JAKAYA KIKWETE CARDIAC INSTITUTE (JKCI)

Cardiovascular Surgeries

When the coronary arteries are found to be significantly blocked, the treating doctor manages this by giving the blood a new pathway to reach the heart muscles. During the surgery, blood vessels can be taken from leg (saphenous vein), inside chest (internal mammary artery) or arm (radial artery) and placed around the area or areas of narrowing to "bypass" the blockages and restore blood flow to the heart muscle.

On-pump(Traditional) Bypass Surgery

During surgery by this method, the surgeon makes a cut (about 6 to 8 inches) in the center of sternum/breastbone in order to get direct access to the heart. Patient is connected to a heart- lung bypass machine, which helps in circulation of blood throughout the patient's body during surgery.

The heart is stopped (generally for about 30-90 minutes of the 4-5 hour surgery) and then the cardiac surgeon performs the bypass surgery described above. After the grafting is done and the surgery gets completed, the surgeon then closes the breastbone with special sternal wires and the chest with special internal or traditional external stitches.

Bypass Surgery (CABG)


Off-pump or beating heart surgery

Surgery by this method allows surgeons to perform surgery while the heart is still beating. The heart-lung machine is not used here. Rather, the surgeon uses highly developed operating equipments to stabilize/ hold portions of the heart and then bypass the blocked or diseased artery. In the meantime, the rest of the heart keeps pumping and circulating blood to the body. With this technology, all coronary arteries can be bypassed off-pump. The off-pump technique may be suitable for those patients who have higher risk of complications from being placed on the heart-lung machine, for example, those who have vascular disease, significant plaque buildup in the aorta, stenosis of carotid artery, transient ischemic attacks (TIAs), or patients with breathing or kidney function problems.

The decision to use off-pump surgery is taken by the treating doctor, depending upon the patient's condition.

One of the goals of beating heart surgery is to eliminate the detrimental effects associated with the use of cardiopulmonary bypass (heart-lung machine). Although these complications occur only in 2-3% of cases but can be avoided by OPCAB surgery. Off-pump surgery requires (OPCAB) less blood transfusion, shorter operating time, less time on the breathing machine, decrease critical care area stay and lesser hospital stay. The elderly, high risk patients or patients with multiple co-morbidity can do much better when the bypass procedures are carried out without the heart-lung machine.

Minimally Invasive Heart Bypass Surgery

It is also known as Minimally invasive direct coronary artery bypass - MIDCAB or Keyhole heart surgery. This surgery is done without stopping the heart and therefore, the patient does not need to be put on a heart - lung machine. The surgery is performed through a small incision (about 3 inches) in the chest. Muscles in the area are then pushed apart and a small part of the front of the rib, called the costal cartilage, is removed. The surgeon then locates and prepares an artery on the patient's chest wall to attach to coronary artery that is blocked.


And then the surgeon connects the prepared chest artery to the coronary artery that is blocked. A device is then attached to the heart to stabilize it.

Following are some of the advantages of minimally invasive bypass surgery :

Less Bleeding and thus lesser blood transfusion.

Lower risk of infection

Minimum pain and trauma

Faster recovery time

Shorter hospital stay - 3 days in most cases, instead of 7 to 8 days of stay in surgery by traditional method.

Smaller scar due to small incision.

Recovery after heart surgery:

Heart-healthy Lifestyle changes are strongly recommended after cardiac surgery.

Take medications as prescribed.

Quit smoking

Treatment of high cholesterol

Management of high blood pressure and diabetes

Exercise regularly

Maintain a healthy weight

Eat a heart-healthy diet

Participate in a cardiac rehabilitation program recommended by the treating doctor.

Regular follow up with your doctor

Regular Comprehensive Cardiac Check Up followed by review from the specialist.

Getting Out of Bed

Getting out of bed is easier if you do the following:

Move closer to the edge of the bed by rolling over on your side.

Swing your legs to the floor and push your upper body up with your elbow; use side rails for help but not for total support of body weight.

Sit on the side of the bed for a couple of minutes to make sure you will not be dizzy.

Stand up

Incision Care

Many patients and attendants feel that they should not leave the hospital till all the stitches are removed. It is really not necessary, if you maintain personal hygiene and do proper cleaning and dressing of your stitches. This is very important in order to avoid infection. Remember that your stitches are quite safe if you take care of the following points while handling them at home:-

  • The incision site should not become wet.
  • The stitches should be cleaned with betadine lotion every day.
  • The attendant must wash hands properly; the nails should be short, before they clean the stitches.
  • Pour betadine lotion in a clean and dry bowl.
  • Beta dine lotion should never be diluted.
  • Do not use cotton wool for cleaning the stitches. Use sterile gauge instead.
  • You need to take one piece of sterile gauge.
  • Dip one piece of gauge in betadine lotion and gently clean the stitches in one direction. Do not press or rub hard. Throw the leftover gauge pieces of the pack. Everyday use a fresh pack of gauge pieces for cleaning the stitches.
  • Do not keep touching the stitches or place hand on the chest while sleeping.
  • Throw away the remaining solution of bowl and clean it thoroughly before using it again.

Clean the leg stitches also in the same manner. Patients with leg stitches should not sit cross legged. Avoid sitting on floor/low stools etc. Do not use Indian toilet seat. If you have to sit on a chair for a long time, place your legs on some stool/another chair i.e. at hip level. This will prevent swelling in the feel which is otherwise very common. Let the lotion get absorbed for at least 5 mins before you put on your clothes. It is fairly easy to do the dressing and you do not need any professional help for this. Thus, there is no need to go to the hospital for the same.

Till the stitches are removed, daily sponging is required. Use lukewarm water, Boil water for 15-20 minutes. Cool it and add a few drops of Dettol or Savlon in it. Use a clean towel and make sure that the wet towel does not touch the stitches.

Heart - healthy Diet For Bypass Surgery Patients

A heart healthy diet helps in the recovery process. It is essential that you adhere to the diet chart provided by your health care provider/dietician. It is suggestive to follow a personalized diet plan that includes specific food for heart patients. You are advised to eat small meals throughout the day.

Following are a few heart healthy diet tips that you can discuss with your doctor and nutritionist:

  • Limit your fat intake with a low fat diet, but don't abolish fats altogether. Variety is essential.
  • Your daily diet should include plenty of fresh fruits and vegetables.
  • Skinless chicken and lean meats like fish and are healthy if taken in small/medium servings only.
  • Simply consume low fat varieties of milk and yogurt, and keep away from egg yolk although egg whites are fine.
  • Significantly reduce your intake of products that are caffeinated and avoid all alcoholic beverages.
  • Reduce your intake of sugar rich refined foods like chocolates, cakes, and biscuits.
  • Also, Cut down on your salt intake as much as possible for you.

Patient Testimonials

The smiles on their faces show appreciation after successfully surgeries

Happy kids after successfully surgeries

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