During operation your surgeon constructs a new passage for blood which bypasses the obstruction and sends blood to the normal blood vessel beyond the site of maximal obstruction. The original blocked vessel is not interfered with. For making this bypass, usually he will use the internal mammary artery from within the chest wall. The removal of the internal mammary artery from the chest wall does not change the blood flow to the chest. Sometimes an artery from the forearm, the radial artery may be used or a vein from the leg may be used.
Internal Mammary Artery
Now a days a lot of times your surgeon may choose to do the bypass operation using a heart stabiliser called “OCTOPUS”. The bypass operation remains the same. The only difference is that with the help of the stabiliser the surgeon can perform the grafting procedure without having to stop the heart and put the patient on heart-lung bypass. With this technique the recovery of the patient is quicker, the complication and risks are lower and also the cost is less. Recently a new model 6f octopus called Octopus IV has become available. Also a new accessory called the STARFISH has become available. This is used in addition to the octopus to improve stabilisation of the heart. Now a days a lot of times your surgeon may choose to do the bypass operation using a heart stabiliser called “OCTOPUS”. The bypass operation remains the same. The only difference is that with the help of the stabiliser the surgeon can perform the grafting procedure without having to stop the heart and put the patient on heart-lung bypass. With this technique the recovery of the patient is quicker, the complication and risks are lower and also the cost is less. Recently a new model 6f octopus called Octopus IV has become available. Also a new accessory called the STARFISH has become available. This is used in addition to the octopus to improve stabilisation of the heart.A few other stabilisation devices are also likely to become available in the near future.
Getting admitted to the Hospital
- You will be admitted to hospital one two days before the operation. You will be reviewed by your sugeon and the anaesthetist and their assistants.
- Please inform them about all the medications you have been taking.
- Please let them know about any drug allergies however minor, any surgery or hospitalization in the past. It is always safe to carry all your previous medical records along.
- If you are a smoker please do stop smoking.
- Please do not have any jewellery on your person.
- You will be undergoing some blood tests and breathing tests before sugery.
- Breathing exercises and incentive spirometery will be started. Please follow these exercises as they will help you in early recovery.
- Some light sedative will be prescribed to you by your anesthesiologist to allay your anxiety and for peaceful sleep.
- Please brush your teeth and use an antiseptic mouth wash on the night before and morning of the surgery. An antiseptic soap bath at night and on the morning of the surgery will be advised.
- Your nurse will give you a small injection and some medicines to be taken before surgery. These will make you slightly drowsy so please stay in bed until you are wheeled into the 0. T.
In the O.T. you will be greeted by your anaesthetist who will give you a local anaesthetic on your forearm to pass a catheter in your vein and artery painlessly. You will then be put to sleep. Your surgery will last for 3 to 4 hours. You will be shifted to the ICCU after surgery. The main operation lasts 3 hour. However, Anaesthesia and preparation before the operation and closure and dressing also take time. Total operation time can be five to six hous.
After the Operation
- You will be in ICCU (Surgical Intensive Care Unit) for 3 days.
- You will be comfortable during your stay in ICCU.
- There will be a tube in your mouth. Because of this you not be able to speak. However the nurses and doctors will be able to understand you from their vast experience of managing ICCU patients.
- Please do not try to speak while there is a tube in your mouth.
- You will feel thirsty. For this, we cannot 3’ive you water, but we can wet your lips. Also, glucose will be given to you through intravenous bottle.
- There will be 3 to 4 drainage tubes on the side of your chest. They will come out in one or two days. Do not worry about them.
- You will feel a little pain particularly when moving or when coughing. If it is too much request the nurse to give you an injection, and the pain will be relieved.
- After three days in I.C.U. you will be able to go back to your room.
- You will be able to walk freely in the ward and corridor, while you are in the room.
- You will be able to go home by the seventh post operative day. Before you go home you should request the physiotherapist to help you. to climb stairs (one flight)
- Please co-operate with the physiotherapist who come comes for Breathing exercises.
