Heart Health

05 January 2009

A routine miracle

Around 23 bypass operations take place in South Africa every day – here’s what to expect, courtesy of the Heart Magazine.

Around 23 bypass operations take place in South Africa every day – here’s what to expect, courtesy of the Heart Magazine.

It sounds a bit like science fiction: while the patient’s heart is stopped, a bypass machine pumps their blood around the body, while surgeons create a new route for blood flow to circumvent obstructions. In fact, it’s the most common form of heart surgery and has been considered routine for almost 30 years.

But after speaking to cardiac surgeon Dr John Hewitson, it’s clear the process amounts to a medical miracle.

When is bypass surgery necessary?
A build-up of plaque in the arteries can block blood flow to the heart. This can cause debilitating chest pain or a heart attack.

Why bypass surgery instead of a stent?
A stent procedure, which involves leaving a wire mesh tube in the artery to keep it open, can be difficult when the obstruction is inaccessible with a catheter, or if it occurs in a primary source of blood flow to the heart, because while the balloon is inflated to place the stent, blood flow to the heart stops.

Surgical walkthrough
Here’s what happens during the bypass operation:

  • An incision is made in the sternum or breastbone.
  • The heart is connected to the bypass machine by clamping the aorta and rerouting blood flow to the machine.
  • The heart is stopped. A cold drug solution is pumped into the coronary arteries to preserve heart tissue.
  • A conduit blood vessel, usually the internal thoracic artery, is selected and connected to the artery beyond the obstruction, as well as to the aorta (the heart’s main artery), providing a route for blood flow that bypasses the blockage. The procedure is repeated for all obstructions.
  • The aorta is unclamped. The heart recovers and the body is slowly weaned off the bypass machine.
  • A drain is inserted into the chest to drain off any extra bleeding.
  • The sternum is wired closed.

Bypass surgery usually lasts between two and six hours and is almost always successful, radically improving quality of life and increasing life expectancy.

When can you go back to work?
Patients can return to physically undemanding work about a month after surgery, while anything requiring exertion should be avoided for at least three months.

When is sex allowed?
It should be fine about a month after surgery. A good indicator for resuming sexual activity is when two flights of stairs can be climbed without causing shortness of breath.

- (Jacqui Zurcher, Heart Magazine, August 2006)

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