Bypass surgery is a surgical procedure performed when the coronary arteries that supply blood to the heart are blocked or narrowed. A healthy blood vessel (graft) taken from another part of the body is attached before and after the blocked vessel to create a new pathway (bridge) for blood flow. This way, the heart muscle is re-supplied with blood and receives proper nourishment.
✓What is Bypass?
Bypass is a surgical intervention performed to eliminate blockages that occur particularly in blood vessels. When insufficient oxygenated blood reaches the heart muscle, chest pain and heart attack can occur. This condition typically develops due to blockages in blood vessels. During bypass surgery, healthy blood vessels are used from the legs, chest wall, or arm. In this way, blood supply is restored to the heart, preventing potential heart problems. After the surgery, it is important for the person to eat healthily, quit smoking, and exercise regularly.
✓What is Coronary Bypass?
Coronary bypass is a surgical intervention performed on blood vessels when narrowing or blockage develops in the coronary arteries that supply the heart, allowing the heart that cannot be adequately nourished and cannot perform its normal functions to work healthily again. This is quite important, as it prevents the risk of heart attack in the person. In coronary bypass operations, generally three or more blood vessels are intervened upon. Although the duration of surgeries varies depending on the number of blood vessels that will undergo bypass and additional procedures to be performed, it averages 4 hours.
✓In Which Diseases is Bypass Applied?
Bypass is performed because it has been decided in cardiovascular examinations that the treatment of the problem detected in the heart cannot be sufficiently or possibly done with methods such as medication or angioplasty. Bypass can be performed in cases of multiple vessel disease, those with severe narrowing in the vessels that supply the left ventricle of the heart, in the presence of significant narrowing in the main coronary vessel supplying the left heart, in individuals where balloon or stent procedures are insufficient, and in cases where there is another heart condition that needs to be corrected surgically along with narrowing in the vessels supplying the heart.
✓How Many Hours Does Bypass Surgery Take?
Bypass surgery generally can take between 3 to 6 hours. However, the duration of bypass performed can vary depending on the number of blocked vessels. Additionally, it may vary depending on the patient's general health status and chronic diseases.
✓What Are the Risks of Bypass Surgery?
Bypass surgery is a procedure that involves eliminating blockages in the heart's blood vessels. This procedure is generally applicable to those with coronary disease. Like any surgical intervention, bypass surgery also has certain risks. It can cause complications such as infection, bleeding, clot formation, heart rhythm disorders, and temporary problems in organ functions. Additionally, after bypass surgery, wound healing difficulties and long-term changes in heart functions may be experienced.
✓The risks of bypass surgery can be listed as follows
✓Infection
✓Bleeding
✓Clot formation
✓Rhythm disorders
✓Temporary problems in organs such as the kidneys or liver
✓Delayed wound healing
✓How is Bypass Applied?
The most classic way to reach the heart is through the method where the breastbone (sternum) is opened from the middle. In some special methods, the length and location of these incisions vary. Some valve and ASD surgeries can be performed with a 5-6 cm incision (window). The blood flow to the internal mammary artery taken from the chest comes from the vessel going to the arm, while the upper ends of other free vessels (radial artery and saphenous vein) are sutured to the aorta. Thus, through a new blood vessel (bypass graft), blood flow carrying energy and oxygen to the heart muscle in the area with narrowing or blockage is provided.
✓The number of bypass vessels performed during surgery varies between 1 and 6. Generally, 2-4 vessels undergo bypass. The blood vessels used by the surgeon during the operation are vessels present in the patient's own body that do not leave a deficiency where they are taken from. In these surgeries, in order of priority, we prefer the internal mammary artery taken from the chest, then the radial artery taken from the arm, and finally the saphenous vein taken from the leg. However, the blood vessel to be used can change depending on the location and severity of the narrowing in the vessel where bypass is to be performed. Sometimes for that target, the saphenous vein may be the best option. In advanced age, chronic lung disease, and in obese patients, the internal mammary artery may sometimes not be usable. The arm vessel is also generally not used in advanced age, in diabetic patients using insulin, and in patients with chronic kidney disease unless absolutely necessary. The final selection of vessels to be used will be made by the surgeon during the operation.
Full recovery after bypass surgery usually takes 6 to 8 weeks. Hospital stay is 7-10 days in open surgery, and 2-5 days in minimally invasive methods. Home rest, healing of the sternum, and medication compliance are the most critical stages of this period.
Hospital and First Days
Intensive Care: Usually lasts 1-2 days, with weaning from the ventilator and initial follow-up.
Room and Mobilization: The patient is helped to their feet shortly and begins light walking.
Discharge: Patients with stable health conditions are discharged home within 4 to 10 days depending on the type of surgery.
