FAQs - ON HEART SURGERY

Bypass surgery is based on multiple factors such as the patient’s symptoms, the coronary anatomy, the type and degree of the blockage, the financial status whether the patient could afford the surgery and his psychological state. He also talks about how to manage mild to moderate blockages with the help of medical therapy. And patients who have a disease which can be corrected by angioplasty then it is a preferable option over bypass surgery.

In earlier times, bypass surgery was done as an open-heart procedure which had a lot of disadvantages. Owing to the disadvantages and whole-body inflammatory response, minimally invasive surgery was introduced to avoid the use of a heart-lung machine. He describes different forms of minimally invasive surgeries used currently and which help to avoid pulmonary complications, deep wound infections and disadvantages that were caused due to Open Heart, Bypass Surgery.

Any surgery in which the sternum is not slit in the center and is approached towards the heart using a small lateral thoracotomy or the anterior thoracotomy is also called the MIDCAB operation. These types of surgeries are called sternal sparing minimally invasive surgeries and can be done for single vessel coronary artery disease.

Bypass is a major surgery and it has both serious as well minor complications. The complication rates depend upon retrospective or prospective clinical studies. Serious complications include stroke, deep sternal wound infection or life-threatening tachyarrhythmias. Temporary complications such as superficial infections, lung infections, and pleural effusion can be managed with conservative treatment.

Normally, a person can drive from the very next day of the bypass surgery as there won’t be any problem with the functioning of his heart but the problem is of safety. The patient has to swirl while driving and this can pull his pectoral muscle leading to severe sternum pain. Driving is not recommended for at least 4 – 6 weeks after the bypass surgery.

Bypass surgery can be performed multiple times. In this video, Dr.O.P. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, will talk about how many times we can undergo bypass surgery. Second time bypass has become a very standard procedure nowadays. As many of the patients are operated in the late 60’s and 70’s so the need for a second bypass surgery arises. There is no specific limit of times that a person can undergo bypass surgery. But with each number of surgeries, the risk also goes on increasing.

Whenever a bypass surgery is done, only arterial conduits are used which is then known as total arterial myocardial revascularization. It can be performed using various configurations. Free grafts, in situ grafts, single grafts or sequential grafts are used in bypass surgery. In sequential grafts, one conduit can be used to bypass two arteries. Dr. Yadava will also describe that a free graft can be attached to a pedicle graft and can-do T or Y configuration of total arterial revascularization known as T or Y grafts.

Robotic bypass heart surgeries are a type of minimally invasive heart surgery. Robots were introduced to perform robotic bypass surgery with equal human dexterity. Robotic surgery has advantages over open heart bypass surgery. Fourth-generation robots and how robotic surgery is gaining attraction. Also, the new arms of the robots have received good feedback and have become feasible in cardiac robotic surgery.

In this video, Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, tells when the bypass surgery is done along with angiography. This type of surgery is known as hybrid cardiac surgery.

The results of total arterial bypass surgery are mostly superior to venous revascularization. Almost 10 – 15 % of the venous grafts are blocked by the end of one year. Whereas the patency rates of arterial grafts are high even at 10 – 20 years. Total arterial bypass surgery revascularization is done when a patient is young but it also depends upon various factors.

In this video, Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, talks about the advantages and complications of redo bypass surgery. Currently, redo bypass surgery is technically demanding.

Dr. Yadava tells us that there is no age limit for bypass surgery. With new techniques introduced, bypass surgery can be done in elderly patients.

In this video, Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, talks about bypass surgery in low ejection fraction. The results of the bypass surgery are not very good if the heart is damaged.

After the bypass surgery, the viable myocardium recovers but the non-viable myocardium does not recover leading to ventricular dilatation and remodeling. Surgical remodeling is superior to medical therapy and improves the patient.

In this video, Dr.O.P. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi tells us that technically the cardiac transplant is not a difficult operation. The main issues are the logistic problems in organ donation, preservation and ongoing follow-ups post-transplant.

In this video, Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, talks about the long-term results of cardiac transplants. The results of this transplant surgery are improving.

In this video, Dr.O.P. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, talks about the person who has undergone bypass surgery, as when he can enjoy his married life.

