Minimally Invasive Heart Bypass Surgery


Minimally Invasive Heart Bypass Surgery

 

THE PROCEDURE

Recent advances in surgical technique and equipment allow our surgeons to perform coronary artery bypass surgery in a less traumatic way. These types of procedures are called “Minimally Invasive Bypass Surgery”, “port-access” or “keyhole surgery”. Minimally Invasive Cardiac Surgery (MICS) include smaller incisions, avoidance of the heart-lung machine, or both.

 

For select patients, our surgeon may decide that Minimally Invasive Bypass Surgery is appropriate, as this technique is usually used only when certain conditions exist. If multiple coronary arteries need to be worked on, it is best to employ a conventional approach.

 

Unlike conventional surgery, which has a 10"-12" incision and places the patient on the heart-lung machine, new minimally invasive approaches may avoid placing the patient on a heart-lung machine, and can be performed through a 3"-5" incision placed between the ribs, or may be done with several small incisions.

 

Advantages of heart bypass surgery

The surgery carries many benefits, including some particularly for patients who have serious cardiovascular disease.

The operation can save your life if you are having a heart attack or are at high risk of having one.

If you have ongoing angina and shortness of breath from diseased heart arteries, elective coronary bypass surgery is highly effective at eliminating or reducing discomfort. Coronary bypass surgery can give you your life back.

Because coronary bypass surgery is an open-heart procedure requiring general anesthesia and in many cases that the heart is stopped during the operation, bypass carries risks. The good news is that recent decades have seen a steep drop in serious complications. Today, more than 95 percent of people who undergo coronary bypass surgery do not experience serious complications, and the risk of death immediately after the procedure is only 1–2 percent.

The risk of serious complications is higher for emergency coronary bypass surgeries, such as for patients who are having a heart attack, when compared to elective surgery for treatment of angina and other symptoms. Additionally, patients may be at higher risk if they are over 70 years old, are female or have already had heart surgery. Patients who have other serious conditions, such as diabetes, peripheral vascular disease, kidney disease or lung disease, may also be at higher risk.

People who have Minimally Invasive Bypass Surgery recover faster, have significantly less pain, and experience fewer post-surgical complications than those who undergo traditional open-heart coronary bypass surgery.

 

Risks Associated with Heart Bypass Surgery

While complications from coronary bypass surgery are relatively rare today, your care team will make every effort to guard against them and to treat them if they do develop. They may include the following:

  • Risk of bleeding from site of attached graft and other sources. About 30 percent of patients will require blood transfusions after the surgery. Very rarely, bleeding will be severe enough to require additional surgery.
  • Heart rhythm problems. Atrial fibrillation (a condition in which the upper chambers of the heart quiver rather than beating properly) is a common complication of coronary bypass surgery and can contribute to blood clots that form in the heart and that can travel to other parts of the body. Other forms of heart rhythm problems are possible as well, though less common.
  • Blood clots. If blood clots form, they can cause a heart attack, stroke, or lung problems.
  • Infection at the incision site where the chest was opened for surgery. This complication is rare, occurring in only about 1 percent of coronary bypass patients.
  • "Post-pericardiotomy syndrome." This condition occurs in about 30 percent of patients from a few days to 6 months after coronary bypass surgery. The symptoms are fever and chest pain.
  • Kidney, or renal, failure. Coronary bypass surgery may damage the functioning of a patient’s kidneys, though this is most often temporary.
  • Memory loss or difficulty thinking. Many patients report difficulty thinking after coronary bypass surgery. This problem typically improves in 6 months to a year. Researchers are not sure what causes this, though one theory is that the use of a heart-lung machine to allow surgery on the heart dislodges tiny bits of fatty build-up in an artery that can travel to the brain. Studies have been inconclusive about whether surgeries on a beating heart and without the heart-lung machine reduce this complication.
  • Reactions to anesthesia. As with any surgery performed while the patient is “asleep,” patients may have reactions to the anesthesia, including difficulty breathing.
  • Death. In-hospital death is very rare after coronary bypass surgery. It is typically caused by heart attack or stroke.

What about alternatives to coronary artery bypass?

In some patients, alternative treatment of coronary artery disease includes medical therapy with specific medication or non-surgical treatment such as Balloon Angioplasty, Laser Angioplasty, Stents or Atherectomy (plaque removal). Our Cardiologist will help decide which treatment is best for you.