- Most patients have a poor appetite after operation because of the antibiotics and medicines. In two or three days this will recover.
In the ICCU
In the ICCU you will be looked after by a highly competent and. dedicated team consisting of cardiac surgeon, cardiac anaesthetist, intensivists, cardiac nurses, respiratory therapist, physiotherapist, to help you towards a speedy recovery. You will be attached to a few tubes that will provide nutrition, oxygen and life saving medicines. Your ICCU stay would be around 3 to 4 days. By the 3rd day you may be able to Set out of bed and walk around with the help of an attendant. As soon as you can walk around on your own and carry out your daily activity with the help of an attendant, you will be shifted to your own room or ward in the hospital.
Out of the ICCU
You will feel euphoric once you are shifted to the room in company of your loved ones. It is common to feel a little depressed after sometime and also tired and weak. This is common to all patients so do not think something has gone wrong. Remember time and nature are the best healers. It is essential to continue all your exercises, medications and above all good rest during this time. Visits by well-wishers should be brief.
Post Surgical Care
As you prepare to go home there are several questions in your mind. The following pages attempt to explain most of your questions. However if you desire to clear any other queries please feel free to do so. This is a generalized overview, and individual patients may want to ask specific questions which we are pleased to answer
To gain access to the heart, the surgeon has to go through the breast bone which is the thick bone in front of the heart. The bone is wired together and takes about six weeks to heal. While this healing process is on, the patient is likely to feel muscular pains and aches in the chest, the shoulders and the back. During this time the patient is advised to take painkillers. It is important to take enough painkillers to be able to move freely and to cough without too much pain, as deep breathing and coughing help to quicken recovery.
What painkillers may I use?
Paracetamol is indeed a very strong painkiller. A 70 kg man may need upto two tablets three to four times a day. Brufen 400 mg three times a day is also helpful to get rid of pain.
Care of your incisions
The best treatment of your incisions is gentle cleaning with soap and water. One of the kinder soaps like Lux is ideal. If your , skin is too dry, you may use a soap like Pears, which has glycerine in it. Avoid Gentle bathing in tap or warm water is ideal. The first time that you are having a bath after the operation, please seat yourself on a comfortable stool, keep the door open and have someone stand by and help you. Bathing can be quite strenuous and may tire you and make you feel dizzy. Minor problems with the leg incision Itching, particularly along the back of the skin incision. Small amounts of yellow discharge. Mild redness of the skin. Mild swelling of the ankles. Occasionally the skin may become dry and flaky. A soft cream like nivea will help. Do not put any other creams, ointments or powders as they have no benefit. They may actually cause harm by allowing resistant bacteria to flourish.
How long must I wear elastic stockings?
The usual advice is to wear elastic stockings for about six weeks after the operation. If, however, you have a past history of arterial disease, stockings should not be worn. It is best to wear stockings all day while walking around, and to take them off at night while sleeping.
Why do I need aspirin?
Aspirin is needed because it reduces the clotting ability of blood and thus keeps your arteries free of clot. If you are allergic to aspirin or you have had a stomach ulcer or asthma, your doctor needs to be told. For antiplatelet activity, one junior aspirin (75 mg) taken every other day is as effective as a larger dose.
What other medication will I need after the operation?
If you are diabetic/you will need antidiabetic tablets or injections. If you have high blood pressure, you may need tablets for high blood pressure even after the operation. There are many types of blood pressure tablets that are now available. Your doctor therefore has a variety of choices. If any one of these does not suit you, please tell your doctor, he can change it. This is better than self medication or no medication.
Cholesterol Lowering tablets
If your cholesterol level is high, you may be advised cholesterol lowering tablets. Cholesterol is of two types': good cholesterol and bad cholesterol. Fortunately, today tablets are available that can increase good cholesterol and reduce bad cholesterol.
You may be put on a water tablet after the operation to help your body lose excess water These tablets may need to be continued for varying periods of time and your doctor would review them at each visit.
If you are on antibiotics, please do not discontinue them on your own. Hease get yourself reviewed every four to six days to make sure if you need them any longer.