In this video, Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, tells us about when a person can return to work after bypass surgery. The patient can start with simple chores at home and get back to their normal desk job within four weeks.

It depends upon the control of risk factors with lifestyle modifications, following the medical treatment properly. It also depends upon how well the surgeon has done his job. He told that if arterial revascularization has been given then the results are for the long term and if veins are used then the chances of failure are higher. Hence, he says that control of blood pressure, lipids, control of diabetes status and weight control is very essential. Also, the patients should be involved in physical activities for long-term benefit after bypass surgery.

With arterial graft, the results are for 20 years. The patency and results of these grafts also depend on the control of risk factors. Quitting smoking, regular physical activities and control of diet will prolong the efficacy of these grafts.

During the first year, in various studies, it is shown that bypass surgery does not reduce the total incidence of a heart attack. It only reduces the incidences of fatal heart attacks but overall heart attacks are not reduced.

The reason behind it is that the side branches, the microcirculation, each coronary arteries branches 10 – 14 times before it becomes a capillary, all these are not bypassed. The cholesterol can also clog in major arteries as well as microcirculation. Even after bypass surgery, there are certain areas that continue to be ischemic. If the graft has failed, then 3% of patients might get a heart attack within a year.

The results are seen in both the short term as well long term. In the short term, it is seen that diabetes is a systemic disease and so is atherosclerosis. Cholesterol gets deposited in the arteries of the heart, also in the arteries of the brain, kidneys or other vasculature. Thus, in these patients, there is multisystem involvement with increased chances of renal failure, CVA or wound infections in diabetes. These patients spend longer time in the hospital with higher mortality and morbidity. Long term results in terms of survival. Graft patency rates are lower in diabetics as compared to non-diabetics. In such patients, aggressive treatment is required for glycemic control.

Bypass can be done with renal artery stenosis, if the coronary anatomy is not critical. Renal artery stenting can be done before the bypass surgery to restore the kidney blood supply. The condition if the coronary artery is critical or the patient gets unstable angina. In such cases, first CABG should be done with certain precautions. He will discuss these precautions to be taken in critical patients. Also, avoid using nephrotoxic drugs in such patients.

Bypass surgery can be done with coronary artery intervention which is also called simultaneous procedure. Dr. Yadava will explain the procedure with different models which are used. He will also talk about the advantages and disadvantages of the methods used. The simultaneous method is the best option for this type of surgery but the patient has to be selected carefully. The patient should be symptomatic and carotid stenosis should be significant.

In this video, Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, Will discuss whether bypass surgery can be done with peripheral artery intervention. He tells us that bypass surgery can be done with peripheral artery intervention. It reduces hospitalization and is cost-effective. It can also be done under the same anaesthesia. Dr. Yadava will also explain the pros and cons of the intervention. Normally coronary bypass is done and the patient is allowed to recover. 4 – 6 weeks is generally recommended for recovery and then peripheral artery intervention is done. If the limb is threatened then both interventions are done under the same anaesthesia.

In this video, Dr. OP. Yadava, Chief Executive Officer & Chief Cardiac Surgeon, National Heart Institute, New Delhi, Will talk about how long to continue aspirin. Dr. Yadava tells us that aspirin has to be continued lifelong.

If the non-cardiac surgery is of emergent nature, it can be done at any time without any problem. There are no such contraindications for doing non-cardiac surgery immediately after bypass surgery. He further told that the problem arises when the patient has elective cardiac surgery. In such patients, it is recommended that the patient should recover which is generally 4 – 6 weeks and then the non-cardiac surgery is scheduled. He will also talk about the consequences if we stop the anti-platelets treatment for non-cardiac surgery and what can be done.

The current recommendations for dual antiplatelet therapy are from 6 – 12 months. There are no adequate data available that suggests continuing the dual antiplatelet treatment beyond 12 months. Ideally, after a year one antiplatelet therapy should be stopped and continue with the other antiplatelet for life.

The standard natural phases of venous grafts are three phases of occlusion: immediate which might be due to technical fault, fibro-endothelial hyperplasia might occur in 1 % of patients after a month. And the last phase is atherosclerosis which happens over one year and can block the coronary artery as well the graft. Overall, approximately 50 % of the venous grafts might get blocked over 10 years.