 

PREPARATION FOR SURGERY

Before traveling to Cyprus, as part of your surgery preparation we require detailed medical information in the form of a medical questionnaire, ECG, Pulmonary tests and blood work. In some cases an Angiogram is required. All of this information will allow the doctors that we work with to determine your eligibility for the procedure.

Your surgeon will give you specific instructions about any dietary changes or activity restrictions you should follow before surgery.

Tell your surgeon what medications you are taking, especially aspirin or an anticoagulant ("blood thinner"). Your surgeon will tell you if you should stop taking them. Also bring a complete list of your current medications (including over-the-counter drugs, vitamins and herbal supplements), allergies, your medical records and any health insurance information.

If you smoke, stop immediately to improve your blood flow and breathing.

If you develop a cold, fever or sore throat within a few days of your surgery, or have other questions or concerns, contact our offices immediately.

Ten days prior to your arrival in Cyprus, you will receive all the necessary pre operative instructions, to prepare yourself both physically and mentally for your chosen procedure.

Upon arriving in Cyprus, as part of the pre-surgery tests done at our partner hospitals you will again receive chest X-rays, blood tests, an electrocardiogram and a coronary angiogram, which is a special type of X-ray procedure that uses dye to visualize the arteries that feed your heart.

Your surgeon and anesthetist will also go through you medical and surgical issues with you. During this visit, your surgeon will discuss your procedure and answer any questions.

Getting your house ready before surgery

It is also important to get your house ready for after you come home from the hospital. At first it will be harder for you to move around, so arrange your furniture and household items ahead of time to make it easier for you during your rehabilitation.

  • Remove all your throw rugs or anything on the floor that may cause you to trip.
  • Move phone and electrical cords close to the walls.
  • Move necessary personal items you need to reach to shelves and tables that are above your waist level.

Preparation for the hospital

Here are a few things to keep in mind as you pack and prepare for the hospital and recuperation:

Clothing
Getting dressed in the morning helps you feel better, so be sure to bring some comfortable clothing to the hospital:

  • Loose shorts or pants
  • Loose tops or T-shirts
  • Underwear and socks
  • Short robe or pajamas
  • Toiletries

Day before surgery

Your surgical nurse will provide you with these instructions the night before surgery:

  • The night before your surgery, you can eat a normal meal, but do not eat, drink or chew anything after 12 o'clock midnight. This includes gum, mints, water, etc.
  • When brushing your teeth, avoid swallowing any water.
  • Bathe or take a shower, wash from your neck down with the anti-bacterial soap provided.

Morning of surgery

On the day of your surgery, your designated SALUS Patient Concierge along with a nurse may talk with you and your loved ones. They shall tell you what to expect. You will most likely feel a little nervous before surgery, so the SALUS team and the hospital staff will do all they can to answer your questions and help you relax.

Make sure all your medicines in their original containers with you to the hospital.

You will meet with the anesthesiologist who will talk to you about general anesthesia. This is a controlled sleep while the surgery is being done so you will not feel any pain or remember the surgery.

You should leave jewelry, watches, money and other valuables with the person who accompanies you or with our staff member who will place them in our safe.

Proceed with your routine morning care:

  • If you bathe or take a shower, wash from your neck down with the anti-bacterial soap provided.
  • To help prevent infection, any hair in an incision area may be shaved. You may also be asked to wash with an antibacterial soap the morning of surgery.
  • Women should not wear any makeup and must remove any nail polish.

You will have an IV or intravenous line put in to give you fluid and medicine during your surgery.

When it is time for you to go to surgery, your family/ companion will be asked to wait in the waiting area. Your doctor will talk to your family/ companion there after your surgery is done.

 

RECOVERY AFTER SURGERY

After surgery, the patient is moved to the Cardiac Surgical Intensive Care Unit where family members can visit the periodically.

Heart rate and blood pressure monitoring devices continuously monitor the patient for 12 to 24 hours. Medications that regulate circulation and blood pressure may be given through the I.V. (intravenously). A breathing tube (endotracheal tube) will stay in place until our surgical team is confident that the patient is awake and ready to breathe comfortably on his or her own. The patient may feel groggy and disoriented, and sites of incisions may be sore. Painkillers are provided as needed.

