Panama Medical Vacations

Having Your Coronary Bypass in Panama

Having Your Coronary Bypass in Panama

Coronary bypass surgery is the most commonly performed open heart surgery in the United States. It is used to surgically treat coronary artery disease, a hardening and narrowing of the arteries that supply oxygen and nutrients to heart muscle. This condition can result cause pain, create pressure and can lead to a heart attack.

The purpose of coronary bypass surgery is to create a new avenue for blood around a blockage by using arteries or veins from other parts of the body to transport oxygen and nutrients to heart. It is not intended to repair or remove blocked coronary arteries. Successful coronary bypass surgery can result in a dramatic increase in blood flow to the heart muscle, reducing the symptoms of coronary artery disease. The procedure can improve a person's quality of life and prolong life, especially when combined with a healthy lifestyle.

Prior to Surgery

Any necessary precautions prior to surgery will be outlined for you in the treatment plan.

Before surgery you will likely require:

  • An echocardiogram –This procedure is an ultrasound of the heart and it is done to evaluate the structure and function of the heart.
  • Cardiac catheterization – This procedure may be done to check for coronary artery disease or other cardiovascular disease that could complicate surgery. This is routinely done for patients over 40 years old.
  • Standard diagnostic tests – A standard set of tests, including blood tests, an electrocardiogram and a chest x-ray, are required.

If you are a smoker, you may be asked to stop for a time prior to your surgery. You might also be asked to refrain from using vitamin E (in large does), aspirin or anti-inflammatory medicines since they can lead to increased bleeding during surgery.

The Procedure

A coronary bypass surgery generally lasts between three and six hours and requires general anesthesia. Typically, three or four coronary arteries are bypassed during surgery, and sometimes as many as six or seven bypasses may be done.

Most coronary bypass surgeries are still done conventionally -- a chest incision is made and the sternum is divided so that the rib cage can be opened to expose the heart. Although the procedure is called open-heart surgery, surgeons don't actually open the heart. They work on the outside of the heart.

Typically a heart-lung machine is used. This machine takes over the function of the heart and lungs during surgery. It allows the surgeon to place replacement grafts that provide detours for blood flow around blocked coronary arteries. In coronary bypass surgery, this pause in heart function allows the surgeon to make the delicate maneuvers that are necessary.

Blood vessel grafts are obtained from other arteries and veins in the body. Typically an artery in the chest is used. It's diverted from the chest wall, and one end is attached to a diseased coronary artery beyond the blockage.

Once the procedure is completed, the heart is restarted. When the surgical team is satisfied that the heart is beating strongly again, the heart-lung machine is disconnected. The chest incisions are then closed.

The sternum will knit back together in six to eight weeks and will be just as strong once the healing process is complete.

After your surgery

After surgery, patients are placed in the intensive care unit (ICU) for up to two days. When patients awake from general anesthesia, they can be groggy and disoriented. Pain medication is used to minimize discomfort from the incision.

While in recovery, a patient breathes with the assistance of a ventilator. The breathing tube is usually removed within two to four hours after surgery. Intravenous (IV) fluids maintain hydration. One or more temporary drainage tubes exit the chest cavity to drain any excess blood or fluid that may build up after surgery. Patients may require blood transfusions during or after the operation.

The length of stay in the ICU depends on the complexity of the surgical procedure. When patients no longer requires the ICU's special facilities, they are moved to a monitored hospital unit.

Within 24 hours of surgery, most patients are out of bed, and they are able to walk within one or two days. Over the next few days, patients usually regain sufficient strength to be discharged within five to seven days after surgery.

When You Leave the Hospital

In most instances, recovery is rapid. Most patients are able to drive in about three weeks. Sexual activity can be resumed in three to four weeks. The main limitation to activity is healing of the sternum which may take up to 12 weeks.

Following conventional bypass surgery, a patient can expect a recovery period of about six to 12 weeks. People who have non-physical jobs often return to work after six weeks. It may be 12 weeks or more before patients can return to strenuous jobs.

Once fully recovered, most people who have bypass surgery are able to resume normal activities, and over 90 percent have a substantial lessening of angina. However, new blockages may occur and may require a second bypass, angioplasty, other procedures, or changes in medication. The risk can be reduced by discontinuing smoking, eating a healthy diet, taking prescribed medications and getting regular physical activity.

Most patients can expect to feel more tired than usual and their stamina may not yet be completely normal. Full energy levels usually start to return in about three months. After six months, most patients are back to normal.

Nearly all patients benefit from cardiac rehabilitation after surgery. Rehabilitation usually focuses on lifestyle changes, including diet and exercise as well as psychological issues. These programs are tailored to each person because individual circumstances vary and different people go into surgery at different levels of health.

Risks

If you're undergoing a scheduled operation to bypass a diseased coronary artery, your risk of death is usually low, but still depends on your overall health. The risk is significantly higher if the operation is done as an emergency or if you have other significant medical conditions such as emphysema, kidney disease, diabetes or peripheral vascular disease. Complications — such as arrhythmias, kidney failure, stroke and infections — also may occur after heart surgery.

Some people experience a decline in memory and other cognitive functions after undergoing coronary bypass surgery. Predictors include older age, high blood pressure, lung disease and excessive alcohol consumption. Of those people who do lose some cognitive ability, most gradually regain their intellectual abilities within six to 12 months. Bypass surgery doesn't cause dementia, but it may worsen any pre-existing mental decline, including early dementia.