Q: What complications arising from heart attacks require surgery?
A: A number of conditions can result from an acute myocardial infarction, or heart attack, that warrant urgent surgical intervention. Recurrent chest pain in the early post-infarction period is a common indication for surgical treatment. A ventricular septal defect (a hole in the muscle wall between the two ventricular chambers at the site of the infarct) or acute mitral valvular insufficiency resulting from the heart attack also may require urgent surgery.
Q: What is a "bypass"?
A: A coronary artery bypass consists of a vascular conduit that is placed to allow blood to travel around an obstruction in a coronary artery. The new conduit may make use of a piece of vein or artery that has been removed from another part of the body. The top end of the graft is attached to the aorta. The bottom end is attached to the coronary artery beyond the obstruction.
Q: Can the blockages in the coronary arteries cause further trouble?
A: Surgery is not a cure for atherosclerosis, the metabolic disease that is responsible for obstruction of the arteries. Therefore, patients must be aware of all the factors that contribute to the process, including smoking, hypertension, diabetes, and high cholesterol, to name a few. Regular visits to a physician will help to control these risk factors which promote progression of the disease.
Q: What are the aortic and mitral valves and why would they require surgery?
A: There are four cardiac valves; one on the inflow and one on the outflow portion of each ventricle. They keep blood flowing by opening to allow forward flow and closing to prevent back flow. The mitral and aortic valves are on the inflow and outflow of the left ventricle. A variety of conditions may cause these valves to malfunction. When the condition results in significant failure of the heart to perform properly, it may necessitate repair or replacement of one or more of the valves.
Q: How much pain does a patient experience after bypass surgery?
A: Patients report remarkably little pain. There is almost no discomfort from the chest incision. It is in the midline and does not result in the cutting of any muscles. The leg incision, if a vein is taken from the leg, is a bit uncomfortable when the patient begins to ambulate on the first post-operative day. Recently, we have been making several short incisions in the leg to remove a segment of vein; this reduces leg discomfort a great deal.
Q: What are the surgical results?
A: Ninety-eight percent of patients recover from this operation and are on their feet within a few days. After complete recuperation, most return to all of their activities, including work and recreation. Most patients feel better than they have in years and do not require all of the medications that they had been taking before surgery.
Q: What does the patient have to do after surgery?
A: Patients are out of bed on the first post-operative day and start on a Cardiac Rehabilitation Program in the hospital. They are discharged on the fourth to seventh day and are given exercises to perform at home. After four to six weeks, an exercise stress test is performed and, if it is normal, a progressive aerobic exercise program with supervision and rapid escalation is recommended. We are fortunate to have an excellent facility at the Centre Club, for this supervised rehabilitation program. Control of all identifiable risk factors is very important. All coronary patients must see their physicians regularly.