Patients usually stay in our partner hospitals for about one week or longer if necessary, after surgery. This time is much longer than what is normally necessary, however, it does give our surgeon adequate time to monitor post operative recovery. During this time, some tests will be done to assess and monitor the patient’s condition.

Hospital discharge and home instructions

Your diet is slowly increased from ice chips to liquids to solid foods as your intestines start functioning.

You will remain hospitalized for about 10 days while your heart is monitored and your vital signs are checked frequently.

Before leaving the hospital, our surgeon and staff will help you adjust to recovery in every way possible. You will receive specific instructions and precautions from your surgeon and nursing staff and they will show you safe techniques of simple activities like getting in and out of bed, bathing, going to the bathroom, managing steps at home and getting in and out of a car.

You will be able to leave the hospital when you are:

  • Able to eat a regular diet and drink fluids
  • Passing gas or you have had a bowel movement
  • Passing urine
  • Not having a fever or other signs of infection
  • Walk for short distances

LIFE AFTER SURGERY

These guidelines give you an overview of what you may expect as part of your care after you leave the hospital. Be sure to follow your doctor’s discharge instructions if they are different from what is listed here.

 

YOUR ACTIVITY 

After release from the hospital, the patient may experience side effects such as:

  • Fatigue, mood swings, feelings of depression, difficulty sleeping
  • You may have pain in your groin area, arm, or wrist. This is from the catheter (flexible tube) that was inserted to do the procedure.
  • You may also have some bruising around and below the incision.

Many of these side effects usually disappear in less than 1 week

Patients are often advised to eat less fat and cholesterol and to walk or do other physical activity to help regain strength.

Doctors also often recommend following a home routine of increasing activity- doing light housework, going out, visiting friends, climbing stairs. The goal is to return to a normal, active lifestyle.

Most people with sedentary office jobs can return to work in 1 week. Those with physically demanding jobs will have to wait longer.

Physical Activities

You may do light, quick activities where your arms are above your shoulders, such as brushing your hair. But do not do any activities where your arms are above shoulder level for a long time, such as washing a window or dusting a high shelf. Do not do any activity that causes pain or pulling across your chest.

To get the most out of your day, plan to do the most important activities first. Don't try to do everything at once, and schedule unfinished activities for another day. Make sure that you get plenty of rest in between activities.

Climbing Stairs and Steps

Unless restricted by your doctor, it's okay for you to climb stairs and steps. If you need to, stop and rest before you finish walking up or down a full flight.

Fatigue

Fatigue is probably the number one patient complaint following any heart procedure. Fatigue results from an extended lack of sleep while in the hospital, energy used by your body to heal its wounds, and energy used to fight off pain. To combat fatigue, listen to what your body is telling you. Space your activities to allow for rest periods. Take plenty of naps, walk regularly, eat well, and use your pain medication as needed. It's important that you rest and get a good night's sleep. Even if it's early in the night, if you feel tired, go to bed.

Driving and Riding in a Car

You should not drive for 1 week from the date of your procedure.

Traveling

Delay vacations or extended trips away from home for approximately 2-3 weeks, or until after the first post operative visit with your surgeon. Avoid air travel for two weeks from the date of your discharge. This restriction is designed to prevent you from being too far away from your surgeon should a problem arise.

Sex

You may resume sexual activity after 1 week of your procedure.

Exercise

Proper exercise will help your healing and recovery, as well as increase your stamina, maintain your ideal weight by burning calories, and lower stress in your everyday life.

Tips for exercising:

  • Check with your doctor or cardiac rehabilitation specialist regarding exercises that are safe for you to do immediately after the procedure and in the long term.
  • Make your exercises a regular/daily routine. Try to walk every day and gradually increase your distance over time.
  • Instead of going for a straight distance, you may want to walk around your block several times so that you are always close to home.
  • Don't worry about how fast you are walking, but concentrate on how much you are walking.
  • Take someone with you the first few times you walk.
  • Always wear comfortable clothes and shoes.
  • Don't exercise if the weather is bad, or if it's too cold or too warm outside. Because of the controlled temperature, an indoor shopping mall is a good place to walk.

Make sure you are not exercising too hard. Stop if you are exhausted, short of breath, feel dizzy, or have discomfort in your chest. Call your doctor if these symptoms persist and you are not able to do your regular exercises.

