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Quadruple Bypass Open Heart Surgery

When To Call Your Healthcare Provider

Quadruple bypass open heart surgery -my experience

Talk to your healthcare provider or surgeon immediately if you have:

  • Pain, redness, heat, or drainage from your incision
  • Temperature of 101 degrees F or higher
  • Weight gain of more than 2 pounds a day for two days in a row
  • Irregular pulse
  • Shortness of breath
  • Cough that doesnt go away
  • Coughing up blood or yellow or green mucus

Preoperative Workup And Strategy

Routine preoperative workup aims to check the baseline status of systems and organs other than heart. Thus a chest x-ray to check lungs, complete blood count, renal and liver function tests are done to screen for abnormalities. Physical examination to determine the quality of the grafts or the safety of removing them, such as varicosities in the legs, or the Allen test in the arm is performed to be sure that blood supply to the arm wont be disturbed critically.

Administration of anticoagulants such as aspirin, clopidogrel, ticagrelol and others, is stopped serval days before the operation, to prevent excessive bleeding during the operation and in the following period. Warfarin is also stopped for the same reason and the patient starts being administered heparin products after INR falls below 2.0.

After the angiogram is reviewed by the surgical team, targets are selected . Ideally, all major lesions in significant vessels should be addressed. Most commonly, left internal thoracic artery is anastomosed to left anterior descending artery because the LAD is the most significant artery of the heart, since it supplies a larger portion of myocardium than other arteries.

What Are The Risks And Benefits Of Such Surgery

It is important to keep in mind that every medical choice involves a trade-off between risks and benefitswhether it is to undergo surgery, take medication, or even just carefully monitor a condition .

In the case of CABG, deciding whether surgery is advisable is sometimes an emergency, life-or-death matter. But sometimes, it involves balancing the risks involved in any heart surgery against the increasing likelihood that your symptoms of CAD, angina or congestive heart failure will worsen. Patients with severe CAD, for example, have a 35% to 50% risk of dying within five years of their diagnosis if they don’t have bypass surgery.

The risks involved in surgery are far lower. A given patient’s risk will vary, depending on such factors as age and overall health status, but the average mortality, or risk of death, from bypass surgery is from 1% to 2%. Bypass surgery is also associated with a risk of between less than 1% and 2% of a blood clot that causes a serious heart attack or stroke. And any surgical procedure involves a very small risk of other complications, such as infection.

The risks are typically higher when bypass surgery must be performed on an emergency basis. But in nonemergency situations, patients who smoke can reduce their risk of complications if they stop smoking at least 2 to 4 weeks before their surgery .

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What Is Quadruple Bypass Surgery

The quadruple bypass surgery, also referred to as CABG is a type of heart surgery that helps clear all the blocked arteries. The surgery helps in removing the blockage of arteries and restores the adequate supply of blood flow to the heart. The surgeons remove a segment of the healthy blood vessel from another part in the body and detour it towards the blocked artery in the heart.

This surgery can be carried out by detaching the artery from the chest wall and attaching the open end to the coronary artery below the blocked area. In some cases, a piece of long vein in the leg may be sewn above the blocked area and the other end grafted to the coronary artery below the blocked area. These two procedures help in giving a new path to the blood and allow it to flow freely in the muscles of the heart.

One may require one or more than one grafts to help restore the free flow of blood. The most common apparatus or machine used in the surgery is the cardiopulmonary bypass with a pump oxygenator. This means in simple language, the heart-lung machine. The other members besides the cardiac surgeon include the cardiac anesthesiologist, surgical nurses, and a perfusionist.

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Why Is Coronary Bypass Surgery Done

What Is The Survival Rate For Quadruple Bypass Surgery

Your heart works 24/7, supplying your entire body with blood. To do its job, your heart also needs blood flow, which it gets through a network of supply arteries that wrap around it. When tissues in your body arent getting enough blood flow, this causes a problem called ischemia .

The muscle cells in your heart are especially sensitive to ischemia, and when it’s severe, those heart muscle cells will start to die. Coronary artery bypass grafting treats ischemia by restoring blood flow to the affected heart muscle.

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Coronary Artery Bypass Surgery

  • Once your doctor has opened the chest, he or she will stabilize the area around the artery to be bypassed with a special instrument.

  • The rest of the heart will continue to function and pump blood through the body.

  • The heart-lung bypass machine and the person who runs it may be kept on stand-by just in case the procedure need to be completed on bypass.

  • The doctor will do the bypass graft procedure by sewing one end of a section of vein over a tiny opening made in the aorta, and the other end over a tiny opening made in the coronary artery just below the blockage.

  • You may have more than one bypass graft done, depending on how many blockages you have and where they are located.

  • Before the chest is closed, the doctor will closely examine the grafts to make sure they are working.

  • What Medications Will I Take After Heart Bypass Surgery

    Your doctor will give you medications to help manage your pain, such as ibuprofen or acetaminophen . You may also receive a narcotic for extreme pain.

