by small incisions. These are then controlled by the Surgeon who sits on a surgeon console 5-10 feet away and perform the surgery.
After surgery, patients typically spend a few days in the hospital for recovery. Full recovery usually takes 6-8 weeks, depending on the individual and the complexity of the procedure. MICS and Robotic patients usually recover in 3-4 weeks time. Cardiac rehabilitation is often recommended to help patients regain their strength and improve cardiovascular health.
Bypass surgery can relieve symptoms of CAD, improve heart function, and reduce the risk of heart attacks. It can also extend and improve the quality of life for many patients.
Bypass surgery is a major surgical procedure and carries certain risks, including infection, bleeding, blood clots, and complications related to anesthesia. Dr.Nikhil says, “Patients often ask about risk of surgery but seldom realize that they are recommended surgery only because other options of taking medicines or stents were of higher risk.”
After bypass surgery, patients are typically advised to make significant lifestyle changes, including adopting a heart-healthy diet, engaging in regular exercise, quitting smoking, and managing risk factors like high blood pressure and high cholesterol to prevent further progression of CAD.
Bypass surgery is a well-established and effective treatment for coronary artery disease, and it is typically recommended when the benefits outweigh the risks.