The heart is stopped (generally for about 30-90 minutes of the 4-5 hour surgery) and then the cardiac surgeon performs the bypass surgery described above. After the grafting is done and the surgery gets completed, the surgeon then closes the breastbone with special sternal wires and the chest with special internal or traditional external stitches.
Surgery by this method allows surgeons to perform surgery while the heart is still beating. The heart-lung machine is not used here. Rather, the surgeon uses highly developed operating equipments to stabilize/ hold portions of the heart and then bypass the blocked or diseased artery. In the meantime, the rest of the heart keeps pumping and circulating blood to the body. With this technology, all coronary arteries can be bypassed off-pump. The off-pump technique may be suitable for those patients who have higher risk of complications from being placed on the heart-lung machine, for example, those who have vascular disease, significant plaque buildup in the aorta, stenosis of carotid artery, transient ischemic attacks (TIAs), or patients with breathing or kidney function problems.
The decision to use off-pump surgery is taken by the treating doctor, depending upon the patient's condition.
One of the goals of beating heart surgery is to eliminate the detrimental effects associated with the use of cardiopulmonary bypass (heart-lung machine). Although these complications occur only in 2-3% of cases but can be avoided by OPCAB surgery. Off-pump surgery requires (OPCAB) less blood transfusion, shorter operating time, less time on the breathing machine, decrease critical care area stay and lesser hospital stay. The elderly, high risk patients or patients with multiple co-morbidity can do much better when the bypass procedures are carried out without the heart-lung machine.
It is also known as Minimally invasive direct coronary artery bypass - MIDCAB or Keyhole heart surgery. This surgery is done without stopping the heart and therefore, the patient does not need to be put on a heart - lung machine. The surgery is performed through a small incision (about 3 inches) in the chest. Muscles in the area are then pushed apart and a small part of the front of the rib, called the costal cartilage, is removed. The surgeon then locates and prepares an artery on the patient's chest wall to attach to coronary artery that is blocked.
And then the surgeon connects the prepared chest artery to the coronary artery that is blocked. A device is then attached to the heart to stabilize it.
Following are some of the advantages of minimally invasive bypass surgery :
This technique, also known as closed heart surgery, is a type of minimally invasive surgery. Here, the cardiac surgeon uses a specially designed computer console to direct surgical instruments on thin robotic arms. Robotically assisted technology lets surgeons to perform certain types of intricate heart surgeries with smaller incisions and accurate motion control, offering patients excellent results. In robotic surgery, very small incisions-less than 2 inches-are done, compared with the 3- to 4- inch incision used in traditional minimally invasive heart surgery. The advent of this technique has revolutionized the concept of heart surgery as it makes the surgery easier to perform.
Conventiond "open bypass incision"
Robotic assisted small incision points
Kindly note that not every patient is a candidate for these surgical techniques. The surgeon reviews the results of diagnostic tests before scheduling surgery to determine if patient is a candidate for minimally invasive surgery. The surgical team very carefully compares the advantages and disadvantages of minimally invasive techniques versus traditional surgery techniques and then decides which one is to be specifically used for the patient.
Getting out of bed is easier if you do the following:
Many patients and attendants feel that they should not leave the hospital till all the stitches are removed. It is really not necessary, if you maintain personal hygiene and do proper cleaning and dressing of your stitches. This is very important in order to avoid infection. Remember that your stitches are quite safe if you take care of the following points while handling them at home:-
Clean the leg stitches also in the same manner. Patients with leg stitches should not sit cross legged. Avoid sitting on floor/low stools etc. Do not use Indian toilet seat. If you have to sit on a chair for a long time, place your legs on some stool/another chair i.e. at hip level. This will prevent swelling in the feel which is otherwise very common. Let the lotion get absorbed for at least 5 mins before you put on your clothes. It is fairly easy to do the dressing and you do not need any professional help for this. Thus, there is no need to go to the hospital for the same.
Till the stitches are removed, daily sponging is required. Use lukewarm water, Boil water for 15-20 minutes. Cool it and add a few drops of Dettol or Savlon in it. Use a clean towel and make sure that the wet towel does not touch the stitches.
A heart healthy diet helps in the recovery process. It is essential that you adhere to the diet chart provided by your health care provider/dietician. It is suggestive to follow a personalized diet plan that includes specific food for heart patients. You are advised to eat small meals throughout the day.
Following are a few heart healthy diet tips that you can discuss with your doctor and nutritionist: