Coronary artery bypass surgery is done for patients with coronary artery disease, and one can think of it really as fancy or sophisticated plumbing. What we do is begin by making an incision in the breast bone and sawing through that breast bone, much as you would open a three-ring binder, so to speak, and at the end of the procedure, the breast bone is rewired together, and brought back together in a sturdy manner.
But the technical aspects the important aspects of the surgery is that tubes or conduits, arteries and veins, are used to go around the blockages from upstream to downstream. This procedure does not deal with the specific blockage in the artery. It, specifically, what it does is it deals with that blockage and any future blockages that a patient might have. So, we go from upstream good, open blood supply to the more downstream side of a blood vessel using these tubes that we harvest either minimally invasively from the leg a vein or an artery that runs along a patient's chest wall.
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Probably, the most important thing to know for all of us about bypass surgery is that it is the only therapy that has ever been demonstrated to prolong life expectancy for patients with multi-vessel disease or single-vessel disease who have poor heart function. So, it's critically important to understand what the indications are for this procedure.
The entire procedure, the technical aspects of sewing new blood vessels to the heart, takes usually less than an hour, but the entire operation will take three to four hours because there is preparation time, opening the patient's breastbone, and harvesting the artery and the veins from the legs, and then making sure that everything is closed up properly at the end of the procedure.
After surgery, most people feel better and might remain symptom-free for as long as 10 to 15 years. Over time, however, it's possible that other arteries or even the new graft used in the bypass will become clogged, requiring another bypass or angioplasty.
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Ninety percent of a group of 1,324 patients operated on between 1972 and 1984 survived five years after surgery, according to one study, and 74 percent survived 10 years. That number has remained relatively stable ever since. In fact, the survival rate for bypass patients who make it through the first month after the operation is close to that of the population in general. But 8-10 years after a heart bypass operation, mortality increases by 60-80 percent.
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When you wake up from heart bypass surgery, you’ll have a tube in your mouth. You may also feel pain or have side effects from the procedure, including:
You’ll likely be in the ICU for one to two days so your vital signs can be monitored. Once you’re stable, you’ll be moved to another room. Be prepared to stay in the hospital for several days.
Before you leave the hospital, your medical team will give you instructions on how to care for yourself, including:
Even without complications, recovery from heart bypass surgery can take 6 to 12 weeks. That’s the least amount of time it takes for your breastbone to heal.
During this time, you should avoid heavy exertion. Follow your doctor’s orders regarding physical activity. Also, you shouldn’t drive until you get approval from your doctor.
Your doctor will likely recommend cardiac rehabilitation. This will involve a regimen of carefully monitored physical activity and occasional stress tests to see how your heart is healing.
After you have been discharged from hospital, you may experience some side effects as a result of the operation. These can include:
It's natural to feel a bit low after having bypass surgery. You'll experience good and bad days, but it's important to remember your recovery will take weeks rather than days.
Side effects tend to disappear within four to six weeks of the operation. A full recovery may take a few months or longer, depending on your overall health before the procedure.
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Trim the fat and cholesterol from your diet. When you eat fatty foods, some of the fat flows through your bloodstream, where it can stick to the walls of your blood vessels. Eventually it builds up and forms a hard, sticky plaque, which clogs blood vessels the reason you had bypass surgery. To keep blood vessels clear after bypass surgery, avoid foods high in fat and cholesterol, such as whole milk, cheese, cream, ice cream, butter, high-fat meats, egg yolks, baked desserts, and any foods that are fried.
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Your recovery will begin in the hospital's intensive care unit (ICU) and typically will continue in another area of the hospital for three to five days before you go home. Once you have been discharged from the hospital, recovery typically takes six weeks or more. You'll usually need to stay in hospital for around 7 days.
Twenty-year survival by age was 55%, 38%, 22%, and 11% for age <50, 50 to 59, 60 to 69, and >70 years at the time of initial surgery. Survival at 20 years after surgery with and without hypertension was 27% and 41%, respectively. Similarly, 20-year survival was 37% and 29% for men and women.
The good news is that recent decades have seen a steep drop in serious complications. Today, more than 95 percent of people who undergo coronary bypass surgery do not experience serious complications, and the risk of death immediately after the procedure is only 1–2 percent.