 

YOUR DIET

Along with exercise, eating healthy will speed up your recovery and healing. If your appetite is poor, try to eat smaller but more frequent meals.

Depending on your condition, your doctor or dietician may put you on a special diet. For example, patients with heart failure must follow a 2,000 mg low-sodium diet. Diabetic patients must follow a low-sugar, low-fat diet.

Tips to healthy eating:

  • Eat a variety of healthy foods.
  • Choose foods low in fat and cholesterol.
  • Eat less salt or sodium.
  • Cut back on sugar and sweets.
  • Eat more carbohydrates (potatoes, rice, pasta, vegetables) and fiber ("roughage").
  • Limit portion sizes.

Poor Appetite and Nausea

Many patients lose weight in the postoperative period. They complain of lack of appetite and mild nausea. Certain medications such as pain pills may cause nausea. Try eating small frequent amounts of food, and take medications on a full stomach unless otherwise directed. If you continue to experience nausea or lack of appetite, call your primary physician.

Constipation

Constipation is due to inactivity, limited fluid intake and lack of dietary fiber. It is aggravated by medications such as pain pills and iron. Eating plenty of fiber and fresh fruits, drinking 6-8 glasses of water daily and using your prescribed stool softener (Colace) as instructed can usually relieve constipation. If this does not work, Milk of Magnesia or Dulcolax may be helpful. Avoid Milk of Magnesia if you have kidney problems.

Caloric Restriction

Your total calories may be changed to increase, decrease, or maintain your weight as necessary. Being overweight increases the work of the heart. Your drug therapy may cause you to be hungry, you may eat more, and you may then gain weight. It is, therefore, very important that you pay attention to the total amount of food you take in. In addition to adding to the work of your heart, being overweight is associated with high levels of Triglycerides (fats) in the blood stream. Having a lot of fats in your blood increases the possibility of having the blood vessels of your heart become thickened. This will be described in more detail in the section on cholesterol and fats that follows.

Cholesterol and Saturated Fat Restriction

Cholesterol is a necessary fatty substance found in the body and many animal foods. Fats are concentrated sources of energy which occur in three forms: polyunsaturated, monounsaturated, and saturated. People who have large amounts of cholesterol and saturated fats in their blood are at increased risk of having thickening of their blood vessels throughout their bodies. This is because saturated fats and cholesterol in your blood will gather along the walls of your blood vessels causing them to narrow. If this narrowing becomes severe in the blood vessels of your heart, the blood supply to your heart will not get enough oxygen, and the cells of your heart will die. This is called "Coronary Artery Disease."

In addition to your diet, your medications may also increase the level of fats in your blood. Thus, in order to prevent coronary artery disease, your overall fat intake must be restricted after the procedure. Generally, your overall fat intake should not be more than 30% of your total calories each day. Increasing the proportion of monounsaturated and polyunsaturated fat in your diet and decreasing your total saturated fat intake to less than 10% of your total fat intake will actually help to lower cholesterol and saturated fat levels in your blood. The aim of this diet is to keep the levels of fats in your blood within normal limits.

Foods high in cholesterol & saturated fats

  • Animal products : Liver and organ meats, luncheon meats like liverwurst & salami, other meats, egg yolks, whole milk, butter, cream, and whole milk cheeses.
  • Vegetables high in saturated fats : Coconut, palm, and cocoa.
  • Other : Fried foods.

Note :Instead of frying your foods, try to bake, boil, or steam when preparing foods.

Foods high in monosaturated and polyunsaturated fats

  • Meats and other protein foods : Lean meats, low fat dairy products, and fatty fish (salmon, tuna, trout, bluefish).
  • Vegetable fats : Olive oil, corn oil, soybean oil, sesame oil, sunflower oil, and tub margarine.

Concentrated Carbohydrate Restrictions

You may be asked to cut down on the amount of sugar and concentrated sweets in your diet as well. Carbohydrates not only add to calories, but large amounts may contribute to an increase in the Triglycerides on the blood.

