Heart surgery is performed on people with heart conditions. Coronary Artery Bypass Grafting (CABG) and heart valve repair or replacement are the most common types of heart surgeries. Such surgeries are carried out during times of emergencies like heart attack, or are recommended by doctors in the event of any malfunction.

Bypass surgery or CABG is a complicated procedure that the doctors only recommend when one or more arteries supplying blood get blocked. In operation, a surgeon takes blood vessels from one part of your body to bypass or go around the blocked artery. As a result, your heart is again supplied with enough oxygen and blood.

The blockage mainly arises when material in your blood called plaque builds up on the artery walls blocking blood flow. This condition is also common as atherosclerosis and can affect any of the body's arteries.

Surgeons perform bypass surgeries to construct a new path for oxygen and blood to reach the heart. Thus, it reduces the chance of undergoing a heart attack or death in some cases. This process is completed using a minimally invasive technique with few incisions.

The doctor may also recommend going through a bypass surgery when there is a severe blockage, and you cannot treat it using medications and other treatment methods.

There are two types of bypass surgery, mainly operated by doctors. These include off-pump surgery and on-pump surgery.

1. On-pump Surgery

In this surgery type, doctors use a heart-lung machine to take over the functioning of your heart. In other words, it circulates blood and carries the breathing process for the body. It also stops the heart from functioning so doctors can carry out their operations easily. The benefits of choosing this process are as below:

• Benefits -
  • Increase in the chance of revascularisation
  • Provide results in emergencies
  • Records lower rate of recurrent angina
• Survival Rate After Surgery
  • 5 years: 92.2%
  • 10 years: 82.1%

2. Off-pump Surgery

Off-pump surgery is also known as 'beating heart surgery, in which the doctors perform the surgery when your heart is still beating and does not involve a heart-lung machine to carry its function. This reduces the risk of stroke and perioperative bleeding associated with on-pump surgery. Other benefits of off-pump surgery are as follows:

• Benefits
  • Lower chances of infection or kidney complications
  • Fast recovery from surgery
  • Reduced chances of complications like memory loss or difficulty in thinking/concentrating
• Survival Rate After Surgery
  • 5 years: 93.9%
  • 10 years: 86.3%

The choice of procedure will mostly depend on your health and the risk involved.

When a doctor recommends you to go through CABG or bypass surgery, he or she also instructs you about what things you need to be prepared with.

For example, if you have time and it is not emergency surgery, the doctor will schedule you to attend various preoperative appointments. In the session, he or she will ask you about your family medical history, any health issues that you have encountered, and other related questions.

In addition to this, your doctor might also recommend you some diagnostic tests like:

• Chest X-ray
• Blood test
• Angiogram
• Electrocardiogram (ECG or EKG)

Your doctor can even perform a physical exam on you to check the condition of your cardiovascular health by looking for symptoms of shortness of breath. Medicines and other procedures that often involve controlling blood pressure, maintaining cholesterol and improving blood flow may also be tried.

The following are some of the advantages of bypass surgery, making it an effective and useful procedure to treat blocked arteries:

• Treat Multiple Blockages or Blockages in Particular Arteries: Doctors often consider CABG the best treatment option when it involves multiple blockages in arteries. It has shown positive outcomes in the past with better survival rates. The chances of recovering increase even further when doctors use the process alongside advanced bypass techniques.
• Low Follow-Up Cases: The best alternative opt by many to skip bypass surgery is angioplasty. It is a percutaneous coronary intervention. However, it holds a higher risk of requiring a follow-up procedure.
• Long History of Use: One of the most important benefits of CABG surgery is its long use history. The first procedure of bypass surgery was performed back in the 1960s. Over the decades, it has gone through many types of research, advancements, studies and follow-ups to make it a reliable and proven technique to treat heart conditions.

There are various complications involved in CABG as being a major surgery. A few risks of bypass surgery are listed below -

• Fever
• Kidney problems
• Heart rhythm problem or arrhythmia
• Blood clots leading to heart attack, stroke or lung problems
• Pain
• Memory loss
• Infection and bleeding
• Pneumonia
• Reaction to anaesthesia
• Problem in breathing

Before CABG or bypass surgery, you are expected to follow every test suggested in the preparation stage. Also, the doctors will give you certain special instructions on what medicines to take, what to eat, what not to eat or drink, and activities you may stop immediately.

You will also be asked to get admitted to the hospital from before, i.e., early in the morning on the day of surgery. However, to be safe, you must be mindful of things like:

• Stop smoking as it may create mucus in your lungs, which may affect the recovery process.
• Do not take any drugs that contain aspirin from at least 3 days before surgery.
• Avoid drinking or eating anything past midnight on the day of your surgery.
• Arrange someone trustable who can stay with you after you get discharged.
• Follow other instructions as suggested by the doctor or nurse.

