When is heart surgery needed?
For narrowing of the coronary arteries, the doctor assesses whether heart surgery is necessary. A stent treatment is usually performed if the constrictions are not very severe. The doctor opts for bypass surgery in the following cases:
- There are severe constrictions in several places
- The left main coronary artery is severely narrowed
- Open heart surgery is already needed for another reason, such as valve surgery
- Using a stent is not possible
Open heart surgery
A bypass operation is an open heart surgery. The surgeon opens the sternum so that the heart is freely accessible. This way the surgeon can see and reach the coronary arteries. This is a significant operation, and it results in a large wound.
Sometimes it is possible to perform the operation through one or more small openings. This is a minimally invasive operation. It is also called a keyhole operation.
There are different ways to perform a bypass operation. The technology used depends, among other things, on:
- number of bypass
- location of the bypass
- patient’s health situation
To be able to perform a bypass, the doctor usually has to stop the heart partially. This is possible with a heart-lung machine that keeps the patient alive.
By default, a bypass operation is an open heart surgery. Sometimes the surgeon can opt for a slightly less invasive surgery: a keyhole operation. A keyhole operation is an operation through a small opening between the ribs.
Use of own artery and veins in heart surgery
Blood vessels from the patient’s own body are used for the bypass. With multiple bypasses, a combination of arteries and veins is used. There is no usable plastic bypass yet.
- Use of arteries – The surgeon usually uses a chest wall artery because it gives the best results. Because this artery is close to the heart, it is most suitable. The chest wall artery is detached on one side. The surgeon then attaches the detached end to the coronary artery beyond the narrowing. It is also possible that the surgeon uses an artery around the stomach, but that is rare.
- Use of veins from legs – When using veins from the legs, 2 methods can be used.
- Using two small incisions below and above the vein that must be removed. The surgeon uses a camera and a special device to inspect the branches of the vein.
- Through an extended cut of 30 – 60 cm in the lower leg. This is not so common anymore.
Usually, arteries from the chest give better results than the veins from the leg. Arteries are more resistant to higher blood pressure and therefore remain open longer. The leg veins are necessary, when there are many bypass heart surgery or when not enough arteries are usable. The lifespan of a bypass depends on many factors, for example:
- Which blood vessels have been used
- For which coronary artery they are used
- Condition of blood vessels
The most common problem is the occurrence of narrowing in the bypass themselves. Arterial calcification is not removed with a bypass operation. And arterial calcification is the cause of closing in the coronary arteries. The chance of new congestion is made as small as possible. This is done by taking the prescribed medication and a healthy lifestyle.
Little chance of complications in heart surgery
A bypass operation is a relatively safe operation with a high probability of success. A bypass operation is only performed when the benefits outweigh the expected disadvantages. Advantages are better health, fewer complaints and better quality of life. Possible complications include:
- Postoperative bleeding
- Cardiac arrhythmias: most common in the first days after heart surgery
- Not closing the breastbone properly – In most heart surgeries, the sternum is opened lengthwise during the operation. At the end of the operation, the two halves of the breastbone are again firmly attached to each other with stainless steel wires.
Most complications can be treated well. They often occur in the hospital. Then doctors can intervene quickly and professionally. The risk of death is small.
The best heart surgeon in India
When it comes to heart surgery there is certainly no lack of good talent in India. To help you find the most talented doctors here is a list –
- Dr. Devi Prasad Shetty at Narayana Hrudalaya, Bangalore
- Dr. Naresh Trehan at Medanta, The Medicity, Gurgaon
- Dr.Nagaradona Sreedhar Reddy at Krishna Institute of Medical Sciences, Secunderabad
- Dr. TS Kler at Escorts Heart Institute & Research Center, New Delhi
- Dr. Dhiren Shah at CIMS Hospital, Ahmedabad