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All You Need to Know About Open Heart Surgery

Open heart surgery is performed when the coronary arteries supplying blood to the heart are blocked and is the gold standard treatment for the same. The condition arising due to blockage of coronary artery is known as coronary artery disease. Open heart surgery is done to regulate the flow of blood through the arteries and prevent damage to the heart. In the procedure, blood vessels from other parts of the body are used to create a bypass. Generally, two to four coronary arteries are grafted for regulating blood flow to the heart.

There are three types of bypass surgeries depending on the number of bypasses done, namely double bypass, triple bypass, and the quadruple bypass.

Open Heart Surgery – Open heart surgery is considered only if the blockage is such that placing the stent is not feasible. Also, if there is severe coronary disease in the left main artery or in multiple arteries and there is high risk of heart damage. To check the exact blockage scenario cardiac surgeons advice on having a complete testing done. An angiogram is used for checking the severity of coronary disease. The other tests done before and after the surgery include electrocardiogram (EKG), blood tests and specific dietary instructions.

Open Heart Surgery

Types of Open Heart Surgeries

  • On Pump Open heart surgery

During the on pump open heart surgery the surgery is performed under general anesthesia while keeping the patient on ventilator support. The primary step in the surgery is harvesting the blood vessels. Generally, the saphenous vein in the leg is used as it is long enough to create multiple grafts. Alternatively, if it cannot be used then vessels from the arm can be used. After the saphenous vein work is done, the chest is opened by making an incision along the breastbone. The surgeon cuts the sternum to gain access to the heart.

In traditional or off-pump CABG procedure, the heart needs to be stopped using potassium so that the surgeon does not have to perform the surgery on a beating heart. The blood circulation is kept on with the help of a heart-lung machine and the ventilator is switched off. The machine then does the work of the heart as well as the lungs. The surgeon either removes the existing blood vessel and replaces the same to remove the blockage or reroutes the blood around the blockage. There could be one or more grafts to be performed. Once the grafting is completed the heart is restarted. The sternum is placed in its original position and closed with the help of a surgical wire. The surgical wire helps in providing strength to the bone for healing. Lastly, the surgeon closes the incision.

On pump, surgery is recommended for unstable patients. The surgeon performs the surgery on a still heart so the process is quicker and even the bleeding is minimal. Alternatively, the cons include inflammation/ clotting after surgery, transfusion and fluid retention. Though after on-pump surgery the risk of stroke does increase.

  • Off Pump Open heart surgery

The off-pump surgery is very much similar to on-pump except that the blood flow through the body is maintained by the heart only and not the heart-lung machine as in on-pump surgery. The area to be grafted is held with the help of surgical instruments while the heart keeps pumping. This surgery is done on tentatively 20% of the CABG patients undergoing the surgery for the first time.

This surgery is less expensive surgery compared to on pump and it also reduces the risk of stroke. Also, blood loss and transfusions are less compared to on pump. The hospital stay required is also less. 70% of the patients are not recommended to do the surgery due to the condition. The surgery is not recommended for unstable patients.

Recovery
The recovery period includes staying in Intensive care unit for 24 hours. The chest tubes are removed post 48 hours and then the patient is shifted out of ICU. Once the patient is awake the breathing tubes are removed so that the patient can breathe on his/ her own. Though supplemental oxygen may be given through the nose to help with breathing. The patient will be monitored closely and if he/she is unable to breathe, the breathing tube might be inserted again. Once the patient starts breathing on his/her own, swift rehabilitation steps are put into place. This includes sitting up on the edge of the bed, walking while taking care of the wound and preventing pain, etc.

Life Expectancy
The life expectancy has greatly increased over the years up to 98% people undergoing the surgery can easily lead a normal life as that of the others who haven’t undergone any surgery.

” Vydehi Institute of Cardiac Sciences is a well equipped super speciality centre located in Vydehi Hospital designed to serve your hearts needs. It is equipped to treat all cardiac, cardiothoracic and vascular cases.  It uses all the latest equipment and technology coupled with the years of experience in its faculty.”

*Sourced from the Internet

North Eastern State Tops the List of Highest Deaths Due to Hemorrhagic stroke

A study on hemorrhagic stroke carried out in the year 2015 revealed that people residing in the northeastern state topped the list of deaths by hemorrhagic strokes and it exceeds the national average by a staggering three times.

Hemorrhagic stroke

The 2015 study stated that one in three people in the age group of 30-69 years die a premature death due to hemorrhagic stroke. The causes of hemorrhagic stroke are cited as too much consumption of salt and hypertension as well. As per the study that was carried out by the University of Toronto in Canada, the reasons behind this major increase in mortality rates could be inadequate stroke care, high blood pressure and risk factors like endemic infections.

It is an emergency situation that needs immediate medical attention because it causes brain bleeding due to a ruptured blood vessel. The states that are worst affected include Assam, Arunachal Pradesh, Sikkim, Manipur, Mizoram, Meghalaya, and Tripura particularly for deaths in males by strokes. While states like Assam, Odisha, Chhattisgarh and West Bengal were considered to be high risk for strokes in females. In 2015, the death toll rose to a freaking 2.1 million across all ages due to ischemic heart disease and stroke.

Though the rate of cardiac disease is a national issue, stroke has surprisingly surpassed its numbers to become the highest killer in north-eastern population. The study further stated that the deaths could have been prevented, but most of the deaths were caused due to irregular consumption of prescribed medications for cardiac disease.

India is amongst the top 5 countries in the world to have cardiovascular disease deaths and the age at which cardiac diseases develop in Indians is almost half a decade earlier as compared to developed countries. Though the sustainable development department has goals to decrease the mortality rates by 2030 does, it does seem to be difficult at the stage keeping in mind the very little progress made against cardiovascular diseases and awareness around it.