What is Bypass surgery? When do we need it?

Coronary Artery Disease (CAD)

Coronary arteries surround the heart and maintain cardiac muscle. There 3 coronary artery systems. Aorta (main artery) nurtures coronary arteries.

Coronary Artery Disease (CAD) occurs with stenosis or embolism of arteries which feeds myocardium and named “coronary arteries”. This stenosis or embolism of arteries block blood flow partially or entirely which leads to CAD.

Coronary artery disease is a leading cause of death in Turkey. Unfortunately, 200 thousand people die from CAD in a year in our country. The most important aspect of CAD is that, it is likely to cause myocard infarctus in the advancing period of the disease.

CAD is generally seen in people who are over 40. Men found 4 times more likely than women to have CAD. Women’s estrogen hormones play a protective role for the disease. Therefore, frequency of the disease increases during the postmenopausal period.This disease is seen mostly seen in men ranging in age from 50 to 60 and in women from 60 to 70.

To know the risk factors of the disease and take protective measures is as essential as the treatment. Main reason of CAD is atherosclerosis which means vessel stiffness. The lipid named “cholesterol” is found generally in animal source food and it decreases the elasticity of vessels when over consumed. It is accumulated on vessel walls and straitens vessel cavity. This stiffness and blockage of vessel is called “atherosclerosis”.

1- What is bypass surgery?”

Arterials which we call “Coronary artery” bring the blood that a heart need. There may be stiffness and blockage in time and because of this, heart cannot be nourished and function sufficiently. These patients may suffer from thoracic pain and heart attack. Coronary Bypass Surgery is to place new veins instead of congested ones.

2- How does Bypass Surgery performed?

Bypass Surgeries are performed both through open or closed heart surgery methods. Bypass on a beating heart was very popular previously whereas nowadays it is only performed on occasional cases. More commonly, surgeons prefer open heart surgery method in which heart is stopped and the body circulation is continued with the help of cardiopulmonary pump and surgeons “bypass” (bridging) to the blocked veins. Arteries from leg, arm or chest may be used for this purpose.

Pieces of arteries taken from body are used in place of aorta for bridging and this provides enough blood flow to these areas.

3- Is it healthy to use other veins of the body for the heart?

Functionally, these veins that are used in place of aortas work as a part of the redundant system and to use these veins for cardiac does not constitute any risk for their functioning.

4- How risky is bypass surgery?

There are different risk factors for bypass surgery such as:

• Age
• Gender
• Existing vascular diseases
• Additional cardiac valve disease
• Functional loss except vascular disorder

5- When do patients need Bypass Surgery?

Bypass operation;

When plural coronary arteries cannot be opened with non-surgical (balloon-stent) methods,

When a single or more veins are previously treated with surgical methods yet there is still vascular occlusion,

It should be performed when there are single or more coronary artery disease in cases where valve surgery is needed.

6- Recovery After Bypass Surgery

After these kind of surgeries people should considerably change their previous life styles. Eating and drinking habits, drug use, travel program, sports activities and daily life style should be planned according to doctor’s suggestions.

7- Is it important to follow a diet after bypass surgery?

The patient should reorganize his drinking and eating habits and adapt himself to diet which are protective for cardiac. Patients are suggested to work with diet and nutrition experts for their meal plan.

8- Does it cause trauma?

Many patients tolerate post-op period of bypass surgery whereas in some cases bypass surgeries cause psychological problems. Psychological support should be received if needed.

9- Does Bypass Surgery effects sexual life of the patient?

These kinds of operations obviously effect sexual life. Whereas, as these patients are generally old age adults, so this eases the situation. Young patients on the other hand should avoid medications which intensify the case. Besides, certain medications that are used in the treatment of “erectile disfunction” should be avoided as they are highly risky for the cardiac patients.

Risk Factors in Coronary Artery Disease

Risk Factors that cannot be changed

• Age (Men for over 45 years and women over 55 years-postmenopausal period-)
• Gender (mostly seen in men)
• Genetics
• Preventable risk factors
• Smoking
• Hypertension (blood pressure over 140/90 mmHg)
• Diabetes
• Stress
• High cholesterol level
• Other risk factors
• Obesity, being overweight
• Sedentary life style
• Gout disease
• Excessive use of alcohol and coffee
• Hypercalcemia
• Use of birth control pills (oral contraceptive)
• Quit smoking.
• Reduce consuming alcohol and coffee
• Regulate high cholesterol
• Walk in the open air
• Protect your ideal weight
• Control hypertension and diabetes with medication if necessary
• Keep away from stress

How to protect from Coronary Artery Disease?

What are the symptoms of Coronary Artery Disease?

• In the early stages of the disease there are probably no symptoms.
• Chest pain (effecting left arm and shoulder). This pain is usually related to exercise when climbing stairs for example or it may appear after meals on the chest bone usually it spreads to arm and chin. It usually disappears in 5-10 min after resting.
• Getting exhausted quickly
• Shortness of breath comes with effort
• Syncope (fainting)
• Sudden death

Remember that sometimes coronary artery diseases are asymptomatic, or the first symptom can be myocard infarctus.

Treatment of Coronary Artery Disease

Coronary Artery Diseases can be treated with medication, bypass surgery or percutaneous interventions (balloon, stent). The method will be decided by the surgeon according to patient’s examination results.

Myocard Infarctus (Heart Attack)

When a tight coronary artery is blocked completely, tissues of cardiac muscles in the related region die. In Myocard Infarctus pain is more intense and long. It is not about psychical exercises. This infarct effects heart’s pumping function in a bad way so the heart can’t pump enough blood and as a result cardiac insufficiency may occur. Also, Myocard Infarctus may endanger patients’ lives. To avoid these stages of the disease, early diagnosis is highly crucial.

Coronary Bypass Surgery

Coronary Artery Bypass Surgery is to constitute vein bridges that are taken from other regions of the body for the heart when coronary arteries of the heart itself is not functioning properly.

Veins that are used for coronary artery bypass surgeries:

• Leg vein (saphena)
• Artery that is feeding anterior thoracic wall (internal Mamarian Artery, IMA)
• Brachial Artery (Radial Artery)

Nowadays, thanks to modern surgery techniques and technology, patients are discharged approximately in 5 days after open heart surgeries. They return their daily lives in a short period of time. In 4-6 weeks, they are completely able to continue their normal lives including driving and sexual intercourse.

Long term results of coronary bypass surgery are successful. Many of the patient complaints such as shortness of breath or pain are stopped, and they claim that their performance regarding their job or private life is enhanced. However, rarely, some patients need the surgery once again 10 or more years after the surgery.

Coronary Artery Bypass surgeries eliminate results not causes. With this surgery changeable risk factors of patients are kept under control to avoid the risk of experiencing further problems. It is important to quit smoking, regulating high cholesterol, avoiding stress and uncontrolled diabetes to prolong new arteries’ lives. It’s also crucial to follow an appropriate diet and taking medications regularly. These precautions ameliorate long term results of the surgery.