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Heart bypass surgery explained

The operation 'bypasses' blocked arteries

Heart Bypass

In this story:

November 5, 1996
Web posted at: 11:50 a.m. EST (1650 GMT)

(CNN) -- The type of surgery Boris Yeltsin underwent Tuesday is becoming common in the United States but is rare in the Russian president's homeland. The number of heart bypass operations performed in the United States each day -- about 1,000 -- is about 10 times the number performed in Russia in an entire year.

For a motorist, a bypass is a road that avoids a congested area. A surgeon performing a heart bypass operation carries out a similar function. Blood vessels taken from other parts of the body are sewn around blocked arteries. In effect, blood is given a way to bypass the problem. movie icon (226K/22 sec. QuickTime movie)

Diagrams

Spaghetti-thin coronary arteries along the outside surface of the heart serve as the organ's lifelines. When they become narrowed by waxy debris called plaque, less blood can get through. That's what causes chest pain, and sometimes heart attack.

The bypass restores healthy circulation to the heart so it can beat stronger and more safely.

While non-surgical treatment is also possible, heart surgeon Dr. John Parker Gott of Atlanta told CNN bypasses "show a great advantage over other therapies" in cases where more than one bypass is necessary.

How it's done

As the operation begins, an incision is made directly through the front wall of the chest. The breast bone is sawed through and the ribs cranked open by a device that works like a carpenter's vise.

The surgeon takes veins from the chest and the legs to use on the heart. Typically, a long but unessential vein is cut out of the leg and fashioned into one or more bypasses.

Heart is stopped ...

While the heart is being repaired, it must be stopped. A heart-lung machine keeps the patient alive for the portion of the operation -- usually one to three hours -- needed to sew in the bypasses.

Heart surgeon Alan Wolfe on bypass surgery:
Wolfe icon 2 reasons for bypass surgery
(13 sec./289K AIFF or WAV sound)
icon The most devastating part
(9 sec./218K AIFF or WAV sound)

Being able to operate on a heart that isn't moving has "allowed us to operate on increasingly smaller (blood) vessels," said Dr. Alan Wolfe, an Atlanta heart surgeon.

... and restarted

X ray

Electric paddles are usually needed to re-start the heartbeat. Patients leave the operating room in critical condition, but most are able to sit up and even get out of bed by the next day.

The length of recovery depends on "the amount of time spent on the heart-lung machine," Dr. Gott said. The fewer number of bypasses, the less time on the heart-lung machine and the quicker the recovery, he said.

For the first 24 hours after surgery, doctors worry about leaks from the bypass. Internal bleeding can be a dangerous complication.

There's also a risk that a heart, weakened by the stress of surgery, might suddenly quit pumping. Infection, pneumonia and stroke are additional worries, Wolfe said.

Quick recovery possible

The odds, however, are solidly on the patient's side. The survival rate for a heart bypass operation is about 95 percent. For many patients what follows next -- rehabilitation -- can be more uncertain.

Resuming normal activities, even something as simple as walking, is a slow but steady process, depending on what the patient can tolerate, says Mary Beth Bova, director of cardio-vascular services at St. Joseph's Hospital in Atlanta. icon (252K/11 sec. AIFF or WAV sound)

Dixon

Three days after his surgery, bypass patient Paul Dixon remains hospitalized, saying he tires easily but feels little pain. Even though Dixon is drained and pale for the moment, his doctors and nurses expect rapid progress each day.

"My recovery was quite phenomenal," said Robert Kern, 60, who left the hospital four days after quadruple bypass surgery and began working from home two weeks later.

Barring complications, many heart bypass patients in the United States go home from the hospital in about five days or less. Some can return to office jobs, part-time at least, about a month after surgery.

Exercise, exercise, exercise

Simple exercises at the hospital start almost immediately after the operation. Within a couple of weeks, formal cardiac rehabilitation begins with regular supervised workouts designed to build endurance and strength gradually.

In addition to continuing regular exercise, bypass patients are urged to reform their diet and quit smoking. They may also take cholesterol-lowering drugs to slow the return of heart problems.

Based on his own experiences, Kern says, Yeltsin "should be able to do some work within a few weeks."

Correspondents Dan Rutz and Andrew Holtz contributed to this report.

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