Bypass Surgery

By now you have been told you have blockages in your coronary arteries and you need to meet a heart surgeon.  I completely understand the overwhelming feeling.  What is going to happen? What are the risks? How long do I need to be out or work? And so many other questions.
Here is a basic talk I have with my patients when they come and visit me for a consult:

So there is not much more I can tell you about your heart than you already know.  You have coronary artery disease. What it means is the arteries which supply blood to your heart have blockages.  The reason for developing those blockages can be several but these can be divided into 2 broad categories: environmental or genetics reasons.  Environmental reasons include things that you can control, for example smoking, bad eating habits, and not exercising.  Genetic reasons are conditions which may have been passed along from one family member to you.  Mainly from your parents, or an immediate family member, who passed the condition onto you.  Such is the case of many patients suffering of coronary artery disease. Usually you can recall of a family member who suffered or died of a heart attack.

The next question is commonly what to do about it?  I typically answer there are 4 choices to consider.  The first is not do anything.  Remember, if you don't want to do anything that's fine except what we know is people who have coronary artery disease who go untreated can except a shorter life span because of the disease if they compare themselves to treated individuals.  Thus the advantage of doing something is not only to take away the symptoms, but also make you live longer.  
A second alternative is medical therapy in the form of pills.  While medicines are good in alleviating symptoms these cannot take the blockages away.  There is not a magic pill which will dissolve the blockages.  Those blockages stay for the rest of your life.  So to some degree medicines are aimed as to taking away or making your symptoms better. These alone may not prolong your life.
A third alternative are balloons or stents.  These are quite effective in opening obstructed vessels.  But believe me, you wouldn't be seeing a cardiac surgeon if that could have been done.  The majority of interventional cardiologist, and surgeons, understand and know the appropriate criteria for stents.  We wouldn't offer surgery if stents hadn't been considered first.
The final alternative is surgery.  Surgery compared to all of the above is probably the best long term alternative. It can provide symptom relief (quality of life), and prolong someone's life (quantity) for years, even decades.  But the advantages of surgery have to be weighed against the risks.  For patients who have a normal functioning heart and have little, or no additional, diseases which may complicate surgery the risk of dying because of open heart surgery can be calculated to be less than 2 %.  In some cases the risk can be as low as 1%.  Again, it is all dependent on how many other medical problems you have at the time surgery is being considered.
Commonly, the process of surgery takes anywhere from 5 to 6 hours. This is calculated from the time a patients enters the operating room until the time he or she arrives to the intensive care unit.  However, the surgery in itself is more than likely 1.5 hours.  
Most surgeons split the breast bone to do the procedure and take an artery from behind the chest and a vein (or veins) from the leg to perform the bypasses around the blockages.  Remember we don't take the blockages out.  We simply establish a road around the blocakage (a bypass) to get blood to the heart.  Depending on the number of arteries, or branches of arteries, blocked is how the number of bypasses patients will need.
Once the surgery is done, the patient is transferred to the intensive care unit.  Here they may spend a day.  The breathing tube typically comes out during the first 24 hours, and any catheter or chest tube inserted at the time of surgery are commonly removed.
After a day in the intensive care unit most patients get discharged to the telemetry unit where they spend 3 to 4 more days. This period of time is when we help patients transition to a more indepent phase of their care.  During this portion of the post operative period patients are helped to walk, take deep breaths, and transition from intravenous pain medications to oral ones.  
I commonly tell patients once they are able to ambulate independently, eat a regular meal, manage their pain with oral pain medicines and remain without supplemental oxygen they are ready to be discharged home.
We commonly provide an order for the patient to attend cardiac rehabilitation.  This is similar to attending a gym, and frequently it requires 3 visits a week for a period of 6 weeks.  Cardiac rehabilitation is arranged by a Case Manager, who helps the patient find a location close to home to facilitate access to the program.
A patient typically returns to the office for their post operative visits 1 week, 1 month and 3 months after their surgery as part of the regular follow up.  Patients are advised not to drive for a month after surgery or if they are taking any narcotics to ease the pain after surgery.  Most working patients return to work 3 to 5 weeks after open heart surgery as long as they do not do heavy lifting in their jobs.  
I do suggest returning to see their cardiologist during the first post operative month so that their medicines can be adjusted accordingly.

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