CABG Surgery - BPR, Problems
CABG - bypass vs Keyhole and Angioplasty
About CABG Procedure - FAQ
To perform the surgery, a surgeon will make an incision in your breastbone, typically 2 to 5 inches long, separating the muscles to provide access to your heart.
Heart Stopped. You will be hooked up to a heart-lung machine during a bypass procedure. This machine continues to push blood through your body so that your doctor can stop your heart from beating to perform the surgery.
Close chest and restart heart. Your surgeon will close your breastbone with special sternal wires and your incision with special internal and/or external stitches. The surgeon will use electrical shocks to restart your heart, and you will be removed from the heart-lung bypass machine.
- ICU care
you will have several tubes remaining in your body, possibly including one down your throat. The Norton Heart Care says typically, those may include pacing wires and a chest tube to drain fluid, as well as a temporary pacemaker. You'll be in the ICU when you waken, or possibly in a special cardiology ICU. You'll be in there one to two days after the surgery and you will stay in the hospital, in a usual situation, three to eight days after the surgery.
Post Op Care
When you get home, it will usually take 6 to 8 weeks to recover from the surgery, and the doctor and hospital will continue to counsel you on diet, exercise, It’s often recommended that you enroll in a cardiac rehab program
Depression is Common Some people report heightened emotions for up to a year after surgery, including a tendency to cry, reports WebMD. The Cleveland Clinic said it is common for patients to feel depressed after heart surgery, with about 20 percent of CABG patients experiencing major depression.
"In one landmark study, the continued presence of depression after recovery increased the risk of death (mortality) to 17 percent within six months after a heart attack (versus 3 percent mortality in heart attack patients who didn't have depression)," reports The Cleveland Clinic.
Be aware of the possibility and communicate with healthcare providers because early detection can help tremendously. Depression also can significantly slow recovery and healing.
National Institutes of Health, one study found about 80 percent of patients who had CABG were angina-free five years after surgery.
The number of open heart surgeries performed since 2008 has actually decreased as many less invasive procedures have arisen that offer less trauma for the patient than actually cutting open his or her chest.
Consumer Reports carry ratings on the procedures. See if your hospital and/or surgeon is listed there or with the Society of Thoracic Surgeons to learn about the number of procedures performed and any outcome statistics. It may make a difference in your choice of provider.
Causes of Post CABG mortality
Old Theory May Explain Mystery of Deaths After Heart Bypass By GINA KOLATA December 18, 1990 http://www.nytimes.com/1990/12/18/health/theory-may-explain-mystery-of-deaths-after-heart-bypass.html
EVERY year, about 10,000 people who had bypass surgery to correct clogged coronary arteries die of heart attacks. All too often, these heart attacks are mysteries.
"A lot of time, it is not completely understood why these people are having heart attacks," said Dr. Timothy Fischell, a cardiologist at Stanford University Medical Center. "They should be better off rather than worse off." In 70 percent of the cases, Dr. Fischell added, the vein or artery graft used to bypass the clogged blood vessel looks perfectly fine.
The problem also occurs in patients who have balloon angioplasty, in which an expandable device is used to open blocked vessels. Theory Is Proposed
Now Dr. Fischell and his colleagues have proposed an explanation for these mysterious heart attacks. Their theory has intrigued other cardiologists even as it has raised controversy.
They suggest that one cause of heart attacks after bypass surgery or balloon angioplasty is that the coronary arteries themselves are trying to recreate the sort of blood flow they were used to when the artery was clogged. Before the operation, only a trickle of blood got past the blockage, and so the blood pressure downstream from the occlusion was very low. Dr. Fischell and his colleagues believe that coronary arteries can clamp down after bypass surgery or balloon angioplasty to try to create the same sort of blood pressure just past the previously occluded areas.
The findings were published in a recent issue of The Journal of Clinical Investigation.
"It's fascinating and it makes physiologic sense," said Dr. Henry Buchwald, a heart disease researcher and professor of surgery at the University of Minnesota.
Researchers have known for years that arteries are far from being passive tubes like garden hoses. Instead, they are rimmed with muscle cells that can twitch, squeeze down and relax to make the arteries wider or narrower. Coronary arteries are known to sometimes go into spasms, which can starve the heart of blood and cause chest pains and even heart attacks. But cardiologists had not thought that previously blocked arteries might clamp down because they remembered their old blood flow situation and thought it normal.
Dr. Fischell first proposed the hypothesis two years ago when he examined a man who had a severe heart attack shortly after having had bypass surgery. The surgeons had bypassed two blocked arteries, one that was nearly completely clogged and the other that was about 50 percent constricted.
To find out what was going on, Dr. Fischell said he put a dye in the man's arteries so he could observe them in X-rays. He saw that the artery that had once been almost completely blocked had squeezed itself down to prevent blood from getting past the site of the previous occlusion. Dr. Fischell opened up the artery by giving the man nitroglycerin, which forced the artery to unclench.
Now Dr. Fischell has garnered further evidence for his hypothesis by studying 20 people who were about to have balloon angioplasty, a procedure in which a small balloon is inflated in a clogged artery to squash the plaque down and open the blood vessel. The patients had varying degrees of blockage and Dr. Fischell and his colleagues predicted that the arteries that had been blocked the most would constrict the most after the procedure and those that had been blocked the least would constrict the least.
The researchers measured the blood pressure downstream from each patient's blockage. Then they opened the arteries with angioplasty. They waited 30 minutes, then measured the blood pressure downstream again. The investigators found that the patients' arteries did constrict and that the arteries that had been most occluded clamped down hardest, confirming their predictions.
None of these patients had constrictions severe enough to cause heart attacks, so doctors cannot say whether such constriction might be the cause of most heart attacks after bypass surgery or angioplasty.
Dr. Fischell believes they are and recommends that patients be given nitroglycerin for a few weeks after surgery to keep their arteries open while they relearn what is a normal blood pressure downstream. Some Are Skeptical
Others are not entirely convinced.
Dr. Jeffrey Isner, chief of cardiovascular research at Tufts University Medical School in Boston, said, "The quality of the clinical investigation is really outstanding," but he said he and others were not sure that the sorts of spasms Dr. Fischell had documented were clinically significant.
But, Dr. Isner said, even if the observation does not explain all heart attacks after bypass surgery or angioplasty, it could still be crucially important to cardiologists once they understand the implications of what is happening.