Coronary Bypass Surgery – The Nebraska Medical Center


What we call conventional heart bypass surgery
would be done through an incision in the chest, so that’s a sternotomy incision.
And it’s ususally about that long, about 8 inches long.
We’d also have a small incision in the leg where a vein from the leg is taken.
The operation consists of first getting the mammary artery prepared, that’s the artery
we use to do bypass. At the same time, we’re taking the vein from the leg.
When that process is taken care of, the patient is put on a heart lung bypass machine. They’re
given heparin so the blood doesn’t clot during that period they’re on the heart-lung bypass
machine. While the heart is still and quiet, we would
sew the vein to the arteries on the heart. The idea is to bypass the blockages on the
heart. We’re not doing anything to the areas that are narrow themselves, we’re placing
a route for blood to go around those areas. Some patients may need two, others three,
four or even five bypasses. It’s individual, it’s based on the how the patient’s arteries
are configured and how many blockages they have.
That whole procedure of doing the bypasses takes somewhere between 3 and 4 hours to do. Almost every patient who has bypass surgery
has atherosclerosis, or hardening of the arteries. We certainly don’t know exactly what causes
atherosclerosis, it’s certainly an active area of investigation.
In general, it’s associated with a strong family history of having had heart disease
or vascular disease. It’s associated with things like diabetes, high blood pressure,
high cholesterol. So these are all indications that a person
has risk factors for that. On the other hand, there are certainly patients who have all
those risk factors and don’t have coronary artery disease and need bypass.
There are certainly some unknowns in the process. A typical stay for patients could range from
4-6 days. There may be a few patients ready to leave after 3 days; that’s less common.
There may be some patients certainly who start out sicker and need more than six days.
Somewhere between 4-6 days after surgery. Patients will typically be in intensive care
for one day, just the night after surgery. The next day on average, 80-90% of patients
will be ready to move to a regular step-down unit.
I think the thing that would be fair to tell someone is the day of surgery and the day
after, the pain and discomfort is there. We use pain medicine to make sure it’s controlled
as well as possible. I think most people who’ve had the procedure
will say after a couple days they’re very comfortable with just oral pain medicine.
And they go home on that. Patients typically don’t need pain medication
after 2-3 weeks. But I think if you asked people who’ve had
bypass surgery they’d say they still had some soreness and discomfort that may have continued
several weeks after surgery. They should typically be back to their normal
activity anywhere from 3-4 weeks after surgery. Some people are ready sooner.
It’s usually a couple months, when we do a typcial sternotomy that people can return
to all activities including lifting weights and those things. Across the country, there are at least 100,000
heart bypass operations done each year. That number has actually decreased over the years,
which is a good thing for patients. with the change in medications, patients are
doing better without having the need for bypass surgery.
But certainly as people get older and the population has other diseases like diabetes
etc they sometimes need heart bypass surgery. The good news we have for them is that people
are doing well with it. I’d say bypass surgery has progressed quite
a bit. Certainly back in the 1970s when the first bypass surgeries were initiated, results
were relatively unknown. Then in the 1980s, we brought in important
changes like using an internal mammary artery which really has made a differnce in the long
term success rate. Really more recently in the 90s and this decade
we’ve seen that survival rates for bypass surgery are extremely good. All across the
country, 98, almost 99% will survive surgery and do very well.
And I think the long term results of bypass surgery are really quite good. I think we can say safely and fairly that
patients can get an excellent bypass operation all across the country at different types
of medical centers. There’s no question about that.
The differnce between a medical center like ours is that we have physicians here who are
experienced not only with bypass surgery but with more complicated types of technologies
and proceedures that some patients who have bypass surgery may need.
For example, there are some patients who have very low heart function who need bypass surgery.
Those patients may need some help before or after surgery with support of their circulation.
We have an excellent program in heart device and heart transplantation. And I think that
addtional expertise really provides the difference for those types of patients.
And I think for patients who don’t need that, we have a center that does a lot of heart
surgery and has excellent results across breadth of the spectrum of heart surgery and that’s
a reason patients should feel comfortable having their operations here.

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