    Your doctor will also give you medications to help you throughout your recovery process. These will include antiplatelet drugs and other drugs prescribed by your doctor.

    Talk to your doctor about what medication plans are best for you. This is especially important if you have existing conditions such as diabetes or conditions affecting the stomach or liver.

    Type of drug

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    What Is Involved In A Typical Recovery

    A typical CABG procedure takes from 4 to 6 hours, in some cases up to 8 hours patients are then maintained under general anesthesia for an additional 4 to 6 hours. If their heart is performing well and there is no excess bleeding, they can emerge from anesthesia and have their breathing tube removed. Most patients stay in the ICU until midday of the day after their procedure if they continue to do well, the drainage tubes in their chest can then be removed and they can be moved to a regular hospital bed later that day.

    The typical hospital stay ranges from four to seven days. At that point, the vast majority of patients are able to go home, with support from the visiting nurse service, though about 15% to 20% may need to spend some time in a rehab facility for more extensive rehabilitation. After discharge, patients are advised not to drive for about three weeks and not to lift anything heavier than 5 pounds for about 6 weeks. Beyond that point, they can resume whatever activities they wish to.

    Patients tend to be surprised at how easy it is to control their pain. By the second day after their operation, most patients are comfortable without intravenous pain medication, taking only oral painkillers, and the overwhelming majority are discharged home on just Tylenol or Motrin.

    Page reviewed on: Jun 26, 2018

    Page reviewed by: Jock McCullough, MD

    What Is Traditional Heart Surgery

    WATCH Triple Bypass Open Heart Surgery

    Traditional cardiac surgery, or open heart surgery as it is often referred, is performed by making a large incision, roughly 6-8, in the chest to gain access to the heart. Once the heart is exposed, the heart is actually stopped and the patient is connected to a heart-lung bypass machine that does the work of the heart and lungs to allow the surgeon to perform the surgery.

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    Purpose Of Quintuple Bypass Surgery

    If a blockage is serious enough, it can prevent or minimize blood flow to the part of the heart that is fed by the diseased blood vessel, causing chest pain and muscle damage.

    When the coronary arteries are completely blocked, the muscle that makes up the heart is starved of oxygen. This oxygen deprivation causes significant pain, and the resulting heart damage is referred to as a heart attack or myocardial infarction .

    In some cases, coronary artery disease can be treated with medication, lifestyle changes such as diet and exercise, and less invasive procedures, including the placement of stents.

    However, for some patients, the blockage are so severe that surgery is necessary to make sure the heart continues to receive adequate blood flow. This surgical procedure is known as coronary artery bypass graft surgery .

    Why Using Chest Arteries Is Better

    Over the past decade, surgeons observed that the traditional leg vein grafts we used developed problems. The grafts started to narrow or close about a decade after surgery.

    The use of an artery from the chest, the internal thoracic artery, greatly improved long-term results. People do better for longer and need fewer repeat surgeries.

    There are two internal thoracic arteries, one on the left side, and one on the right side of the chest area. Ordinarily, only the left artery is rerouted in CABG surgery. In certain cases, both left and right arteries are used to restore blood flow to the heart.

    We now know that using both chest arteries improves outcomes for heart patients, and we conducted a study to confirm this benefit for those with diabetes in particular.

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    The Quintuple Bypass Procedure

    The procedure is performed under general anesthesia and starts with blood vessels being taken from another area of the body, often the leg, and grafted onto the existing heart vessel before and after the blockage.

    A quintuple bypass requires more vessels than any other procedure, so multiple sites, including the arm, left internal mammary artery , and other vessels may be used.

    Obtaining adequate vessels to use for the grafts can be one of the most challenging aspects of the procedure if the vessels to the heart are diseased, it is likely that the vessels in other regions of the body are also affected.

    These vessels are then used to detour blood around the blockage on the way to the heart, with the blood literally being routed around the blocked portion of the vessel.

    Once the vessels needed for the grafts are harvested, the chest portion of the surgery begins with a sternotomy, the incision that opens the chest and divides the sternum in half to allow the surgeon access to the heart.

    Quintuple bypass is most often performed on pump using a cardiopulmonary bypass machine to temporarily do the work of the heart and lungs, allowing the surgeon to stop the heart and perform surgery without the constant movement of the heart beating. In some cases the procedure is done off pump, but this is far less common.

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    Igarni: Quadruple Bypass Open Heart Surgery Survival Rate

    Quadruple bypass heart surgery is a complex procedure. Your surgeon will most likely recommend it if it significantly improves your health and quality of life and the risks do not outweigh the potential benefits .

    However, this surgery alone is not a cure for coronary heart disease. After the procedure, it is important to make healthier lifestyle changes to improve your overall health.