Fluid and Sodium Restriction

  • Salt is made up of two minerals - Sodium (Na+) and Chloride (C). It is the sodium portion of salt that we are concerned with in your diet. Sodium must be restricted in your diet because it causes your body to hold fluids.
  • You must also control your sodium and fluid intake since Prednisone causes your body to hold both of these. The result of holding fluid and sodium is that extra fluid builds up in your veins and arteries. To avoid this fluid and sodium build up, you should cut down on both.
  • To cut down on fluids, choose solid foods instead of liquids; for example, eat fruit instead of drinking juice. To cut down on salt, your doctor may prescribe a sodium-restricted diet for you. Your diet order may read: "No added Salt" or 3 to 4 gram Na+ diet. The doctor may also prescribe a water pill to help get the sodium and fluid out of your system.

Meat and Other Protein Foods

Ham, Canadian bacon, bacon, luncheon meats, frankfurters, sausages, scrapple, pepperoni, dried beef, chipped beef, corned beef, canned meats, pastrami, canned fish, sardines, herring, lox, anchovies, smoked salmon, caviar, cheese, regular peanut butter, and frozen TV dinners.

Vegetables
Sauerkraut or other vegetables prepared in brine, olives, pickles, relish, vegetables packed with sauces or seasonings, salted mixed vegetable juice (V-8), regular tomato juice, regular spaghetti sauce, tomato sauce or tomato paste, frozen peas, and lima beans.

Breads & Cereals

Bread and rolls with salt toppings, corn chips, potato chips, salted pretzels, salted popcorn, and other salted snack foods.

Fats
Bacon fat, salt pork, olives, salted nuts, party spreads and dips.

Soups
Canned broth soups, commercially prepared stews, bouillon cubes, and instant or dried soups.

Other
Be careful of monosodium glutamate (MSG) used in Chinese food. When you order Chinese food, you can request that it be prepared without MSG.

Note: You should check with your doctor or dietician before using salt or salt substitutes.

Medications

Your medicines: Take the medicines you were taking before procedure, unless your surgeon has made a change.

Your doctor will likely prescribe medications (anticoagulants) to prevent blood clots, relax your arteries and protect against coronary spasms.

Call your surgeon right away if you have:

  • Diarrhea that lasts more than three days
  • Nausea and vomiting that will not go away
  • Pain in your abdomen that gets worse or isn’t eased by the pain medicine
  • Pus drainage or redness around your incision
  • Fever with a temperature of 100.5 or higher

SLEEPING PATTERNS

You should return to your normal sleeping patterns within 2-3 weeks. Try these tips to help you sleep:

  • Make sure you take enough rest breaks in between your normal daily activities, but avoid napping during the day.
  • Talk to a trusted family member or a friend if you have something on your mind.Get it off your chest so it worries you less when you are trying to sleep.
  • Avoid caffeine, especially after dinner. Remember that there's caffeine in regular coffee and some sodas, as well as chocolate and tea.
  • Take a relaxing shower (or bath, if permitted). Listen to relaxing music.
  • Take your pain medication about ½ hour before bedtime.
  • Find a comfortable sleeping position by arranging the pillows.

If you still have problems sleeping after 2-3 weeks, call your doctor.

Night Sweats

Patients often complain of night sweats for the first few weeks. Should you experience this, check your temperature to make sure that you do not have a fever. If your temperature is 101 degrees Fahrenheit or greater, call your doctor. If you do not have a fever, there is very little that can be done, but you should make yourself as comfortable as possible while waiting for the night sweats to go away. Change your linens and pajamas so you do not sleep in a damp bed. Night sweats usually disappear in a few weeks.

Disturbed Sleep

Following the procedure, some patients experience nightmares or insomnia. This will also disappear with time. To help you sleep better, try shortening your naps during the day and/or increasing your afternoon activities so that you will feel tired in the evenings. It is OK to sleep on your back, side or stomach. You will not hurt your incisions.

 

FOLLOW- UP

Follow-up after your procedure is extremely important and our surgeons at Salus are committed to providing all the post surgical care you need. In order to identify and treat any complications as they may arise, close, lifetime follow-up is essential.

Any time before your appointments, you should call your doctor if you:

  • Experience chest pain or discomfort similar to what you felt before the procedure.
  • Have new or increased swelling of the legs and feet.
  • See any signs of infection at the incision line.
  • Gain weight of more than 2 pounds in one day.
  • Have a fever higher than 101 degrees Fahrenheit (38 degrees Celsius).
  • Experience new or increasingly rapid or irregular heart beats.
  • Have shortness of breath or dizziness even when you are resting.