BYPASS OPERATION
Bypass Operation
By-pass operation is surgical method applied when an artery can not transport sufficient level of blood to a tissue. There is a bridge connected thanks to a resection of other arteries and their preparation in the upper part of the occluded area and it enables the sufficient level of blood to reach the other area. "Coroner by-pass operation" are the by-pass operations in occlusions in "coroner artery" which feeds heart.
What are the Risk Factors?
The risk factors associated with coroner by-pass operations varies depending on the pre-operation state, age, sex of the patients as well as other accompanying diseases. Higher risk is reported for women and patients over 70 years old. There are also diabetes, obesity, another organ disease, a prior heart attack or seizure, presence of accompanying disorders in cardiac valves or rhythm disorders, a prior heart operation which can be added to most important risk factors. However, especially in the last 15 years, the risk factors have been reduced to acceptable levels as a result of the technological possibilities, increasing experience and joint studies carried out in the pre- and post-operative periods with other specialties.
How Long Do By-Pass Operations Take?
The operation period varies depending on the type of the operation being carried out, the number of by-passes to be conducted, additional surgical intervention in the same session of the operation or previous heart operations. For example, a patient needing two or three of his/her arteries to be by-passed, the operations may take 2.5 to 3 hours, while an operations needing a change in cardiac vaLves simultaneously, it may take 4 or 5 hours.
Which Arteries are Eligible for Coroner By-Pass Operation?
Three coroner arteries and their lateral branches feed the heart. The number of lateral branches, the size of the area they feed varies from one person to another. Usually the diameter of coroner arteries in human heart is between 1 to 4 mm. As detected in the coroner angiography, depending on the number of arteries, by-pass operation can be performed on the arteries Larger than 1 mm.
How is Anesthesia Applied in By-Pass Operations?
By-pass and cardiac valve operations are performed under general anesthesia. There are higher probabilities of heart failure, previous heart attach, hypertension, diabetes, usage of cigarette and Lung disorders related with eldery and kidney function disorders in many of the patients needing a heart operation. Therefore, the anesthesia of these patients requires a different approach.
The patients taken to the operation are asses by the anesthesiologist at most one day prior to the operation.The anesthesiologist prepares the medicine that would enable the patient to spend the night comfortably. After the tranquilizers medicine is applied to the patient in order to ease his/her anxiety on the day of operation, after being taken to the operation room.The patient is plugged to respiratory device while under the general anesthesia. The blood pressure, heart speed and rhythm are monitored during the operation. At the end of the operation the patient is taken to intensive care unit, and necessary check-ups are performed. The patient is followed-up closely in the intensive care unit and necessary precautions are taken against the risk of pain and infection. The patient, completing his/her recovery period in the intensive care unit, is sent to the service aftermath of the final controls by anesthesiologist and the surgeon.
Which Grafts are Used in By-Pass Operations?
The different grafts are used in by-pass operations. Characteristically artery and veins. Today mostly left mammalian artery, right or left arm artery are used as arteries. The grafts used as vein can be prepared both in right and Left legs. The graft decision in by-pass operations depends on the age of the patient, the various anatomical aspects of coroner arteries, the other accompanying diseases and the number of diseased vessels to be operated. Arterial grafts are preferrable for by-pass to veins, however it depends on the number of the graft required.
How Long is the Period of Hospital Stay?
The hospital stay period of a patient who has normal attributions and are in the low-risk group varies between 4 and 7 days after the by-pass operation. In our Hospital, every patient, after being discharged , is recalled one week after for check-up and is referred to the cardiology department in order to prepare the medicines, perform the long-term follow-ups, and control the risk factors [hypertension, obesity, cholesterol levels, bloodsugar, stress, use of tobacco etc.]
The return to normal daily activities of the patient, depending on the clinical conditions prior to the operation, can take place between 2 and 4 weeks.
What to Do After the Operation?
The fundamental philosophy of by-pass operations is to save the patient from the danger of immediate death and heart attack, to prevent a life style restricted by medicines and as a result of these, to improve the life quality. Therefore the most important issue after these operations is to control the changeable risk factors. Additionally another important matter is the regular controls and the follow-up.
