Heart Bypass Surgery
Heart Bypass Surgery is an open-heart surgery that is used to treat blockages of the heart arteries. When there is a heart artery blockage, blood supply to areas of the heart are affected. A heart bypass is attached beyond the blockage restoring blood flow to that area. Heart bypasses are either arteries or veins taken from other parts of the body including the chest wall and the legs. This article is a picture guide to heart bypass surgery that takes you through many critical stages of the operation.
The Heart Bypass Vessel
The most well known bypass is called the LIMA to LAD. LIMA stands for left internal mammary artery and is an artery that runs from the left collarbone area down the chest wall. LAD stands for left anterior descending artery which is the artery commonly responsible for the ‘Widowmaker Blockage.” In a bypass it is carefully taken down from the chest wall and attached beyond a blockage acting as a bypass. The LIMA to LAD is very successful as a bypass and has good long-term results. In other types of bypasses, arteries can be taken from the forearm, or veins can be taken from the legs. Read this article on heart blockages and this article on the ‘Widowmaker” for more information. This article titled “how long does a bypass last” is useful and goes in to a little more depth about the different bypasses.
Heart Bypass Surgery – A Picture Guide
Cutting The Skin
The first operative step in a heart bypass surgery is cutting the chest wall to expose the breastbone. A scalpel is used initially. Then electrocautery is used to dissect through the superficial layers. In these images the superficial tissues are dissected through, then the deeper layers down to the breastbone.
Sawing Open The Breastbone
Heart bypass surgery is an open-heart surgery and the heart needs to be exposed. In the case of bypass surgery this is done by sawing through the breastbone in a technique known as median sternotomy. A specially designed electric saw is used for this. A median sternotomy is demonstrated in the next image. Once the bone is cut, small bleeders are cauterized to stop the bleeding.
Freeing Up the LIMA
As described above, the best bypass to use when possible is known as the LIMA. This runs on the left inner chest wall. In this next image the breastbone on the left is retracted and then the LIMA is freed up from the chest wall so it can be used as a bypass.
Harvesting The Leg Vein
In the old days of heart bypass surgery the leg was literally cut open to expose then harvest the leg veins to be used as bypasses. A more modern technique is known as endoscopic harvest where a small endoscope is inserted in to the leg and a keyhole technique is used to take out the vein to be used as a bypass. This leaves us with a much smaller leg wound and improved healing with less complication.
Putting the Patient On Cardiopulmonary Bypass
The patient undergoing heart bypass surgery is placed on a heart lung bypass machine to take over the work of the heart during the operation. This allows the heart to be stopped. Some people advocate doing heart bypass surgery on a beating heart, most do not, it is an ongoing debate with no clear winner.
Preparing The Heart Bypasses
The bypasses are cut appropriately. The small branches on the side are clipped so blood isn’t lost when they are attached. The veins are expanded with fluid to ensure they are competent for use.
Attaching The Bypasses
The arteries to be bypassed are carefully exposed. The bypass grafts are then carefully attached. Good technique here is critical to ensure good results.
In many patients other operations will be needed at the same time. Patients with mitral regurgitation (a leaky mitral valve) or mitral stenosis (a tight mitral valve) may need mitral valve repair or mitral valve replacement at the same time. Patients with aortic stenosis or aortic regurgitation may need aortic valve replacement at the same time also.
Restarting The Heart
Once the heart bypasses are attached the heart can be restarted so it can start beating again in its normal fashion.
Closing The Chest
The breastbone is closed using a technique known as sternal wiring to hold it together until it heals over time. After that the superficial tissues and the skin can be sutured together. Drains are left in the heart sac and the lungs to allow drainage of blood over the next 24-48 hours.
To The ICU
After heart bypass surgery the patient will be transported to the cardiac intensive care unit. The breathing tube is typically taken out the same day. Patients are typically in the hospital 3-5 days after heart bypass surgery.