Robotic cardiac surgery

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Bypass Surgery Navigate your way to a Healthy
Heart
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What is a bypass surgery? Imagine traveling by
road and getting stuck in a traffic jam. To
'bypass' the jam, you take another route and join
the same road back again. That's exactly what
takes place in a CABG (Coronary Artery Bypass
Graft surgery) or commonly known as bypass
surgery. Coronary Artery Bypass Grafting (CABG)
is a surgical procedure done to create a 'bypass'
around the blocked part of a coronary artery
(blood vessels that supply blood to the heart) to
restore blood supply to the heart muscle. The
bypass is made with the help of blood vessels
(known as grafts taken from the other parts of
the body (leg, hand, chest wall, etc.)
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Why and when is a bypass done? When one or more
of the coronary arteries becomes partially or
totally blocked, the heart does not get adequate
blood supply. This is called an ischemic heart
disease or Coronary Artery Disease (CAD). It can
cause heart pain (angina) or a heart attack
(myocardial infarction). CABG is one of the
treatment options for ischemic heart disease.
Bypass surgery is advised for 1. Disease of the
left main coronary artery 2. Significant,
multiple blockages in all three main vessels of
the heart 3. Failure of angioplasty 4.
When the efficiency of the left ventricle is
reduced to less than adequate.
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How is the surgery done? Before the surgery Once
the patient has been diagnosed with a triple
vessel disease and has been advised to undergo a
bypass surgery he has to plan accordingly.For a
bypass surgery a stay in the hospital of
approximately 10 days is expected with a recovery
time of a month after the surgery to get back to
the normal routine.
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• The pre-operative investigations include the
  following
• Blood tests includes CBC, Serological tests,
  blood grouping, blood sugars,
• Urine tests creatinine, electrolytes
• Chest x-ray
• Ultra sonography
• Carotid and radial Doppler studies
• 2D Echo
• CT angiography of the internal mammary arteries
• Sputum and nasal swabs to check for any active
  infections in the body
• Lung function tests

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• Preparing the patient
• On the day of surgery the patient is given
  medicines to reduce anxiety and then rolled into
  the Operation Theatre (OT)
• Electrodes connected to ECG monitor are attached
  to the patients back to monitor the hearts
  activity during the operation
• Intravenous lines are then inserted into the
  veins of the wrist or arm for administration of
  medicines and salt solutions
• One IV line is threaded up the vein all the way
  to the vena cava ( the biggest vessel that
  carries impure blood from all the parts of the
  body to the heart) to allow administration of
  medication directly to the heart.

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• Surgery
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• For the surgery, first the chest is cut open at
  the mid line of the breast bone ( sternum) and
  the sternum is separated.
• Then the internal mammary artery to be used for
  the surgery is separated from the chest wall
  gently.
• Then the surgeon will work on the patients limbs
  to remove the vein or the artery.
• After this the grafting of the conduits is done.
• After several hours of grafting the chest closure
  is done in layers.
• The patient is then shifted to the ICU

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However, in a beating heart surgery the heart
lung machine is not used and the surgery is
performed on a beating heart. This method is know
as an Off-Pump Coronary Artery Bypass surgery
(OPCAB) or beating heart surgery. It allows the
bypass to be created while the heart is still
beating by using a device known as 'octopus'. The
advantage is a quicker recovery, fewer
complications and better long term outcome,
especially in elderly patients and in patients
with problems like kidney failure, previous brain
strokes, etc. Asian Heart Institute is one of the
few centers in the world that specializes in this
type of surgery, performing nearly 100 of its
bypass surgeries on a beating heart with a very
significant percentage using total arterial
grafting.
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  Redo bypass surgery A second or redo bypass
surgery is needed if blockages develop after the
first surgery. It is complex and risky because
after surgery, the heart and lungs stick to the
breast bone. A beating heart surgery using
arterial grafts reduces the risk of a redo bypass
surgery. At Asian Heart Institute redo bypass
surgery is also performed 'Off-Pump', thereby
suggesting the competence of the team.
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Frequently Asked Questions After Bypass
Surgery 1. When can I drive on my own? It is
wise to wait for 2 months after surgery, before
driving on your own. This is the amount of time
it takes for the healing of your sternum (breast
bone), which was cut open during surgery. Any
chance injury, can cause damage if driving is
started too early. Please consult with your
surgical team before undertaking any activity
after a bypass. 2. Can I travel by car? Yes.
You may travel by car as soon as you are
discharged. However, for the first few weeks, it
is advisable to restrict your travel to less than
two hours. If the drive is going to be longer,
then take a break every two hours and walk around
for a few minutes.
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3. Should I speak less? There is no reason for
you to 'speak less' after surgery. However,
during the first few days of your recovery, you
might feel short of breath while speaking for a
long period of time. If so, your body is telling
you to rest, and your may keep silent for some
time. 4. Will eating curd or watermelon affect
the stitches and slow down the healing of the
breast bone? No. Eating curd or watermelon has
no effect on your stitches and healing process.
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5. When can I start climbing the staircase? If
there is an elevator, there is no need to climb
stairs just for the sake of exercising. If you do
not have an elevator and have to take the
staircase, you can do so as soon as you are
discharged. While climbing, pace yourself. Take a
minute's rest after climbing 10-12 steps during
the first week after discharge. As your walking
capacity increases, there is no restriction on
climbing steps, as long as you do not run out of
breath. 6. When can I go back to work? It is
advisable to wait for at least 2 months after
surgery before returning to work. However,
depending on the condition of your heart, you may
be able to start light work after a month. Please
consult with your doctor before returning back to
work.
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7. What about the blockages in the arteries,
will they remain? The blockages which are present
is the arteries remain as they were. The 'graft'
which provides the 'new blood supply' is
connected below your old blockages, thereby
providing adequate blood to the heart muscle. 8.
After my surgery, why do I still feel pain in my
chest? To perform your surgery, your chest-bone
was cut open and stitched together after surgery.
It is quite normal to feel some pain or altered
sensations in your chest region for a few months
after surgery. However, this pain will be
different from the pain of 'angina' which you
might have experienced before surgery.  
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The AHI Advantage The latest trend in healthcare
is to have lesser invasive surgeries, i.e.
surgeries which involve minimal cuts ensure
that patient has a faster recovery. Keyhole or
Minimally Invasive Surgery (MIS) is a modern
innovative surgical technique that reduces the
patient's post-surgery distress allows them to
return back to their normal life in just a couple
of days. In Minimally Invasive Surgery (MIS) is a
modern innovative surgical technique that reduces
the patient's post-surgery distress allows them
to return back to their normal life in just a
couple of days.
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Recovery/ Prognosis Recovery from the surgery
takes time. The patient who has received a CABG
can expect considerable relief from symptoms and
in many cases, increase life span. It should be
remembered however that the graft vessels are
subject to fatty blockage at any increased rate,
so care must still be taken to reduce the risk
factors that cause the original blockage.
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• You can do many things to reduce the risk factors
  like
• Not smoking
• Regular exercising
• Control of vitals like Blood Pressure, sugar
  levels, cholesterol levels etc
• Rectification of other clinical conditions if any
• Related Tags Best cardiac arrest treatment
  Hospitals for cardiac arrest treatment Best
  cardiologist for angioplasty

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THANK YOU.
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