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Why Is Bypass the Last Resort?

Friday, 12 Jun 2015 03:39 PM Current | Bio | Archive

There’s no minimizing the trauma of a bypass surgery. Opening a patient’s chest cavity like the door of a birdcage inevitably puts a tremendous stress on the whole body. The grafts (sections of good vessel substituted for blocked vessel) are usually taken from veins in the legs.

But those vessels were meant to support a lower carrying capacity — to be part of a lower blood pressure system — than the vessels near the heart. When they are grafted to the main arteries near the heart, they become part of a high pressure system.

Also, the way the veins are dissected from the leg and then stretched to make them fit the graft can damage the tissue of the vessel.

Another bypass method is to redirect the right and left internal mammary arteries that feed the tissues over the breastplate. In this case, one or both arteries are separated painstakingly from the surrounding tissues and redirected to the heart.

The great plus of using the mammary arteries is that they are meant to be part of a high pressure system, so they don’t inevitably close up. They also have enough sub-arteries branching off of them to continue feeding the tissues over the breastplate — at least in non-diabetic patients.

Diabetics can only use one of their mammary arteries for a bypass; otherwise, the tissues over the breastplate don’t receive adequate blood flow.

Even so, in triple, quadruple, or quintuple bypass procedures, human veins or pig vessels have to be used for the other grafts. Using internal mammary arteries is a much more difficult procedure — beyond the skill level of some surgeons. It’s a time-consuming operation, and any increase in the duration of a surgery increases the risk.

Any patient who opts to have the internal mammary arteries used for grafts must consider this.

All told, 15 percent of bypass surgeries fail within the first three months. Within 10 years, 50 percent of bypass grafts have plugged up. Chances are that a bypass surgery will fail at some point.

The surgery itself also carries the risk of sternal infections, stroke, and blood clots in the lungs.

And there are particular risks for patients 70 years or older. In order to perform bypass surgery, the surgeon assigns blood flow and respiration to a heart-lung machine. This allows the surgeon to work on a quiet heart that’s no longer beating, and one that, drained of blood, goes from its normal globular shape to being flat as a pancake.

This “quiet field” is the ideal landscape for the delicate incisions and suturing that must be done on grafts. Unfortunately, heart-lung machines carry the risk of what’s commonly known as “pump brain.”

No one knows exactly why, but patients who are put on heart-lung machines can suffer neurological damage, such as confusion or loss of memory — and in the elderly, there is a possibility of introducing or exacerbating dementia.

An elderly patient could undergo a bypass operation that seems a resounding success, ridding him of heart disease completely — only to quickly decline into a dementia that results in death.

In addition, during bypass surgery the lungs are deflated and tubes are inserted into the bottom of each lung to drain fluid. After surgery, the lungs remain partially collapsed.

For this reason, bypass patients are urged before surgery to take deep breaths as soon as they wake up from the anesthesia — their lungs need clearing.

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There’s no minimizing the trauma of a bypass surgery. Opening a patient’s chest cavity like the door of a birdcage inevitably puts a tremendous stress on the whole body.
heart disease, bypass surgery, pump brain
Friday, 12 Jun 2015 03:39 PM
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