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Protecting Your Heart
Creating Detours in the HeartNew techniques are being developed for bypass surgery
How a Bypass Works
Cardiac RehabilitationOnce your surgery is over, it’s time for the next phase of treatment. “Cardiac rehabilitation is absolutely essential for successful recovery,” says cardiologist James Pantano, M.D., of Lehigh Valley Hospital and Health Network.Patients typically start rehab while still in the hospital and continue for several weeks afterward to boost healing and help prevent future problems. The program includes exercise, stress management, dietary advice and education on topics like smoking cessation and weight loss. Your heart is a hard-working muscle that needs a steady supply of oxygen-rich blood to keep it pumping. That flow can’t happen when coronary (heart) arteries get clogged with a fatty substance called plaque. Many different factors contribute to a blocked artery, but the end result is the same—chest pain (angina) and eventually, a heart attack. Bypass surgery is one way to treat blocked arteries by rerouting blood around the blockage. If you’re diagnosed with coronary artery disease, in most cases your doctor will first recommend lifestyle changes. While you can’t control heart disease risk factors like family history or age, you can exercise, follow a low-fat diet, lose weight and quit smoking, says cardiologist Robert Biggs, D.O., of Lehigh Valley Hospital and Health Network. Your doctor also may prescribe medications to lower your cholesterol and blood pressure. For serious one- or two-vessel blockages, you may need an “interventional” technique to improve the blockage, such as angioplasty (opening the artery with a balloon-like device) or stenting (inserting a tiny wire mesh tube to keep the artery open). “This is especially important for patients with unstable angina or heart attack,” Biggs says. If these treatments fail, it’s time to consider a bypass. “That also may be the best treatment for patients with severe, multivessel blockages, especially with low heart-pump function,” he says. Most bypass surgeries involve a breast bone incision and the use of a heart-lung machine so the surgeon can operate on a quiet heart. A healthy artery or vein is sewn to the affected vessel to bypass the blocked portion. “This standard approach, used in more than 90 percent of our patients, is well-tolerated and yields excellent results,” says cardiac surgeon Raymond Singer, M.D., of Lehigh Valley Hospital and Health Network. The hospital’s surgeons perform more than 1,000 heart procedures annually, with some of the best reported results in Pennsylvania. At the same time, they are researching less-invasive techniques that offer a speedier recovery for the patient. These include:“Beating heart” or “off-pump” surgery — While the heart-lung machine allows surgeons to perform complex procedures, there are potential side effects. “In select cases, we can perform a bypass with the heart beating,” Singer says. “There are some theoretical advantages to this approach, but most patients still benefit more from conventional surgery.” “Small incision” or “endoscopic” surgery — Surgeons now routinely work through small incisions when “harvesting” a healthy artery from the arm, or vein from the leg, for use as the bypass graft. “This greatly speeds recovery, since patients can get up and walk sooner,” Singer says. As for a small chest incision for the bypass itself, “that has not come to fruition yet,” he says. “But we’re making advances in small-incision valve and arrhythmia surgery.” While bypass surgery restores blood flow to the heart, Biggs says, it doesn’t address the underlying heart disease. Even after surgery, you’ll need to work on re-ducing your risk through diet, exercise and other lifestyle measures. This page last updated 2/12/08 04:08 PM
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