During the bypass surgery, you can expect to be treated by a group of experts, which includes a cardiothoracic surgeon who will perform the surgery. In addition, there will be a physician assistant, anesthesiologist, perfusionist, nurses, and other surgeons. The process will depend on whether you are undergoing on-pump bypass surgery or off-pump.

On-Pump Bypass Surgery

This surgery type will take three to four hours or more, depending on how many arteries doctors treat.

At first, the doctors will give you anaesthesia to put you to sleep. During this time, an anesthesiologist will record your heartbeat on the monitor along with oxygen level, blood pressure and breathing rhythm. He or she will place a breathing tube and connect your lungs to a ventilator.

Next, the doctors will make an incision at the centre of your chest to open your ribcage so that surgeons can operate on your heart. Meanwhile, you will be given some medicines to enable surgeons to perform the surgery while your heart is not beating.

In this surgery, the doctors take a vein or an artery from a different part of your body, like the leg or chest and prepare it to use as a graft. However, if several bypasses need to be done, they may use several combinations of arteries and vein grafts. After the process is successful, doctors start your heart using a mild electric shock.

Lastly, the doctors disconnect the heart-lung machine from your chest and insert tubes to drain fluids.

Surgeons also use wires that stay in your chest permanently to keep the chest bone close. Also, they close the skin incision using staples and stitches. Finally, they remove the breathing tube after ensuring you can breathe independently.

Off-Pump Bypass Surgery

This is a beating heart CABG surgery to bypass any coronary artery. Here, instead of using a heart-lung machine, the surgeons perform grafting using a mechanical device to steady your heart.

It reduces complications in operation and is often helpful for those patients who already have a history of mini-strokes, have crossed the age of 70, have kidney disease, have lung disease or have diabetes.

After CABG surgery, you may have to go through three stages of recovery, including:

Recovery in Hospital

Right after the completion of your surgery, the doctors will transfer you to their hospital's intensive care unit or ICU. You must stay in the unit so you can be under the supervision of trained staff who are well experienced in meeting the specialised needs of people who have gone through CABG.

Here, when a doctor sees the patient is stable and ready for the next stage of recovery, they transfer him or her to the regular medical-surgical room. The average hospital stays doctors recommend to complete for CABG patients ranges from 8 to 12 days.

Recovery at Home

To ensure full recovery, the doctors will give a list of instructions like:

• You will be asked to look out for the signs of infection or complications
• You need to take care of your incisions to help them heal
• Also, you must know when it is urgent to call the doctor
• You also must be aware of when to go for a follow-up appointment

Remember, full recovery generally takes a time of 6 to 12 weeks, and during this period, the doctors may suggest you refrain from performing some physical activities. Meanwhile, you can also suffer after-effects of surgery, including chest pain, fatigue, muscle pain, swelling, constipation and discomfort.

Ongoing Care

After getting discharged from the hospital, you may also have to follow a cardiac rehabilitation program as post-operative care after CABG surgery recommended by the doctor. These programs help rebuild your strength and recover from the intensive procedure.

There will be highly qualified staff and trained professionals overseeing this program. These mainly include nutritionists, exercise physiologists, nurses, counsellors, dieticians, and doctors.

Make sure you share every update of your discomfort and after-effects with your doctor in the regular follow-ups. This will help him or her to point out any complications you may be experiencing.

However, if you notice any of the following side effects of bypass surgery, you may reach out to your doctor immediately:

• Rapid heartbeat
• Fever over 38-degree Celsius or 100.4-degree Fahrenheit
• Redness or unusual discharge around the incision
• Increase in chest pain 

There are less invasive procedures that you can follow as its alternatives to avoid the risks of CABG surgery. These include:

• Angioplasty: In angioplasty, surgeons will thread a deflated balloon to your coronary artery while attaching a special tube to it. Once it is in position, doctors will inflate this balloon to widen the blocked area. Often this positioning of the balloon is combined with the installation of a stent, a wire mesh which acts as a prop to open up your arteries. Another version of angioplasty is also available in which doctors use a laser instead of a balloon to remove the plague causing artery blockage.
• Enhanced External Counterpulsation (EECP) : One best alternative to bypass surgery is enhanced external counterpulsation (EECP). It is an outpatient procedure for congestive heart failure (CHF) patients. In this procedure, the doctors compress blood vessels in the lower limbs to increase the blood flow to the heart. It helps to provide extra blood to your heart which initiates the development of extra branches in certain blood vessels over time. This later becomes a sort of natural bypass.

The average cost of bypass surgery in India generally ranges from ₹ 95,000 to ₹ 4,50,000. However, this amount may vary depending on the hospital where you are carrying your surgery and the complications involved in your case.

We hope this guide might have helped you understand bypass surgery, its type, the procedure the doctors follow, the risk and other important details. It is a common procedure people carry at large to cure artery blockage and also have proved effective for many.

However, to make sure you recover from this invasive surgery, follow instructions led by the doctors carefully.