Rules to Follow at Home
Sleeping Position: For the first 6 weeks, the patient should sleep on their back for sternum healing.
Wound Care: Incision sites should be kept clean and dry, and signs of infection (redness, discharge, fever) should be monitored.
Supports: A chest brace and compression stockings (if recommended by the doctor) should be used regularly.
Heavy Lifting: Heavy objects should not be lifted for the first 6-8 weeks, and arms should not be strained excessively.
Return to Social and Work Life
Walking: Daily short walks are encouraged to increase fitness.
Work: Return to desk work is possible after 6-8 weeks, and to physically demanding work after approximately 3 months.
Sexual Activity: Generally, normal activity can resume from the 6th week onward with doctor's approval.
What are Bypass prices?
Bypass prices are determined based on which surgical method will be used (classical, minimally invasive or robotic surgery) and the hospital and team where the operation will be performed.
Who can be candidates for Coronary Bypass?
Following cardiac examinations, individuals who have been determined that the problem detected in their heart cannot be adequately or possibly treated with methods such as medication or stent placement can be candidates for coronary bypass. Coronary Bypass is one of the safest and best treatment methods.
How to prepare for Coronary Bypass surgery?
Once all examinations are completed and surgery is deemed necessary, Bypass preparations will begin. The operating room coordinator will add the patient's name to the surgical list according to the urgency of the patient's condition. Most cardiac surgery patients do not require emergency admission. However, if a patient waiting for surgery experiences a negative situation, they should inform the cardiologist, surgeon, or operating room coordinator. Sometimes the surgery appointment may be postponed by a few days due to emergency patients who arrive in between and intensive care bed availability. The operating room coordinator will provide information about the hospital admission date and what needs to be done beforehand. Generally, except in special cases, patients are admitted to the hospital one day before surgery. Here, the cardiologist, cardiovascular surgeon, and several doctors from the surgical team review the examinations performed and complete any deficiencies in the patient's preparation. For example, in some special cases, consultations from neurology, nephrology (kidney), diabetes, and lung diseases may be necessary. Any infection or cavities in the patient's gums is very important as they can cause a general infection after surgery. Before valve surgeries, and in coronary bypass surgeries if deemed necessary by the surgical team, the patient must be examined by a dentist.
Is Bypass performed on a beating heart?
It is applicable but not every patient undergoes this method. During beating heart bypass surgery, special techniques are used and only the movements of the heart region to be operated on are reduced. During this time, the heart continues to pump blood to both the body and itself and maintains the functions necessary for life. "Open heart surgeries" in which a heart-lung pump is used and the heart is temporarily stopped and taken out of circulation are safely performed today, and some possible risks to patients are minimized with precautions taken. With beating heart bypass, risks such as consciousness disturbances, behavioral changes, kidney insufficiency, elevated liver enzymes, and decreased stomach and intestinal movements are kept to a minimum level. Beating heart bypass provides beneficial and successful results when applied in patients with severely reduced heart contraction function who cannot tolerate a heart-lung pump, in those who have previously suffered a stroke or transient ischemic attack (mini-stroke), in those with advanced kidney insufficiency, in those with chronic lung disease, in patients being treated for or who have been treated for cancer, and in patients aged 70 and above.
What are the advantages of Coronary Bypass?
When narrowing in the coronary arteries exceeds a certain level, it obstructs blood flow, which prevents the heart from performing its function. Coronary bypass in this context eliminates chest pain and prevents possible heart attacks. With coronary bypass, negative habits are abandoned, and taking a step toward a healthier and better quality of life is among the advantages of the surgery. One of the advantages of coronary bypass is that existing arterial stiffness is eliminated. Coronary bypass allows blood that is not supplied by the narrowed or blocked vessel to nourish the heart muscle.
What are the disadvantages of Coronary Bypass?
Coronary heart diseases are among the most common causes of death. However, with technological advances, improved equipment, and experienced surgical teams, the disadvantages of coronary bypass have been eliminated. Coronary bypass surgeries can be performed with or without stopping the heart. Both techniques have different advantages and disadvantages. All advantages and disadvantages are explained by the doctor. Since not every patient undergoes the same technique, disadvantages and advantages vary from patient to patient.
Is Coronary Bypass painful?
Like all surgeries, coronary bypass can cause pain. However, pain is minimized with pain relievers given during and after surgery. If pain occurs, the nurse and doctor caring for the patient should be informed.
Is Coronary Bypass safe?
Before surgery, all body functions are evaluated through examinations. The cardiologist, physiotherapist, cardiovascular surgeon, anesthesiologist, intensive care physician, and intensive care nurse care for the patient. Coronary bypass surgeries performed with technology, equipment, and an experienced team are among the safest surgeries.