Coronary Bypass Surgery

Heart and vascular diseases develop due to unhealthy lifestyle factors or genetic factors. If these diseases are not treated or kept under control, they put a person's life at risk or adversely affect quality of life. The most common form of heart and vascular disease is vascular occlusion. Narrowing or blockage of the arteries of the heart can be partial or complete. Blockages in these vessels put the person's life at risk. Narrowing or blockage of the coronary arteries manifests through various symptoms and seriously affects daily life. As a result of blockage in the heart's arteries, obstruction of blood flow can lead to severe chest pain, heart attack or heart failure, and in some cases may cause life-threatening situations resulting in death. The risk of damage to the heart caused by coronary artery blockage can be treated with bypass surgery. Bypass surgery uses a healthy vessel as a bridge in place of the blocked vessel, allowing blood to pass beyond the blocked section and ensuring the nourishment and viability of heart tissue. You can read the rest of our article for more information about bypass surgeries.

What Is Bypass Surgery?

Bypass surgery is a method used to deliver blood through a new vessel to the area supplied by a blocked or partially blocked artery in the heart. Coronary artery bypass surgery does not eliminate the arterial hardening disease that causes the blockage. It prevents the area supplied by the vessel from being affected and destroyed as a result of the blockage, and by providing the adequate blood supply it needs, it eliminates the symptoms caused by the blockage. At the same time, the life-threatening risk associated with heart disease is also reduced. If other treatments given to the person are not responding, it can also be applied as an emergency treatment procedure. The aim of bypass surgery is to use a healthy vessel taken from another site to replace the closed coronary artery. In this process, bypass procedures can be performed on one or more problematic vessels. The vessels used may be taken from regions such as the leg, arm or chest.

How Is Bypass Surgery Performed?

Bypass surgery is performed in two different ways. Depending on the method used to reach the heart, it can be performed using two different techniques called the open technique and the closed technique. The first of these methods, also described as the OPEN TECHNIQUE, involves reaching the heart by cutting and opening the sternum, the large bone at the front of the chest. The second method, known as CLOSED HEART BYPASS, can be performed by reaching the heart through an incision of approximately 4 cm on the left side of the chest, between two ribs. Heart bypass can be performed with or without stopping the heart. In 90% of patients and in 98% of clinics worldwide, bypass surgery is performed with the heart stopped, as this is accepted to allow for a more precise vessel anastomosis. In cases where stopping the heart poses a risk, bypass surgery can be performed without stopping the heart. Heart bypass is performed by connecting the heart to a heart bypass machine. The function of the heart is taken over by the heart-lung machine. Once the bypass procedure is completed, the function of the heart-lung machine is discontinued. The new vessels used during heart bypass can be harvested from the chest, arm and leg, either by open technique or endoscopically.

Can Bypass and Valve Surgery Be Performed at the Same Time?

It is possible to perform heart valve surgery together with bypass surgery, but this can only be done through the open technique. Combined valve and coronary bypass surgery is not performed through the closed technique. However, this procedure must be carried out by a team of experts in the field. It should also not be forgotten that performing these two procedures together is a higher-risk operation. In such cases, all of the person's risk factors are evaluated by the heart team, consisting of surgeons and cardiologists, and the planning is carried out accordingly.

How Long Does Bypass Surgery Take?

This surgery typically takes about 3–6 hours, depending on the number of arteries (blood vessels) that need to be operated on. In some cases, this process can extend to around 8 hours. The duration varies according to the number of vessels to be treated. Another factor that changes the duration is whether the open or closed technique is chosen for the procedure.

Open Bypass Surgery

For open bypass surgery, the heart is first reached by cutting the sternum, the bone located at the front of the chest. The aim of bypass is to deliver blood beyond the blocked section of the diseased vessel of the heart, using healthy vessels taken from other parts of the body. One end of the healthy vessel is connected to the large aorta, and the other end is connected to the healthy segment beyond the narrowed part of the diseased vessel. This connection can be performed with or without stopping the heart. If the heart is stopped, a bypass machine is used to keep the blood vessels circulating. In the other method, the bypass procedure is performed without stopping the heart.

Closed Bypass Surgery (Minimally Invasive)

In this method, the chest is not opened as in open bypass surgery. The heart is reached between two ribs through a small incision of 4–5 cm at the level of the left breast. Since the heart is accessed between the ribs through this incision, no bone needs to be cut. During this procedure, the bypass is again performed with the heart stopped. In a limited number of closed cases, closed coronary bypass can also be performed without stopping the heart. The vessel from the leg is harvested endoscopically using a camera.

Who Is Bypass Surgery Performed On?

