THE PROCEDURE
This procedure allows surgery to be done on the still-beating heart using special equipment to stabilize or quiet the area of the heart the surgeon is working on.
This type of surgery is challenging because the heart is still moving. Because of this, it is not an option for everyone.
To perform an open-chest, Beating-Heart Bypass procedure, surgeons make an incision through the breastbone to gain access to the heart.
In many cases, surgeons do a partial sternotomy - which is a shorter incision through the breastbone than a full sternotomy. Unlike traditional bypass surgery, the heart is not stopped during a beating-heart bypass procedure.
This approach uses special devices to stabilize the part of the heart the surgeon is operating on. Like the traditional version of a Heart Bypass, either the Saphenous Vein or Internal Mammary Artery is used to create the graft, used to bypass the blocked coronary arteries.
Advantages of heart bypass surgery
The surgery carries many benefits, including some particularly for patients who have serious cardiovascular disease.
The operation can save your life if you are having a heart attack or are at high risk of having one.
If you have ongoing angina and shortness of breath from diseased heart arteries, elective coronary bypass surgery is highly effective at eliminating or reducing discomfort. Coronary bypass surgery can give you your life back.
Because coronary bypass surgery is an open-heart procedure requiring general anesthesia and in many cases that the heart is stopped during the operation, bypass carries risks. The good news is that recent decades have seen a steep drop in serious complications. Today, more than 95 percent of people who undergo coronary bypass surgery do not experience serious complications, and the risk of death immediately after the procedure is only 1–2 percent.
The risk of serious complications is higher for emergency coronary bypass surgeries, such as for patients who are having a heart attack, when compared to elective surgery for treatment of angina and other symptoms. Additionally, patients may be at higher risk if they are over 70 years old, are female or have already had heart surgery. Patients who have other serious conditions, such as diabetes, peripheral vascular disease, kidney disease or lung disease, may also be at higher risk.
People who have Minimally Invasive Bypass Surgery recover faster, have significantly less pain, and experience fewer post-surgical complications than those who undergo traditional open-heart coronary bypass surgery.
Risks Associated with Heart Bypass Surgery
While complications from coronary bypass surgery are relatively rare today, your care team will make every effort to guard against them and to treat them if they do develop. They may include the following:
What about alternatives to coronary artery bypass?
In some patients, alternative treatment of coronary artery disease includes medical therapy with specific medication or non-surgical treatment such as Balloon Angioplasty, Laser Angioplasty, Stents or Atherectomy (plaque removal). Our Cardiologist will help decide which treatment is best for you.
PREPARATION FOR SURGERY
Before traveling to Cyprus, as part of your surgery preparation we require detailed medical information in the form of a medical questionnaire, ECG, Pulmonary tests and blood work. In some cases an Angiogram is required. All of this information will allow the doctors that we work with to determine your eligibility for the procedure.
Your surgeon will give you specific instructions about any dietary changes or activity restrictions you should follow before surgery.
Tell your surgeon what medications you are taking, especially aspirin or an anticoagulant ("blood thinner"). Your surgeon will tell you if you should stop taking them. Also bring a complete list of your current medications (including over-the-counter drugs, vitamins and herbal supplements), allergies, your medical records and any health insurance information.
If you smoke, stop immediately to improve your blood flow and breathing.
If you develop a cold, fever or sore throat within a few days of your surgery, or have other questions or concerns, contact our offices immediately.
Ten days prior to your arrival in Cyprus, you will receive all the necessary pre operative instructions, to prepare yourself both physically and mentally for your chosen procedure.
Upon arriving in Cyprus, as part of the pre-surgery tests done at our partner hospitals you will again receive chest X-rays, blood tests, an electrocardiogram and a coronary angiogram, which is a special type of X-ray procedure that uses dye to visualize the arteries that feed your heart.
Your surgeon and anesthetist will also go through you medical and surgical issues with you. During this visit, your surgeon will discuss your procedure and answer any questions.
Getting your house ready before surgery
It is also important to get your house ready for after you come home from the hospital. At first it will be harder for you to move around, so arrange your furniture and household items ahead of time to make it easier for you during your rehabilitation.
Preparation for the hospital
Here are a few things to keep in mind as you pack and prepare for the hospital and recuperation:
Clothing
Getting dressed in the morning helps you feel better, so be sure to bring some comfortable clothing to the hospital:
Day before surgery
Your surgical nurse will provide you with these instructions the night before surgery:
Morning of surgery
On the day of your surgery, your designated Salus Patient Concierge along with a nurse may talk with you and your loved ones. They shall tell you what to expect. You will most likely feel a little nervous before surgery, so the SALUS team and the hospital staff will do all they can to answer your questions and help you relax.
Make sure all your medicines in their original containers with you to the hospital.
You will meet with the anesthesiologist who will talk to you about general anesthesia. This is a controlled sleep while the surgery is being done so you will not feel any pain or remember the surgery.
