Emergency No.
Emergency No.
There are several coronary arteries which deliver oxygen and nutrients to the heart's own tissue. These coronary arteries can become blocked by a buildup of cholesterol fats, often referred to as "plaque". Plaque deposits can make the arteries stiff and irregular. This is called atherosclerosis, or "hardening of the arteries". There can be a single blockage or multiple blockages, and they can vary in severity and location. Any narrowing, or blockage, of the coronary arteries reduces the blood supply to the heart tissue, therefore reducing the amount of oxygen and nutrients delivered. This inhibits the normal function of the heart muscle.
Coronary Artery Bypass Grafting (CABG), or bypass surgery, is a surgical operation in which the surgeon uses a section of vein, usually from the patient's leg, or an artery from inside the patient's chest, to create a new route for oxygen-rich blood to reach the heart muscle. The most commonly used vessels are the internal mammary arteries, which are inside the chest wall, or the greater saphenous veins, which are in the leg. These vessels are "spares." Blood flow is usually not affected by removing them. Less often, the radial artery in the arm may be used for a graft.
One end of the vein or artery is connected to the coronary artery that is blocked or narrowed beyond the blockage or narrowed area. The other end of the vein is connected to the aorta. Usually the other end of the artery is left connected to the main artery from which it branches. By creating this new conduit for blood flow to the heart muscle, the graft is said to "bypass" the narrowed or blocked section of the coronary artery in question. Depending on the number and location of blockages, between one and seven bypasses are performed.
Almost all bypass operations at out institute are done “off pump”, which means operating on a beating heart. Heart-lung machine is avoided which means less morbidity to the patient.
One of greatest challenges in minimally invasive bypass surgery is the difficulty of suturing or “sewing” on a beating heart. If the surgeon chooses to operate on a beating heart, a stabilization system is used to steady only the portion of the heart where the surgeon is operating. A stabilization system avoids use of the heart-lung machine by making it possible for the surgeon to carefully work on the patient’s heart while it continues to beat.
Beating heart bypass surgery is believed to have the same beneficial results as conventional bypass surgery—restoring adequate blood flow and normal delivery of oxygen and nutrients to the heart. Beating heart bypass surgery, however, has additional advantages.
Shorter length of stay :
Patients may experience less pain and may have a better ability to cough and breathe deeply after the operation so they are often discharged from the hospital in 2 to 3 days, compared to the typical 5 to 10 days for conventional CABG surgery.
Faster recovery :
Avoidance of the heart-lung machine and the use of smaller incisions may reduce the risks of complications such as stroke and renal failure so that patients can return to their normal activities in 2 weeks rather than the typical 6 to 8 weeks with conventional surgery.
Less bleeding and blood trauma :
Any time blood is removed from the body and put into heart-lung machine, the patient must be put on anti-clotting medications or given “blood products”. Artificial circuits such as the heart-lung machine can also damage blood cells. These factors may affect the blood’s ability to clot after surgery. Avoiding the heart-lung machine can alleviate this blood trauma.
Lower infection rate:
A smaller incision means less exposure and handling of tissue, which may reduce the chances of infection.
Available to more patients :
Some patients are poor candidates for traditional bypass surgery because their illness is too widespread, their heart is too weak, or because they will not accept blood products. Some patients are able to receive this life-saving surgery through minimally invasive techniques.
Less cost :
The cost of minimally invasive cardiac surgery may be less than the cost of conventional surgery.