The arteries that supply the heart are called coronary arteries. In the coronary arteries, arterial hardening, meaning the calcification of vessels, leads to narrowing of the vessel lumen and, as the process continues, to blockage. The development of narrowing and blockage in the coronary arteries is defined as coronary artery disease. For this reason, bypass surgery is a procedure that can be performed on patients diagnosed with coronary heart disease. This is because coronary heart disease causes the walls of the blood vessels that carry blood to the heart, namely the coronary arteries, to become blocked or narrowed. This condition obstructs blood flow. When blood flow is obstructed, the heart muscle cannot receive sufficient blood, which can cause chest pain, and complete blockage can result in a heart attack. Therefore, if a person has a vessel blockage or narrowing of the vessels, this blockage must be relieved. The blockage is relieved either by bypass or by stenting. Placing a stent inside the vessel to keep small vessels open may be a solution. When angioplasty with stent placement, a simpler procedure, is not sufficient, bypass surgery is considered as the solution. In addition, bypass surgery is also considered when there are blockages in multiple vessels.

Why Is Bypass Surgery Performed?

All organs of the body are nourished by blood coming from the heart, and this blood is delivered to the organs through the blood vessels. The arteries that supply the heart are two major arterial systems called the left and right coronary arteries. Over time, these two vascular systems may accumulate fat depending on age, the person's genetic and familial predisposition to disease, and additional factors such as cigarette smoking, excessive weight or obesity, and a high-fat diet. These accumulated fats harden and calcify, which can close part or all of the vessel's diameter in certain areas of the vessel. In this case, blood cannot reach the tissues of the heart and serious, life-threatening problems arise. To eliminate or prevent this risk, bypass surgeries are performed. Bypass surgery is especially preferred when the person has the following problems:

• Severe narrowing of the main coronary artery
• Blockage in the left main coronary artery
• Severe chest pain caused by narrowing of multiple coronary arteries
• Impaired function of the lower left chambers of the heart
• Coronary artery blockage not treated with coronary angioplasty

What Should Be Considered After Bypass Surgery?

After surgery, the person may be kept under observation in the hospital for about one week. However, there is first an intensive care process lasting several days. After surgery, attention is generally paid first to whether the person can sit in a chair, then whether they can walk, and finally whether they can go up and down stairs. Once the person can perform these activities and has no health problems, discharge takes place. After this process, various medications are prescribed to the person at discharge. Regular use of these medications is important. Within about 1.5 months after discharge, the person begins to return to normal life, and full recovery may take up to 3 months on average. However, the opening of the vessels after surgery does not mean that the risks have been completely eliminated. If the person does not pay attention to nutrition, does not perform sufficient physical activity, or continues unhealthy habits, coronary heart disease may recur. It should not be forgotten that bypass surgeries do not cure heart disease. This surgery is a good option for patients for whom results could not be obtained with methods such as angiography. The surgery is performed to eliminate the life-threatening risks caused by heart disease, and after surgery the person must keep heart disease under control through lifestyle changes, prescribed medications and other necessary precautions.

Things to Pay Attention To

• Consuming foods that do not adversely affect heart health
• Reaching a healthy weight
• Staying away from stress
• Getting adequate sleep
• Staying away from cigarettes
• Being active during the day
• Avoiding alcohol consumption

Pain After Bypass

Bypass surgeries, whether open or closed, are serious procedures. It is normal for various changes to occur in the body after this procedure. For this reason, pain may occur at the wound site in the early postoperative period, on the first day. A doctor prescribes medication to relieve this pain. In patients who have been discharged, there may be temporary pain that is insignificant and not disturbing; however, if the pain increases, becomes unexpected, or occurs together with bleeding, it is essential to consult a healthcare facility.

Which Vessels Are Used for Bypass?

During bypass, the new vessel used to ensure blood flow is obtained from various points in the body. For this purpose, vessels of the chest, arm and leg are used. Which vessel should be used is decided according to the person's medical history and needs.

IMA (Internal Mammary Artery): When a single bypass is applied to a patient, the IMA is considered the gold standard. The internal mammary artery, that is, the artery located in the chest, is connected to the left anterior descending artery, and the procedure is carried out. However, this method cannot be applied to persons with severe lung disease, those who have previously undergone chest surgery, and patients over 85 years of age.

Radial Artery: The radial artery is located in the arm, and in this procedure the artery within the arm is used as the vessel. When a radial artery graft is used, the patency period of the vessel is longer for individuals and the risk of heart attack is reduced. At the same time, because it is longer and thicker, it can make the procedure easier.

Saphenous Vein: When more than one bypass graft is required in a person, the procedure is performed using the saphenous vein from the leg. The saphenous vein is a vein located in the legs. It enables the vessel taken from the leg to be harvested endoscopically.

Although bypass surgeries eliminate the problems caused by the existing blockage, they are not a permanent solution. The permanence of this surgery is possible through changes in lifestyle. The person who has undergone surgery must absolutely eat, take medications and be physically active under expert supervision. This treatment gains permanence thanks to many factors, ranging from psychological well-being to nutrition.

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