By-pass operation is surgical method applied when an artery cannot transport sufficient level of blood to a part that it feeds due to a tightened or occluded part upon itself. There is a bridge connected thanks to a resection of other veins and their preparation in the upper part of the occluded area and it enables the sufficient level of blood to reach this area. "Coroner by-pass operation" are the by-pass operations in occlusions in "coroner veins" which feeds heart.
Which Age Groups are Eligible for Coroner By-Pass Operation?
In last years, the age range of coroner by pass operations in our country has significantly widened. Thanks to the experience accumulated and technological advances, these operations can be performed safely and at the level of world standards for very elder peoples.
What are the Risk Factors?
The risk factors associated with coroner by-pass operations varies depending on the pre-operation state, age, sex of the patients as well as other accompanying diseases. Higher risk is reported for women and patients over 70 years old. There are also diabetes, obesity, another organ disease, a prior heart attack or seizure, presence of accompanying disorders in cardiac valves or rhythm disorders, a prior heart operation which can be added to most important risk factors. However, as result of the technological opportunities which advanced especially in the last 15 years, increased experiences and the cooperative works with other specialties in periods both before and after the operation, the risk rates for those who have one or more the risk factors stated below have been reduced to acceptable levels.
How Long Do By-Pass Operations Take?
The operation period varies depending on the type of the operation being carried out, the number of by-passes to be conducted, additional surgical intervention in the same session of the operation or previous heart operations. For example, in a patient needing two or three of his/her veins to be by-passed, the operations may take 2.5 or 3 hours while in operations needing a change in cardiac vaLves simultaneously, this period may take 4 or 5 hours.
Which Veins are Eligible for Coroner By-Pass Operation?
Three coroner veins and their lateral branches feed the heart. The number of lateral branches, the size of the area they feed varies from one person to another. Usually the diameter of coroner veins in human heart is between 1 and 2.5 mm. As detected in the coroner angiography, depending on the number of veins, by pass operation can be performed fo veins having a Larger diameters than 1 mm.
How is Anesthesia Applied in By-Pass Operations?
By pass operation and cardiac valve operations are performed under general anesthesia. There are higher probabilities of heart failure, previous heart attach, hypertension, diabetes, use of cigarette and Lung disorders related with older ages and kidney function disorders in many of the patients needing a heart operation. Therefore, the anesthesia of these patients requires a different approach.
The patients to be taken to the operation are asses by the anesthesia doctor at most one day prior to the operation and thus the most appropriate anesthesia method is planned. The anesthesia doctor prepares the medicine that would enable the patient to spend the night comfortably. After the tranquilizers medicine is applied to the patient in order to ease his/her excitement on the day of operation, the patient is taken to the operation room. The patient is plugged to respiratory device generally using general anesthesia. The blood pressure, heart speed and rhythm and heart pressures are monitored during the operation. At the end of the operation the patient is taken to intense care unit, and necessary checks are performed here. The patient is closely followed in the intense care unit and necessary precautions are taken against the risk of pain and infection. The patient, completing his/her recovery period in the intense care unit, is sent to the service aftermath of the final controls by anesthesia doctor and the surgeon.
What is the Maximum Number of Veins That Can Be By-Passed?
In coroner by-pass operations that have been performed in Medical Park Hospitals Group until today, by-pass of 6 veins simultaneously was accomplished.
Which Grafts are Used in By-Pass Operations?
The different grafts are used in by-pass operations. One of them is characteristically artery and the other is characteristically venius. Today mostly right or left breast artery and right or left arm artery are used as arteries. The grafts used as venius can be prepared both in right and Left legs. The graft decision in by pass operations depends on the age of the patient, the varying anatomical aspects of coroner veins, the other accompanying diseases and the number of by-passes to be operated. For the Last years, in patients who are younger than 60, only artery use are preferred while in patients above this age, generally artery and venious grafts are used depending on the number of by-pass to be operated.
How Long is the Period of Hospital Stay?
The hospital stay period of a patient who has normal attributions and are in the low-risk group varies between 4 and 6 days after the by-pass operation. In our clinic, every patient, after discharge from hospital, is recalled for policlinic control one week later and is referred to the cardiology department in order to prepare the medicines, perform the long-term follow-ups, and control the controllable risk factors [hypertension, obesity, cholesterol levels, blood sugar, stress, use of tobacco etc.]
The return to normal daily activities of the patient, depending on the clinical conditions prior to the operation, can take place between 2 and 4 weeks.
What is the Importance of Breathe Exercises After Operation?
Immediately after the by-pass operation, the patient is taken to the Intense Care Unit and his vital evidence are continuously monitored. The patients following a normal period after they are taken to the Intense Care Unit, are waken up in a few hours and unplugged from the respiratory device. From this moment onwards exercises are performed in certain periods under the supervision of breathing physiotherapists in the Intense Care Unit. The increase of secretions which are encountered in all surgical operations under general anesthesia is more frequently seen aftermath of a heart operation. While it is possible to clean mechanically these secretions in patient plugged into the respiratory device, the cleaning of the secretions only could happen by self-breathing exercises. Otherwise the secretion becomes gradually solid and turns into occlusions and thus leads to breathe disorders and decreasing levels of oxygen in blood.
What to Do After the Operation?
The fundamental philosophy of by-pass operations is to save the patient from the danger of immediate death and heart attack, to prevent a life style restricted by medicines and as a resuLt of these, to improve the life quality. Therefore the most important issue after these operations is to control the changeable risk factors that could lead to or facilitate vein disorders. Additionally another important matter is the regular controls and the follow-up of the disease level.