Patient information

Cardiac Revascularisation

Ever since the first operation performed in 1967, the commonly known Bypass operation has saved thousands of lives and has improved the quality of life of many more thousands of people. In the United Kingdom nearly 24,000 bypass operations are performed each year. This operation, known as Coronary Artery Bypass Grafting, is performed in the treatment of angina.
 
Fat deposition within the arteries of the heart causes narrowing and eventually blocking of the arteries of the heart. The reduced blood supply to the heart muscle causes chest pain (angina) usually on exertion and causes heart attack when the artery is totally blocked. The risk factors for this condition include a strong family history of heart attacks, high blood cholesterol level, diabetes, high blood pressure and smoking. Once diagnosed, the condition is treated by controlling cholesterol, diabetes and high blood pressure. Drugs like nitrates, beta blockers and calcium channel blockers help in relieving the angina. Stopping smoking is very important for immediate and long term results.

A simple test called a Coronary Angiogram, done in an awake patient, shows the presence of narrowing in the arteries of the heart. For minor narrowing only, drug treatment is recommended along with preventive measures. If the narrowing of the arteries in the heart is severe and/or the chest pain is not controlled by drugs, patients are advised to undergo intervention in the form of balloon dilatation of the narrowing (angioplasty or P.T.C.A.), when feasible, or otherwise bypass surgery is recommended. The operation is done to relieve chest pain, to improve quality of life and sometimes as a life saving procedure.

In the commonly performed bypass operation the surgeon bypasses the narrowing in the heart artery by connecting a new artery or vein beyond the narrowing thereby restoring the blood supply to the heart muscle. This is done by using arteries from the chest and arm and veins from the legs. In very simple terms, it is like plumbing and very fine suturing techniques are used. The heart is commonly stopped to facilitate the operation and for this a Heart Lung machine is used. The operation is done under General Anaesthesia and takes about three to four hours. The patient stays in intensive care for one or two days and is usually ready to go home in less than a week. The results are very good with an early death risk of under 2%. It is very important to reduce cholesterol, control diabetes and blood pressure and stop smoking for long term good results.

The recent past has seen a number of new innovations and techniques. A now well-established technique is Beating Heart Bypass Grafting where the operation is performed without stopping the heart. This technique was done in the early days for patients requiring only one or two bypass grafts and in the front of the heart. With improvement in surgical devices, it is now possible to operate on many more patients using the beating heart technique. The advantages of this include avoiding the heart lung machine, reducing the need for blood transfusion and stroke risk. Recovery is said to be quicker and also better results are achieved in higher risk patients such as the elderly.
 
Use of arteries from the chest and arms, particularly in younger patients has shown to give better results in the long term. Second time bypass operations are also well established.
 
With the development of keyhole surgery in other surgical fields, heart surgery also has developed techniques to do operations through small incisions. Using a video camera, it is now possible to operate through small cuts under the breast. Bypass operations in selected patients and heart valve surgery can be done by this method. The recovery time is quicker and the cosmetic results are good, especially in women, completely hiding the scar. Naturally not all patients are suitable for this kind of surgery.
 
Heart surgery has also taken up computer guided robotic techniques. A computer controlled robotic arm is passed through a small keyhole incision and the surgeon can sit in another room to operate on the patient. This is not yet common and is still limited to a very few centres but the number is growing.

Surgical techniques for heart failure and heart rhythm disorders have also developed very well to complement the more commonly performed bypass and heart valve operations.