Asian Heart Institute

Bypass Surgery
Navigate your way to a Healthy Heart
What is a bypass surgery?
Imagine traveling by road and getting stuck in a traffic jam. To
'bypass' the jam, you take another route and join the same road
back again. That's exactly what takes place in a CABG (Coronary
Artery Bypass Graft surgery) or commonly known as bypass
surgery.
Coronary Artery Bypass Grafting (CABG) is a surgical procedure
done to create a 'bypass' around the blocked part of a coronary
artery (blood vessels that supply blood to the heart) to restore
blood supply to the heart muscle. The bypass is made with the
help of blood vessels (known as grafts taken from the other parts
of the body (leg, hand, chest wall, etc.)
Why and when is a bypass done?
When one or more of the coronary arteries becomes partially or
totally blocked, the heart does not get adequate blood supply.
This is called an ischemic heart disease or Coronary Artery
Disease (CAD). It can cause heart pain (angina) or a heart attack
(myocardial infarction).
CABG is one of the treatment options for ischemic heart
disease. Bypass surgery is advised for:
1.

Disease of the left main coronary artery

2.
Significant, multiple blockages in all three main vessels of
the heart
3.

Failure of angioplasty

4.
When the efficiency of the left ventricle is reduced to less
than adequate.

How is the surgery done?

1) Before the surgery
Once the patient has been diagnosed with a triple vessel
disease and has been advised to undergo a bypass surgery he
has to plan accordingly.For a bypass surgery a stay in the
hospital of approximately 10 days is expected with a recovery
time of a month after the surgery to get back to the normal
routine.
The patient is generally put on blood thinners after being
diagnosed with a triple vessel disease. So before the surgery
the patient is expected to stop blood thinners 5 days prior.
The patient plans with his surgeon or assistant doctors to
surgeons and comes for pre-operative investigations.
These are important as the surgery would not be carried out
unless the patient is found to be fit to undergo surgery.
This is important to avoid complications during surgery and to
ensure a smooth recovery.
With any deviation in the parameters the patient is treated for
the same before being taken for the surgery.

The pre-operative investigations include the following:

Blood tests: includes CBC, Serological tests, blood
grouping, blood sugars,
Urine tests: creatinine, electrolytes
Chest x-ray
Ultra sonography
Carotid and radial Doppler studies
2D Echo
CT angiography of the internal mammary arteries
Sputum and nasal swabs to check for any active infections
in the body
Lung function tests

a) Preparing the patient:

On the day of surgery the patient is given medicines to
reduce anxiety and then rolled into the Operation
Theatre (OT)
Electrodes connected to ECG monitor are attached to
the patients back to monitor the hearts activity during
the operation
Intravenous lines are then inserted into the veins of the
wrist or arm for administration of medicines and salt
solutions
One IV line is threaded up the vein all the way to the
vena cava ( the biggest vessel that carries impure
blood from all the parts of the body to the heart) to
allow administration of medication directly to the heart.
A Foleys catheter is inserted into the patients bladder
for collection of the urine. Urine output helps to
determine the functioning of the kidney.
After the initial preparation the patient is anaesthetized
by an anesthetist who then carefully monitors the
patients vital signs throughout the operation.

 After the patient is anesthetized , a tube is inserted into

the windpipe which is connected to a respirator that
performs the work of breathing.
Another naso-gastric ( which goes from nose to the
stomach) is inserted through the nose to collect
stomach fluids.
b) Surgery:
For the surgery, first the chest is cut open at the mid
line of the breast bone ( sternum) and the sternum is
separated.
Then the internal mammary artery to be used for the
surgery is separated from the chest wall gently.
Then the surgeon will work on the patients limbs to
remove the vein or the artery.
After this the grafting of the conduits is done.
After several hours of grafting the chest closure is done
in layers.
The patient is then shifted to the ICU
In a traditional bypass surgery, the heart is stopped after
connecting to the heart long machine, which adds oxygen to the
blood and circulates it to the other parts of the body during
surgery. This is necessary because the heart muscle must be
stopped before the grafting can be done.
However, in a beating heart surgery the heart lung machine is
not used and the surgery is performed on a beating heart. This
method is know as an Off-Pump Coronary Artery Bypass surgery
(OPCAB) or beating heart surgery.
It allows the bypass to be created while the heart is still beating
by using a device known as 'octopus'. The advantage is a quicker
recovery, fewer complications and better long term outcome,

