Sometimes blood vessels that take blood to the heart (coronary arteries) get blocked by deposition of fats and cholesterol. This happens more in patients with risk factors like diabetes mellitus, high blood pressure, smoking, obesity and family history. Due to this, patients may develop heart attacks, chest pain (angina) or sometimes they suddenly die. When suspected, blocks are diagnosed after doing a test called coronary angiogram. This will show the number of blocks, severity of blocks, location of blocks etc. Based on that, the doctor will decide whether we can leave patient on medical management or needs angioplasty and stenting or bypass surgery (CABG-coronary artery bypass surgery).
Bypass surgery is a very common heart operation. This is done normally through median sternotomy- 20-25 cm incision is given in front of the breast bone and then breast bone is split. After that heart is often stopped and artificial heart-lung machine is used to keep the patient alive during this procedure. Because of the big incision on the front of the chest, scar is often big and sometimes it can even become ugly (keloid). It takes nearly 3 months for the bone to heal and infections (mediastinitis) can be very dangerous.
In the last few years, new developments have come in bypass surgery. Most important is –key hole bypass surgery also called minimal access bypass surgery. With this there is no cut on the front of the chest and there is no need to divide any bones. Bypass surgery is done through a small incision on the left side of the chest below the breast through the space between the ribs. Everyone cannot be done through this approach. Suitable patients are identified based on the chest shape, lung function capacity and urgency of the situation and only surgeons with lots of experience in heart surgery can do this.
As many as 3-4 bypass grafts can be done through this approach on a beating heart. 5 bypasses were done through this approach by Dr. A.G.K.Gokhale for a needy patient for the first time in India. Along with experienced surgeons from abroad, Dr. Gokhale regularly conducts live workshops and trains heart surgeons. Very few surgeons in India are offering this to their patients and Dr. Gokhale feels that due to lots of benefits, key hole surgery will become the standard in the next few years.