Coronary Artery Bypass Grafting (CABG) / Heart By Pass Surgery / Open Heart Surgery

Coronary Artery Bypass Grafting (CABG) surgery is a procedure used to treat coronary artery disease in certain circumstances. Coronary artery disease (CAD) is the narrowing of the coronary arteries (the blood vessels that supply oxygen and nutrients to the heart muscle), caused by a buildup of fatty material within the walls of the arteries. This buildup causes the inside of the arteries to become narrowed, limiting the supply of oxygen-rich blood to the heart muscle.

Coronary arteries of the heart

The heart is basically a pump. The heart is made up of specialized muscle tissue, called the myocardium. The heart’s primary function is to pump blood throughout the body, so that the body’s tissues can receive oxygen and nutrients. When the heart tissue does not receive an adequate blood supply, it cannot function as well as it should. If the myocardium’s blood supply is decreased for a length of time, a condition called ischemia may develop. Ischemia can decrease the heart’s pumping ability, because the heart muscle is weakened due to a lack of oxygen.

For many years, coronary artery disease (CAD) was commonly called “hardening of the arteries” and was not easily treated. However, in the last 30 years, many advances have been made in the diagnosis and treatment of cardiac diseases.

There are 2 types of Heart By Pass Surgery in India – 

  1. On Pump Procedure
  2. Off Pump Procedure

Coronary artery bypass graft surgery (CABG) : On Pump Procedure in India

  1. In order to sew the grafts onto the very small coronary arteries, the heart must be stopped to allow the doctor to perform the very delicate procedure. Tubes will be inserted into the heart so that the blood can be pumped through your body by a cardiopulmonary bypass machine.
  2. Once the blood has been diverted into the bypass machine for pumping, the heart will be stopped by injecting it with a cold solution.
  3. When the heart has been stopped, the doctor will perform the bypass graft procedure by sewing one end of a section of vein over a tiny opening made in the aorta, and the other end over a tiny opening made in the coronary artery just below the blockage. If the internal mammary artery inside your chest is being used as a bypass graft, the lower end of the artery will be cut from inside the chest and sewn over an opening made in the coronary artery below the blockage.
  4. You may have more than one bypass graft performed, depending on how many blockages you have and where they are located. After all the grafts have been completed, the doctor will examine them to make sure they are working.
  5. Once the bypass grafts have been completed, the blood circulating through the bypass machine will be allowed back into your heart and the tubes to the machine will be removed. Your heart will be restarted.
  6. Temporary wires for pacing may be inserted into the heart. These wires can be attached to a pacemaker and your heart can be paced, if needed, during the initial recovery period.

Coronary artery bypass surgery (CAB) : Off Pump Procedure In India

  1. Once the chest has been opened, the area around the artery to be bypassed will be stabilized with a special type of instrument.
  2. The rest of the heart will continue to function and pump blood through the body.
  3. The cardiopulmonary bypass machine and the perfusionist who runs it may be kept on stand-by should the procedure need to be completed on bypass.
  4. The doctor will perform the bypass graft procedure by sewing one end of a section of vein over a tiny opening made in the aorta, and the other end over a tiny opening made in the coronary artery or internal mammary artery just below the blockage.
  5. You may have more than one bypass graft performed, depending on how many blockages you have and where they are located.
  6. Before the chest is closed, the doctor will examine the grafts to make sure they are working.

How do patients recover after Coronary Artery Bypass Surgery (CABG) surgery in India?

After the surgery, Sutures are removed from the chest prior to discharge and from the leg (if the saphenous vein is used) after 7 to 10 day. Patients are advised not to lift heavy weight or drive for the first four weeks to avoid any injury to the chest. Exercise stress testing is routinely done four to six weeks after CABG. Patients are also counseled to stop smoking, reducing weight and dietary fat, controlling blood pressure and diabetes, and lowering blood cholesterol levels.

Valve Replacement Treatment in India / Valve Replacement Surgery in India

Heart  Valve Replacement (VR )

The heart is a pump made of muscle tissue. The heart has four pumping chambers: two upper chambers, called atria, and two lower chambers, called ventricles. To keep the blood flowing forward during its journey through the heart, there are valves between each of the heart’s pumping chambers.

  • Tricuspid valve. Located between the right atrium and the right ventricle
  • Pulmonary valve. Located between the right ventricle and the pulmonary artery
  • Mitral valve. Located between the left atrium and the left ventricle
  • Aortic valve. Located between the left ventricle and the aorta

Heart Valve Replacement (VR) surgery be done when valves are damaged or diseased and do not work the way they should. Conditions that may cause heart valve dysfunction are valve stenosis (stiffness) and valve regurgitation (leaky valve).

When one (or more) valve(s) becomes stenotic (stiff), the heart must work harder to pump the blood through the valve. Some reasons why heart valves become narrow and stiff include infection (such as rheumatic fever or staphylococcus infections) and aging. If one or more valves become leaky, blood leaks backwards, which means less blood is pumped in the right direction. Based on your symptoms and the overall condition of your heart, your health care provider may decide that the diseased valve(s) needs to be surgically repaired or replaced.

What are the Causes of Valve Replacement (VR)?

  • Valve Stenosis: valve does not open fully, it will obstruct the flow of blood
  • Valve Incompetence: valve does not close properly, it will allow blood to leak backwards.

Treatment for Valve Replacement (VR) Surgery In India – Aortic Valve Replacement Surgery / Mitral Valve Replacement Surgery / Tricuspid Valve Replacement Surgery / Pulmonary Valve Replacement Surgery 

Traditional Heart Valve Surgery in India

During traditional heart Valve Replacement (VR) surgery, a surgeon will make an incision down the center of your sternum (breastbone) to get direct access to your heart. The surgeon then repairs or replaces your abnormal heart valve or valves. While this approach remains in use, today most patients with isolated valve disease can be treated with minimally invasive techniques.

Minimally invasive heart valve surgery in India (The modern procedure)

Minimally invasive surgery is a type of surgery performed through smaller incisions.         This type of surgery reduces blood loss, trauma, and length of hospital stay. Heart Valve Replacement (VR) surgery is the most common minimally invasive procedure. Your surgeon will review your diagnostic tests prior to your surgery to see if your are a candidate for minimally invasive Valve Replacement (VR)  surgery.

The Ross Procedure for Valve Replacement in India

This specialized aortic Valve Replacement (VR) surgery is used most often with children and adults under age 35. The procedure involves replacing the patient’s diseased aortic valve with the patient’s own pulmonary valve, called an autograft. Then the surgeon replaces the pulmonary valve with a homograft pulmonary valve. That is, a pulmonary valve from a human donor. Compared to traditional valve replacement using manufactured prosthetic valves, the Ross Procedure is most beneficial for young people and active older patients: The pulmonary valve lasts longer than prosthetic valves, which tend to fail after a few years in younger patients.