Bypass surgery, especially the beating heart surgery. is more durable as it increases survival and is a safe option as compared to angioplasty with stents. This is well proven with the recent trail, and the American Heart Association recommends that. Another major benefit of bypass surgery is in damaged heart due to previous heart attacks. Any heart attack severe or mild leaves some past of the heart muscle dead or weak, which affects the heart function.

The weak muscle or the hibernating myocardium as we call it improves significantly after bypass surgery. Since it’s complete revascularisation so all regions of the heart start getting blood and with the result the hibernating myocardium (Heart Muscle) starts working again after getting adequate blood supply or the nutrition in layman’s form so a patient with multiple blockage with heart dysfunction are the ideal candidate for bypass surgery only.

Till about moderate heart dysfunction on pump. bypass surgery have equal results so to say but it’s the severe heart dysfunction where beating heart bypass surgery scores. Now coronary artery disease complicated with severe heart dysfunction becomes a challenge specially when heart function is below 30%. Many of the surgeons will like them to be on medical management or in worst.

heart function below 25% will be referred for heart transplant an option which is rare in India and i expensive but with beating heart surgery coming in and coupled with certain other modalities like PET scan now results and outcomes are far better than any other modality and not only that these patients now can be offered bypass surgeries.

Any patient who has severe heart dysfunction no doubt is a high risk patient but if the target vessels are good and more importantly on PET scan if majority of heart muscle is viable then this becomes a real life saviour procedure as against medical treatment or stents. intra-aortic balloon pump is an adjunct to the beating heart bypass surgery in all such situations. The benefit of this machine which is temporary during surgery or after surgery is that it increases the blood flow through the arteries and graft and importantly unload the heart so that heart muscle has to exert less.

The best benefit of this is during surgery when heart is being manipulated and with the help of LABP heart tolerates the procedure much better and safely. After 72 hours if heart muscle has improved LABP is taken out and patient recovers to be discharged.

We as Sarwal heart surgery at Ojas and as a team have the experience of treating such patients, many of them refused by other centres in tricity and we are happy to note that in many patients heart function has come back to normal or near normal.
So bypass surgery score here also over any other modality where heart is damaged due to blockage in coronary arteries and increase the survival rates if done after through assessment with PET scan.

The above article was contributed by Dr Virender Sarwal.

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