    If you have surgery, lifestyle changes may be long-term for you as you adjust to your daily routine, but diet and exercise will be important in the long run.

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    What Are The Risks Or Complications Of This Procedure

    CABG is a major surgery, which means there are some potential risks and complications. While most of these risks and complications are avoidable or treatable, its still important to understand them. Possible risks include:

    • Irregular heart rhythms . The most common arrhythmia after CABG is atrial fibrillation, which causes an increased risk of stroke. Fortunately, its usually only a temporary concern.
    • Bleeding. This is a risk with any major surgery. To avoid this, people who take blood thinners will need to stop taking them before the surgery.
    • Infections. Another possible complication of surgery is infection. When infections spread throughout your body, they can cause , a life-threatening overreaction of your immune system. Sepsis is a medical emergency, and having two or more of its symptoms should be considered as dangerous as a heart attack or stroke. Fortunately, major infections after CABG are rare thanks to improved surgical care and techniques.
    • Confusion or delirium. These cause symptoms like agitation, trouble thinking clearly, memory problems or someone behaving unusually .
    • Kidney problems.

    Why Might I Need Coronary Artery Bypass Surgery

    Your doctor uses coronary artery bypass graft surgery to treat a blockage or narrowing of one or more of the coronary arteries to restore the blood supply to your heart muscle.

    Symptoms of coronary artery disease may include:

    • Swelling in the hands and feet

    Unfortunately, you may not have any symptoms in early coronary artery disease, yet the disease will continue to progress until theres enough artery blockage to cause symptoms and problems. If the blood supply to your heart muscle continues to decrease as a result of increasing blockage of a coronary artery, you may have a heart attack. If the blood flow cant be restored to the particular area of the heart muscle affected, the tissue dies.

    There may be other reasons for your doctor to recommend CABG surgery.

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    What Happens During Heart Bypass Surgery

    Youâll be asleep the whole time. Most operations take between 3 and 6 hours. A breathing tube goes in your mouth. It’s attached to a ventilator, which will breathe for you during the procedure and right afterward.

    A surgeon makes a long cut down the middle of your chest. Then they’ll spread your rib cage open so that they can reach your heart.

    Your surgical team will use medication to temporarily stop your heart. A machine called a heart-lung machine will keep blood and oxygen flowing through your body while your heart isn’t beating.

    Then the surgeon will remove a blood vessel, called a graft, from another part of your body, like your chest, leg, or arm. They’ll attach one end of it to your aorta, a large artery that comes out of your heart. Then, they’ll the other end to an artery below the blockage.

    The graft creates a new route for blood to travel to your heart. If you have multiple blockages, your surgeon may do more bypass procedures during the same surgery .

    In some cases, the surgeon may not need to stop your heart. These are called âoff-pumpâ procedures. Others need only tiny cuts. These are called âkeyholeâ procedures.

    Some surgeries rely on the help of robotic devices. Your surgeon will recommend the best operation for you.

    Results Compared To Stent Placement

    Quadruple bypass CABG heart surgery from a patient’s perspective.

    CABG or stent placement is indicated when medical management â anti-angina medications, statins, antihypertensives, smoking cessation, and/or tight blood sugar control in diabetics â do not satisfactorily relieve ischemic symptoms.

    A 2018 meta-analysis with over 4000 patient cases found hybrid coronary revascularization to have significant advantages compared with conventional CABG. Reduced incidence of blood transfusion, reduced hospital stay duration and reduced intubation duration were all reported. In contrast, HCR was found to be significantly more expensive compared to CABG.

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    Coronary Artery Bypass Grafting

    When arteries that feed oxygen to the heart are blocked, the heart muscle is at risk for damage called a heart attack and even death. In an operation known as coronary artery bypass grafting , an artery or vein from another part of the body is used to reroute blood flow around the blockage. Surgeons use chest wall arteries and segments of the patients own veins to construct new pathways for blood and oxygen to reach the heart. The veins used for this reconstruction are usually taken from the patients legs, using a minimally invasive technique that leaves only a few tiny incisions. By restoring blood flow to the heart, CABG can relieve symptoms and potentially prevent a heart attack. Coronary bypass operations are performed half a million times a year with an overall success rate of almost 98 percent.

    There are two types of CABG operations currently available: on-pump and off-pump surgery. On-pump procedures require the surgeon to open the chest bone , stop the patient’s heart, and place the patient on a heart-lung machine. This machine takes over the function of the patient’s heartdelivering oxygenated blood through out the body and brainwhile the bypass is performed.

    When You Were In The Hospital

    Your surgeon took a vein or artery from another part of your body to create a detour, or bypass, around an artery that was blocked and could not bring enough blood to your heart.

    Your surgery was done through an incision in your chest. If the surgeon went through your breastbone, the surgeon repaired it with wire and a metal plate, and your skin was closed with stitches. You also had an incision made in your leg or arm, where the vein was taken to be used for the bypass.

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