St George’s Hospital
This week I have the amazing opportunity to shadow a cardiothoracic consultant and so I will document all of the exciting things I see! Day 1 was spent at St George’s Hospital, and after seeing outpatients in the morning, I had the amazing opportunity to witness a Coronary artery bypass surgery! The coronary artery bypass surgery I witnessed was performed on someone who suffered from Coronary artery disease , which is a condition involving the clogging of arteries that bring blood to the heart muscle caused by fatty deposits on the inner walls of the arteries. The main factors which contribute to coronary artery disease are:
- High blood pressure
- High cholesterol
- Diabetes or insulin resistance
- Sedentary lifestyle
- Family history
- High blood pressure
- High blood cholesterol levels
- Overweight or obesity
- Physical inactivity
- High stress
- Unhealthy diet
A doctor will diagnose coronary artery disease from symptoms and tests such as performing a physical examination, blood tests, an exercise stress test, a cardiac nuclear scan, and cardiac catheterization. Any of these tests will play an important part in deciding whether or not bypass surgery will be needed. It is a fairly low-risk procedure. For someone who has a normal functioning heart, non-emergency bypass surgery carries a risk of death of 1% or less. There is a 5% chance of a heart attack during surgery. The risk from surgery is a bit higher if someone has had other cardiovascular problems. About 90% of people who undergo the surgery experience complete or dramatic relief of their symptoms.
- Coronary artery bypass surgery is an open-heart procedure. The patient was placed under general anesthetic and the surgeon began the operation by making an incision down the centre of the chest, then dividing and separating the sternum. Tubes were then attached to the heart and connected to a heart-lung machine that keeps the blood supplied with oxygen, and the blood was pumped from the heart to the machine and back to the body to be circulated again. Blood pressure, temperature, and breathing were all able to be regulated throughout the whole procedure.
- The surgeon then clamped the aorta, and he then sewed 4 veins taken from the legs to join the aorta to the coronary artery, bypassing the blocked part of the coronary artery to allow blood carrying oxygen to reach the heart.
- When the grafting finished, the patient was taken off the heart-lung machine, and the surgeon rejoined the breastbone with stainless steel wires.
The operation I saw lasted 4 hours, and an average operation lasts from 3 to 6 hours. After surgery, all patients will need to continue taking medications that decrease the work of the heart and reduce the risk of future heart attacks. More than 80% still work 10 years after the surgery. Vein grafts more often become obstructed. After 5 years, one-quarter of any vein grafts may be clogged. New techniques of bypass surgery may be used in some cases, such as the “beating-heart” technique which does not use the heart-lung machine setup but still needs to be done through the incision in the middle of the chest. Bypasses are sewn directly onto the heart without stopping the heart which means that the risk of complications from the heart-lung machine is lower.
Overall I found today VERY interesting and learnt a lot! Stay tuned to hear about Day 2 tomorrow!…