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Open-Heart Surgery
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Coronary Artery Bypass Graft (CABG) surgery is one of the most rigorously studied operations in surgical history. Over the past 30 years, bypass surgery has contributed to the cardiac health of millions of patients. About 600,000 CABG procedures are performed in the United States each year. Other "open heart" surgeries include 80,000 valve surgeries, and 2,300 heart transplants annually. This article will focus primarily on CABG and the processes involved.
Why is CABG performed?
The conventional open-chest surgery is done to reroute or "bypass" blood around clogged arteries and improve the supply of blood and oxygen to the heart. Fatty deposits may build up and narrow the arteries over time in a process called atherosclerosis. When blood flow is severely restricted or blocked through the heart’s blood vessels, a heart attack can occur.
How is the bypass constructed?
"During surgery, the surgeon may ’borrow’ blood vessels from other places in the patient’s body," explains William Sweezer, M.D., a cardiothoracic surgeon on staff at John Muir Medical Center, Walnut Creek Campus. "Commonly, a piece of a long vein in the leg is removed and stitched to the large artery leaving the heart, the aorta. The other end of the vein is grafted to the coronary artery below the blockage. Or, an artery may be diverted from the chest wall so that the open end is attached to the coronary artery below the blocked area." With either method of constructing new conduits, blood uses a new path to again flow freely to the heart muscle.
The heart surgery team
The surgical team includes two or more surgeons, a cardiac anesthesiologist, two surgical nurses and a heart-lung machine specialist. All team members work smoothly to complete repairs needed during the surgery which generally lasts between two and four hours, depending on the number of grafts needed. A pump oxygenator (heart-lung machine) is used for most of the comprehensive bypass graft operations and also for heart valve replacements.
"In some cases, with carefully selected patients, the bypass procedure may be done on the beating heart without using a heart-lung machine," says cardiothoracic surgeon Rolf Sommerhaug, M.D., who is on staff at John Muir Medical Center, Concord Campus and John Muir Medical Center, Walnut Creek Campus. "This off-pump (OP-CAB) procedure is increasingly being used with excellent results."
The recovery process
After surgery is completed, the patient is monitored closely in the Intensive Care Unit while coming out of anesthesia. After a day or two of careful observation in ICU, if recovery proceeds as expected, the patient is moved to a monitored regular hospital room. Most open-heart artery bypass patients are able to go home in five to seven days.
Increasing activity gradually
Persons with sedentary office jobs may be able to return to work in four to six weeks. Those with jobs that are especially physically demanding may have to wait longer, modify their work activities, or sometimes find different employment. The patient’s physician may recommend gradually increasing the amount of activity at home to include light housework, going out, visiting friends and climbing stairs. The goal is to help the patient resume an active lifestyle and return to former activities and pursuits.
Making long-term lifestyle changes
"For grafts to remain open for many years, it’s vital that heart bypass patients change their diets to reduce fat and cholesterol and make other important lifestyle changes," Dr. Sweezer emphasizes. Usually, the patient’s physician will advise walking regularly, or other forms of appropriate physical exercise to help regain strength.
Other support available
"Participation in a cardiac rehabilitation program is the most effective way to receive the guidance and support needed to make necessary changes," Dr. Sommerhaug suggests. Learning biofeedback or stress management techniques can also help prevent another heart attack in the future. In addition, hospital volunteers who have had bypass surgery are invaluable in providing emotional support and information about the recovery process.
The future of CABG
Although new, less invasive techniques are emerging for coronary artery bypass grafting, Dr. Sommerhaug believes these promising procedures will remain—at least in the near future—a complementary option for carefully selected patients.