You should leave jewelry, watches, money and other valuables with the person who accompanies you or with our staff member who will place them in our safe.
Proceed with your routine morning care:
When it is time for you to go to surgery, your family/ companion will be asked to wait in the waiting area. Your doctor will talk to your family/ companion there after your surgery is done.
RECOVERY AFTER SURGERY
After surgery, the patient is moved to the Cardiac Surgical Intensive Care Unit where family members can visit the periodically.
Heart rate and blood pressure monitoring devices continuously monitor the patient for 12 to 24 hours. Medications that regulate circulation and blood pressure may be given through the I.V. (intravenously). A breathing tube (endotracheal tube) will stay in place until our surgical team is confident that the patient is awake and ready to breathe comfortably on his or her own. The patient may feel groggy and disoriented, and sites of incisions may be sore. Painkillers are provided as needed.
Patients usually stay in our partner hospitals for about one week or longer if necessary, after surgery. This time is much longer than what is normally necessary, however, it does give our surgeon adequate time to monitor post operative recovery. During this time, some tests will be done to assess and monitor the patient’s condition.
Hospital dischrage and home instructions
Your diet is slowly increased from ice chips to liquids to solid foods as your intestines start functioning.
You will remain hospitalized for about 10 days while your heart is monitored and your vital signs are checked frequently.
Before leaving the hospital, our surgeon and staff will help you adjust to recovery in every way possible. You will receive specific instructions and precautions from your surgeon and nursing staff and they will show you safe techniques of simple activities like getting in and out of bed, bathing, going to the bathroom, managing steps at home and getting in and out of a car.
You will be able to leave the hospital when you are:
LIFE AFTER SURGERY
These guidelines give you an overview of what you may expect as part of your care after you leave the hospital. Be sure to follow your doctor’s discharge instructions if they are different from what is listed here.
YOUR ACTIVITY
After release from the hospital, the patient may experience side effects such as:
Many of these side effects usually disappear in less than 1 week.
Patients are often advised to eat less fat and cholesterol and to walk or do other physical activity to help regain strength.
Doctors also often recommend following a home routine of increasing activity- doing light housework, going out, visiting friends, climbing stairs. The goal is to return to a normal, active lifestyle.
Most people with sedentary office jobs can return to work in 1 week. Those with physically demanding jobs will have to wait longer.
Physical Activities
You may do light, quick activities where your arms are above your shoulders, such as brushing your hair. But do not do any activities where your arms are above shoulder level for a long time, such as washing a window or dusting a high shelf. Do not do any activity that causes pain or pulling across your chest.
To get the most out of your day, plan to do the most important activities first. Don't try to do everything at once, and schedule unfinished activities for another day. Make sure that you get plenty of rest in between activities.
Climbing Stairs and Steps
Unless restricted by your doctor, it's okay for you to climb stairs and steps. If you need to, stop and rest before you finish walking up or down a full flight.
Fatigue
Fatigue is probably the number one patient complaint following any heart procedure. Fatigue results from an extended lack of sleep while in the hospital, energy used by your body to heal its wounds, and energy used to fight off pain. To combat fatigue, listen to what your body is telling you. Space your activities to allow for rest periods. Take plenty of naps, walk regularly, eat well, and use your pain medication as needed. It's important that you rest and get a good night's sleep. Even if it's early in the night, if you feel tired, go to bed.
Driving and Riding in a Car
You should not drive for 1 week from the date of your procedure.
Traveling
Delay vacations or extended trips away from home for approximately 2-3 weeks, or until after the first post operative visit with your surgeon. Avoid air travel for two weeks from the date of your discharge. This restriction is designed to prevent you from being too far away from your surgeon should a problem arise.
Sex
You may resume sexual activity after 1 week of your procedure.
Exercise
Proper exercise will help your healing and recovery, as well as increase your stamina, maintain your ideal weight by burning calories, and lower stress in your everyday life.
Tips for exercising:
Make sure you are not exercising too hard. Stop if you are exhausted, short of breath, feel dizzy, or have discomfort in your chest. Call your doctor if these symptoms persist and you are not able to do your regular exercises.
YOUR DIET
Along with exercise, eating healthy will speed up your recovery and healing. If your appetite is poor, try to eat smaller but more frequent meals.
Depending on your condition, your doctor or dietician may put you on a special diet. For example, patients with heart failure must follow a 2,000 mg low-sodium diet. Diabetic patients must follow a low-sugar, low-fat diet.
Tips to healthy eating:
Poor Appetite and Nausea
Many patients lose weight in the postoperative period. They complain of lack of appetite and mild nausea. Certain medications such as pain pills may cause nausea. Try eating small frequent amounts of food, and take medications on a full stomach unless otherwise directed. If you continue to experience nausea or lack of appetite, call your primary physician.