especially in elderly patients and in patients with problems like

kidney failure, previous brain strokes, etc. Asian Heart Institute is
one of the few centers in the world that specializes in this type of
surgery, performing nearly 100% of its bypass surgeries on a
beating heart with a very significant percentage using total
arterial grafting.
c) stay in the ICU:
The patient stays in the ICU for 3-4 days depending
upon his clinical condition after which he is shifted to
the wards.
In the ICU the vitals are carefully monitored as it is the
most critical stage after surgery.
Redo bypass surgery
A second or redo bypass surgery is needed if blockages develop
after the first surgery. It is complex and risky because after
surgery, the heart and lungs stick to the breast bone. A beating
heart surgery using arterial grafts reduces the risk of a redo
bypass surgery. At Asian Heart Institute redo bypass surgery is
also performed 'Off-Pump', thereby suggesting the competence of
the team.
Re-redo bypass surgery
Owing to the complications, a third bypass surgery is very rare.
Frequently Asked Questions After Bypass Surgery
1.

When can I drive on my own?

It is wise to wait for 2 months after surgery, before driving on

your own. This is the amount of time it takes for the healing of
your sternum (breast bone), which was cut open during surgery.

Any chance injury, can cause damage if driving is started too

early. Please consult with your surgical team before undertaking
any activity after a bypass.
2.

Can I travel by car?

Yes. You may travel by car as soon as you are discharged.

However, for the first few weeks, it is advisable to restrict your
travel to less than two hours. If the drive is going to be longer,
then take a break every two hours and walk around for a few
minutes.
3.

Should I speak less?

There is no reason for you to 'speak less' after surgery. However,

during the first few days of your recovery, you might feel short of
breath while speaking for a long period of time. If so, your body
is telling you to rest, and your may keep silent for some time.
4.

Will eating curd or watermelon affect the

stitches and slow down the healing of the breast bone?

No. Eating curd or watermelon has no effect on your stitches and

healing process.
5.

When can I start climbing the staircase?

If there is an elevator, there is no need to climb stairs just for the

sake of exercising. If you do not have an elevator and have to
take the staircase, you can do so as soon as you are discharged.
While climbing, pace yourself. Take a minute's rest after climbing
10-12 steps during the first week after discharge. As your walking
capacity increases, there is no restriction on climbing steps, as
long as you do not run out of breath.
6.

When can I go back to work?

It is advisable to wait for at least 2 months after surgery before

returning to work. However, depending on the condition of your
heart, you may be able to start light work after a month. Please
consult with your doctor before returning back to work.
7.

What about the blockages in the arteries, will they remain?

The blockages which are present is the arteries remain as they

were. The 'graft' which provides the 'new blood supply' is
connected below your old blockages, thereby providing adequate
blood to the heart muscle.
8.

After my surgery, why do I still feel pain in my chest?

To perform your surgery, your chest-bone was cut open and

stitched together after surgery. It is quite normal to feel some
pain or altered sensations in your chest region for a few months
after surgery. However, this pain will be different from the pain of
'angina' which you might have experienced before surgery.

9.

What are the restrictions after CABG?

For the first three months avoid swimming, driving, sex, breath
holding exercises and yoga. This is because your heart is at time
irritable and sensitive. It may lead to irregular heart beat and
could be risky for you.
The AHI Advantage
The latest trend in healthcare is to have lesser invasive surgeries,
i.e. surgeries which involve minimal cuts & ensure that patient
has a faster recovery. Keyhole or Minimally Invasive Surgery
(MIS) is a modern innovative surgical technique that reduces the
patient's post-surgery distress & allows them to return back to
their normal life in just a couple of days. In Minimally Invasive

Surgery (MIS) is a modern innovative surgical technique that

reduces the patient's post-surgery distress & allows them to
return back to their normal life in just a couple of days. In
Minimally Invasive Surgery, surgeons operate through tiny
incisions with the help of long instruments and HD cameras. The
AHI team is one of the leading experts in Minimally Invasive
Bypass Surgery in India. The team has pioneered the LESS
(Lower End Sternum Split) technique which entails only a two
three inch incision in the chest in order to carry out a coronary
artery bypass surgery, thereby enabling patients to be discharged
within 2-3 days. The LESS is advantageous for patients requiring
less number of grafts. Depending on your condition your surgeon
will decide whether you can undergo surgery through LESS
technique.

Recovery/ Prognosis:
Recovery from the surgery takes time. The patient who has
received a CABG can expect considerable relief from symptoms
and in many cases, increase life span. It should be remembered
however that the graft vessels are subject to fatty blockage at
any increased rate, so care must still be taken to reduce the risk
factors that cause the original blockage.

You can do many things to reduce the risk factors like:

Not smoking
Regular exercising
Control of vitals like Blood Pressure, sugar levels, cholesterol
levels etc
Rectification of other clinical conditions if any
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