Heart Bypass Complications

Heart Bypass Complications


Coronary artery bypass surgery is usually reserved for patients with multiple sites of disease in their coronary arteries. Patients with diabetes and poor heart function may do better with bypass surgery than with angioplasty, according to MayoClinic.com. Heart bypass surgery requires the surgeon to use pieces of vein from the legs or other extremities and place them on the heart to bypass the blocked vessels. Sometimes the surgeon uses the internal mammary artery for bypass as well. This major surgery does have potential complications.


According to the Mayo Clinic, complications are rare following heart bypass surgery. The most common problems are stroke, bleeding, irregular heart rhythm (arrhythmias), kidney failure, memory loss that can persist for six months to a year, and infections of the chest wound.


Fact is, bypassed arteries may be blocked again but not for another ten to fifteen years and depending on the patient’s lifestyle after the surgery.


Here are the reported serious as well as mild complications of the surgery, either triple bypass surgery or quadruple bypass surgery. The injection of general anaesthesia on the patient could lead to serious problems like state of shock and heart collapse. It would take time to revive the heart and may be fatal to the patient. The mild allergic reactions of the patient are nausea and vomiting.


Another risky complication during the surgery is the bleeding of the organs near the heart or the heart itself. It would imply great loss of blood from the patient and would require bags of blood to transfuse and replace the loss. The patient must be prepared with bags of blood with the same blood type ahead of time. Blood clotting may also take place during the surgery. There is a machine called heart- lung bypass that assists the surgeon to keep the blood from the heart to divert the flow through the machine.


Memory loss is another mild complication after the surgery. The lack of sleep and narcotics injected cause confusion and memory loss. Often times, this will only last for a few days and soon after the patient will regain his memory again.


Lastly, the worst surgery complication is infection. The infection may start from the incised area of the chest and getting vast penetration inside. It may reach the immediate organ involved in the surgery which is the heart. Infection may affect other organs like the lungs and the bladder. If it affects the lungs it may lead to pneumonia and the bladder infection may lead to cystitis. Infection could also travel through the bloodstream that may lead to sepsis.


It must be countered with strong and costly antibiotics given to the patient through intravenous fluids. The vial is injected directly to the intravenous fluid that penetrates the veins of the patient. The patient who has acquired sepsis stays at the hospital for few weeks to have the infection fully reversed. Sepsis is a fatal infection if left untreated.


The presence of other illness lengthens the recovery period of the patient. The span of recovery varies from case to case. Some may undergo cardiac rehabilitation for few weeks after the surgery while others may be physically well after few weeks of suffering from pain after the surgery. Some may still be sensitive in the coldness of the weather for few months, which will constantly cause chest pain. A recovery period varies from two months until a year. It is when their hearts have fully recovered that they can go back to their daily routine without any hassles for the heart. But there are some who may not recover from the surgery and adds to the fatality rate.


STERNAL INFECTION:
In order to access the heart, traditionally an incision is made from the top of the chest bone--the sternum--to the bottom.Then it is necessary to saw the sternum open. If the internal mammary artery will be used for a bypass, it is dissected away from the chest wall to use as a new vessel for the heart. Disrupting this blood flow to the chest wall, and the trauma that occurs during opening of the chest, can result in an infection of the chest bone and surrounding tissues. This complication can be devastating and result in the removal of the sternum if long-term antibiotics fail. Sternal infection is a rare complication but potentially life-threatening.


BLEEDING:
The cardiopulmonary bypass machine,also known as the CPM or the heart-lung machine, is used to maintain circulation to the body while the heart is stopped during the procedure. This machine takes the patient's blood through a system of tubes placed in the aorta and right atrium and cleans the toxins and oxygenates the blood. The blood is subsequently returned to the patient. Use of this machine can create bleeding because as the blood passes through the machine, it is diluted with extra fluids, thereby diluting the necessary clotting factors. In addition, the platelets, which are also necessary for clotting, can become damaged as they pass through the CPM. Finally, heparin, a blood thinner, is used to prevent the blood from clotting while passing through the tubing, but this can also lead to undesired bleeding later.


ARRHYTHMIAS:
The significant handling of the heart during surgery can affect the conduction system of the heart. About 15 to 40 percent of patients will have atrial fibrillation about two to three days after surgery, states the Merck Manual. Nonsustained ventricular tachycardia, a fast, chaotic, heart rhythm, is seen in about 50 percent of patients. This rhythm can quickly switch to a sustained ventricluar tachycardia and become life-threatening. About 1 percent of patients will have a heart attack after the operation.


ORGAN FAILURE:
The blood reacts to the tubing of the CPM by releasing special proteins called cytokines into the blood. These cytokines are responsible for creating a system-wide inflammatory response. Cytokines travel in the bloodstream and when they pass through the organs, they can cause organ damage or failure. Cytokines can cause the lungs to react with acute respiratory distress syndrome or cause kidney failure.


REFERENCES:
MayoClinic.com: Coronary Artery Disease: Angioplasty or Bypass Surgery?

BMC: Superficial and Deep Sternal Wound Infection after more than 9000 coronary artery bypass grafts, incidence, risk factors and mortality. Abbas Salehi Omran, MD and et.al. BMC Infectious Disease. 2007

The Merck Manual Online Medical Library.com: Coronary Artery Bypass Grafting (CABG)

Sage Journals Online: Understanding Cytokines Part I: Physiology and Mechanism of Action.

MedlinePlus: Acute Respiratory Distress Syndrome


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