Bypass operations:

Bypass operations:

Also known as coronary artery bypass graft (CABG), bypass operations are surgical procedures that are done to rectify a blocked or obstructed coronary artery in order to restore normal blood flow. A coronary artery supplies blood from and to the heart. People suffering from coronary artery disease (See: Coronary Artery Disease) and ventricular dysfunction experience angina (a chest pain caused due to reduced blood supply to the heart). This is due to the buildup of plaque and fatty deposits, which obstructs the blood flow to the heart. A major cause for the buildup of plaque, calcium, and fatty deposits is due to arteriosclerosis, and atherosclerosis. A bypass operation is advised when the patient does not exhibit satisfactory responses to medications. The objective of the operation is to reduce the risk of ventricular dysfunction and death. A bypass operation is suggested to patients who have artery blockages from 50% to 90%. The concept of a bypass operation is to bypass the obstructed artery and use a harvested vein from the leg. The harvested vein is attached to the heart so that there is free flow of the blood. Bypass operation can be single, double, triple, quadruple, and quintuple depending upon the number of coronary arteries bypassed. However, coronary arteries that are present inside the heart, less 1.5 mm, and heavily calcified are not suitable for bypass operation. Prior to the surgery, a coronary angiogram is performed in order to identify and assess the number of obstructions and the extent of the obstructions. The number of bypass grafts needed and the exact location for the bypass graft attachment is decided before the surgery. The location and the number of bypass grafts might be changed after surgeons examine the heart directly. During surgery, the patient is given general anesthesia. The heart is stopped and the patient is put on a cardiopulmonary bypass (a heart-lung machine). The most common procedure used is LIMA to LAD. In this procedure, the left internal mammary artery (LIMA) is used to bypass left anterior artery (LAD). This is a proven method and a highly successful procedure for surgical revascularization. LIMA to LAD is the gold standard for coronary artery bypass graft procedures. In other procedures, arteries from the forearm and veins from the leg are harvested. This is done in a keyhole surgical procedure. In the past, bypass operations used to be open-heart, but with new technologies CABG is now minimally invasive. A bypass operation has both risks and benefits. The risks include the risk of bleeding, heart rhythm issues, and risk of blood clots, renal failure, difficulty thinking, and post-pericardiotomy syndrome. It also does not prevent myocardial infarction (heart attack). The benefits include improved blood circulation, better quality of life, reduced angina symptoms, improved longevity, and reduced risk of complications. People with diabetes tend to have higher LDL levels along with higher triglyceride levels. Moreover, they have an inflammatory condition where higher blood sugar levels causes irritation in the blood vessels leading to inflammatory response. The body tends to heal this condition by formation of plaques in order to form a sort of bandage to the irritated area. As such people with diabetes are at an increased risk of atherosclerosis and plaque burden. Added inflammation and plaque break down leads to plaque rupture leading to cardiovascular events. These necessitate a bypass surgery. People with diabetes who undergo bypass operation for severe left ventricular dysfunction are generally known to have poor outcomes. Some of the risk factors include postoperative wound infection of the sternum, and renal failure. Many people with diabetes who undergo bypass operation have to undergo re-hospitalization due to infections, cardiac problems and arrhythmias.

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