Constipation
Constipation is due to inactivity, limited fluid intake and lack of dietary fiber. It is aggravated by medications such as pain pills and iron. Eating plenty of fiber and fresh fruits, drinking 6-8 glasses of water daily and using your prescribed stool softener (Colace) as instructed can usually relieve constipation. If this does not work, Milk of Magnesia or Dulcolax may be helpful. Avoid Milk of Magnesia if you have kidney problems.
Caloric Restriction
Your total calories may be changed to increase, decrease, or maintain your weight as necessary. Being overweight increases the work of the heart. Your drug therapy may cause you to be hungry, you may eat more, and you may then gain weight. It is, therefore, very important that you pay attention to the total amount of food you take in. In addition to adding to the work of your heart, being overweight is associated with high levels of Triglycerides (fats) in the blood stream. Having a lot of fats in your blood increases the possibility of having the blood vessels of your heart become thickened. This will be described in more detail in the section on cholesterol and fats that follows.
Cholesterol and Saturated Fat Restriction
Cholesterol is a necessary fatty substance found in the body and many animal foods. Fats are concentrated sources of energy which occur in three forms: polyunsaturated, monounsaturated, and saturated. People who have large amounts of cholesterol and saturated fats in their blood are at increased risk of having thickening of their blood vessels throughout their bodies. This is because saturated fats and cholesterol in your blood will gather along the walls of your blood vessels causing them to narrow. If this narrowing becomes severe in the blood vessels of your heart, the blood supply to your heart will not get enough oxygen, and the cells of your heart will die. This is called "Coronary Artery Disease."
In addition to your diet, your medications may also increase the level of fats in your blood. Thus, in order to prevent coronary artery disease, your overall fat intake must be restricted after the procedure. Generally, your overall fat intake should not be more than 30% of your total calories each day. Increasing the proportion of monounsaturated and polyunsaturated fat in your diet and decreasing your total saturated fat intake to less than 10% of your total fat intake will actually help to lower cholesterol and saturated fat levels in your blood. The aim of this diet is to keep the levels of fats in your blood within normal limits.
Foods high in cholesterol & saturated fats
Note :Instead of frying your foods, try to bake, boil, or steam when preparing foods.
Foods high in monosaturated and polyunsaturated fats
Concentrated Carbohydrate Restrictions
You may be asked to cut down on the amount of sugar and concentrated sweets in your diet as well. Carbohydrates not only add to calories, but large amounts may contribute to an increase in the Triglycerides on the blood.
Fluid and Sodium Restriction
Meat and Other Protein Foods
Ham, Canadian bacon, bacon, luncheon meats, frankfurters, sausages, scrapple, pepperoni, dried beef, chipped beef, corned beef, canned meats, pastrami, canned fish, sardines, herring, lox, anchovies, smoked salmon, caviar, cheese, regular peanut butter, and frozen TV dinners.
Vegetables
Sauerkraut or other vegetables prepared in brine, olives, pickles, relish, vegetables packed with sauces or seasonings, salted mixed vegetable juice (V-8), regular tomato juice, regular spaghetti sauce, tomato sauce or tomato paste, frozen peas, and lima beans.
Breads & Cereals
Bread and rolls with salt toppings, corn chips, potato chips, salted pretzels, salted popcorn, and other salted snack foods.
Fats
Bacon fat, salt pork, olives, salted nuts, party spreads and dips.
Soups
Canned broth soups, commercially prepared stews, bouillon cubes, and instant or dried soups.
Other
Be careful of monosodium glutamate (MSG) used in Chinese food. When you order Chinese food, you can request that it be prepared without MSG.
Note: You should check with your doctor or dietician before using salt or salt substitutes.
Medications
Your medicines: Take the medicines you were taking before procedure, unless your surgeon has made a change.
Your doctor will likely prescribe medications (anticoagulants) to prevent blood clots, relax your arteries and protect against coronary spasms.
Call your surgeon right away if you have:
SLEEPING PATTERNS
You should return to your normal sleeping patterns within 2-3 weeks. Try these tips to help you sleep:
If you still have problems sleeping after 2-3 weeks, call your doctor.
Night Sweats
Patients often complain of night sweats for the first few weeks. Should you experience this, check your temperature to make sure that you do not have a fever. If your temperature is 101 degrees Fahrenheit or greater, call your doctor. If you do not have a fever, there is very little that can be done, but you should make yourself as comfortable as possible while waiting for the night sweats to go away. Change your linens and pajamas so you do not sleep in a damp bed. Night sweats usually disappear in a few weeks.
Disturbed Sleep
Following the procedure, some patients experience nightmares or insomnia. This will also disappear with time. To help you sleep better, try shortening your naps during the day and/or increasing your afternoon activities so that you will feel tired in the evenings. It is OK to sleep on your back, side or stomach. You will not hurt your incisions.
FOLLOW- UP
Follow-up after your procedure is extremely important and our surgeons at Salus are committed to providing all the post surgical care you need. In order to identify and treat any complications as they may arise, close, lifetime follow-up is essential.
Any time before your appointments, you should call your doctor if you: