Triple bypass surgery

Overview

Triple bypass surgery, also known as coronary artery bypass graft (CABG) surgery, is a procedure performed during open-heart surgery to redirect blood flow around three obstructed segments in the coronary arteries of the heart. In this surgical intervention, a surgeon utilizes blood vessels sourced from other parts of the body to establish new pathways for blood, thereby enabling it to circumvent the blocked arteries and ensuring proper circulation through unobstructed vessels.

Reasons for undergoing the procedure

Triple bypass surgery is typically the most suitable option for individuals with coronary artery disease who have significant plaque buildup in three regions of their heart’s arteries, leading to blockages that supply blood to the heart muscle. These blockages can result in symptoms such as chest pain, shortness of breath, and heart attacks. Triple bypass surgery is recommended when there is 50% or greater blockage in the left main vessel or 70% or more blockage in branch coronary arteries, and when less invasive procedures like angioplasty are either ineffective or not advised due to the severity and complexity of the blockages.

Risk

Major complications are uncommon in over 95% of patients who undergo coronary bypass surgery. Those undergoing emergency surgery or those with certain underlying medical conditions, may be at higher risk of complications. The following risk may include.

• Atrial fibrillation.
• Blood clots.
• Blood vessel that was relocated fails.
• Infection at the breastbone.
• Kidney failure.
• Stroke.

Typically, the risk of death from an elective triple bypass procedure is less than 1%.

Procedure

Some individuals may be eligible for a triple bypass surgery that involves only a 3-inch incision between the ribs, while others might opt for a robotically assisted procedure with a few 2-inch incisions. It’s important to note that these minimally invasive techniques are suitable for a limited number of patients and may not be the ideal choice for everyone. Unlike traditional surgeries, these procedures typically do not require the use of a heart-lung machine, allowing the patient’s heart to keep beating throughout the operation. Patients should consult their healthcare provider to determine the most suitable approach for their specific case.

Before the procedure

Before your scheduled surgery, your healthcare provider will require you to undergo a series of preparatory steps and tests. These pre-surgery procedures may include:

• Angiogram (Angiography)
• Chest X-ray or computed tomography (CT) scan of your chest
• Blood tests
• Echocardiogram
• Electrocardiogram (EKG)
• Ultrasound of your carotid artery

In addition to these tests, your healthcare provider will instruct you to observe specific guidelines leading up to your surgery. These guidelines typically involve:

• Fasting: You will be asked to refrain from eating or drinking anything after midnight on the night before your surgery.
• Medication management: Certain medications may need to be temporarily discontinued for several days leading up to your operation.

On the day of your surgery, you will follow these steps:

• Intravenous (IV) medication: You will receive an IV to administer medication that will induce sleep for the surgical procedure.
• Breathing assistance: A breathing tube will be inserted to ensure proper respiration during the surgery.

During the procedure

During general anesthesia, a surgeon performs the following steps for open-heart surgery:

• Make an approximately 6-inch vertical incision down the center of your chest.
• Split your breastbone in the middle to access your heart.
• Harvest a blood vessel from your leg, arm, or chest.
• Attach one end of the harvested blood vessel to your aorta and the other to your coronary artery, typically below the blocked area. In some cases, an artery under your collarbone may be used, leaving one end connected and attaching the other end to your heart. Multiple connections may be necessary depending on the location of blockages.

Triple bypass surgery typically lasts from three to six hours.

After the procedure

After triple bypass surgery, you will typically have a breathing tube inserted into your mouth and throat for up to 12 hours, and machines will continuously monitor your heart rate and blood pressure. Additional tubes may be used for fluid drainage or other purposes. You will receive medication through an IV in your arm to prevent blood clots, and long-term aspirin usage may be prescribed. Early mobility, such as walking in your hospital room and hallways, will be encouraged. Your surgeon may also suggest cardiac rehabilitation to enhance your heart’s strength during the recovery process.

Outcome

After triple bypass surgery, most individuals spend a night in an intensive care unit and then transition to a regular hospital room for an additional three to five days. The total recovery time after leaving the hospital typically extends to about six weeks or more, although some may recover in as little as four weeks, while others may require a longer period. Healthcare professionals encourage a gradual return to daily activities while avoiding strenuous endeavors. After six weeks, you can gradually reintroduce strenuous activities and heavy lifting.

As for resuming certain activities, you can usually start eating a day or two after surgery and begin walking around within a day or two post-operations. However, it’s important to refrain from driving for six weeks, especially if you’ve had open-heart surgery where your breastbone is split and wired back together. During this recovery period, avoid lifting objects that weigh more than 10 pounds (a gallon of milk, for example, weighs 8 pounds).

Many people can enjoy a long and healthy life after undergoing triple bypass surgery. Statistics indicate that more than 75% of individuals are still alive ten years after having a coronary artery bypass. To improve your long-term prognosis, it’s essential to adhere to prescribed medications and implement lifestyle changes, such as maintaining a healthy diet, abstaining from tobacco use, and engaging in regular exercise.

If you experience any signs of infection after returning home from the hospital, including bleeding from your wound, fever, worsening wound pain, or a fast heart rate, promptly contact your healthcare provider. It’s crucial to attend all follow-up appointments with your provider after triple bypass surgery to ensure proper healing and detect any potential complications.