Heart Bypass Surgery Abroad

Heart bypass surgery is the colloquial name for coronary artery bypass surgery or coronary artery bypass graft surgery (CABG – often pronounced ‘cabbage’). It is the most frequently performed surgery in the USA.

Because of skyrocketing costs of health care in the US, some people are looking abroad for coronary bypass surgery, especially because heart bypass surgery in India, Mexico, and Costa Rica combines low cost with top-notch quality cardiac care.
Heart bypass surgery is done to treat coronary artery disease – the condition in which the arteries that supply blood and oxygen to the heart harden and thicken.
But coronary artery bypass surgery is not to be taken lightly. Doctors recommend it only when lifestyle changes and medicines don’t work.

CABG (Coronary Artery Bypass Graft) – Procedure Overview

In the heart bypass surgery, a piece of a vein from the leg or artery from the chest or wrist is used as the graft. This is attached to the coronary artery above and below the blockage, thus creating a bypass for blood flow. Some patients may need more than one bypass.
There are three types of heart bypass surgery. They are:

• Traditional Coronary Artery Bypass Grafting: This is the most common type and is performed when at least one major artery has to be bypassed. The surgery involves opening the chest bone to get through to the heart. The body is put on a heart-lung machine as the heart needs to be stopped during the surgery. The heart is re-started after the surgery with mild electric shocks.
• Off-Pump Coronary Artery Bypass Grafting: It is much like the traditional CABG as in the chest bone is opened to access the heart, but the heart isn’t stopped. Hence, a heart-lung machine is not required in this method. This type of surgery is also called beating heart bypass grafting. It may cut down complications and speed up recovery, when compared to the traditional method of surgery.
• Minimally Invasive Coronary Artery Bypass Grafting: Instead of opening up the chest bone, several small incisions are made on the left side of the chest between the ribs. This method is mainly employed for bypassing the vessels in front of the heart. It’s a comparatively new procedure not performed as frequently as the other types. It is also not recommended for people who have blockages in more than one or two coronary arteries.

How to Prepare for CABG Surgery?

Knowing about the procedure that will be performed on you can only help you prepare mentally and physically. CABG is a major surgery and the recuperation period is fairly long. Hence, here are a few tips for you to prepare for heart bypass surgery (detailed instructions will be provided by your health professional):

• Several tests will be done before your surgery, like blood test, chest X-ray, and cardiac catheterization. These tests will help your doctors evaluate your health before and after CABG surgery and also forewarn them about anything else that may need to be treated before surgery. These tests are done either days or weeks before surgery.
• Make a list of all the medications and vitamin supplements that you take and give this to your doctor well ahead of your surgery. He/She will then tell you which can be continued and which need to discontinued until after the surgery.
• Pay bills ahead of time, because you don’t want to be running around for that after your surgery.
• Get someone to help you manage your daily needs for up to a month or so.
• Attend any scheduled appointments with your surgeon before the surgery.
• To prepare for the rare event of serious complications cropping up (including death), arrange your personal matters, like a will.
• Relax. Stress might complicate matters.

Aftercare and post-CABG precautions

Care after heart bypass surgery is very important. Mainly, all the factors that originally caused the blockages in the heart need to be kept in control. Here are some guidelines:

• Diabetics must keep blood sugar in control. Same goes for people suffering from high or low blood pressure.
• Regular light exercises, like walking for 30 minutes, needs to be done daily. However, please consult your doctor about when you can start such exercises.
• Do not smoke and keep away from smokers, as you may be subjected to passive smoking.
• Try not to get tense or stressed over anything. Listening to soothing music, yoga or meditation may help to keep you calm.
• Go slow on the calories, as you need to keep your blood lipid profile normal and your weight in check. Bad cholesterol (LDL) must be kept below 70 mg% and triglyceride closer to 100 mg%. The HDL cholesterol, which is good cholesterol, should be kept as high as possible and certainly above 40-45 mg%.
• Do not miss the post-surgery appointments with your doctor for regular medical check-up.

Risks of Coronary Artery Bypass Grafting

It has been seen that there are more chances of complications developing after heart bypass surgery if it was an emergency situation (for example, if performed during a heart attack), if you are over 70, or if you are or were a smoker. You are also more at risk if you have other diseases or conditions such as diabetes, kidney disease, lung disease, or peripheral vascular disease.

Risks of heart bypass are:

• Infection and bleeding
• Anesthesia reactions
• Fever with chest pain, irritability, and reduced appetite
• Pain
• Stroke, heart attack, or even death
• Memory loss, difficulty in concentrating or thinking clearly may occur in some people as a result of the use of the heart-lung machine.
• The heart-lung machine can also increase the risk of blood clots forming in your blood vessels. Clots can move to the brain or any other part of the body and block the flow of blood, which may cause stroke or other problems.

Benefits of Heart Bypass Surgery

Most CABG patients have a good prognosis, provided they are committed to the cardiac rehabilitation program. You can look forward to the following benefits from heart bypass surgery:

• Improvement in quality of life and decrease in angina (chest pain) and other symptoms of CAD.
• You will be able to adopt a more active lifestyle.
• Better pumping action of the heart.
• Lower chances of a heart attack.
• Better chances of survival.

Alternatives to Coronary Artery Bypass Grafting

The first and most important alternative to CABG is, of course, medication and a change in lifestyle. Only when this does not work or when there is not enough time to exercise these options, surgery is advised.
The other alternatives are balloon angioplasty and stent placement. (Angioplasty includes temporarily inserting and expanding a tiny balloon at the blockage site to widen the narrowed artery. A small metal coil called a stent is then implanted in the clogged artery to prop it open and see that it does not narrow again.)
Balloon angioplasty and stents increase blood flow, but are not for everyone. Your doctor will talk to you about what’s the best option for you.

CABG vs. Heart Stents

Stenting has certain restrictions when compared to CABG. Heart stents are recommended only if:

• Your blockage is small
• Your blockage can be reached by angioplasty
• The problem artery is not the main one supplying blood to the left side of your heart
• You don’t have heart failure

Not everyone meets these conditions and are, hence, best suited for heart bypass. Also, studies indicate that bypass surgery results in better outcomes than angioplasty in patients with multi-vessel disease, and at a lower cost.

Heart Bypass Surgery Abroad

With rising cost of medical care, CABG in the US may cost $20,000 or more. However, cheaper and quality heart bypass options are available in India, Costa Rica, and Mexico, all of which are established medical tourism destinations.
India, Turkey, Costa Rica, and Mexico have some of the leading cardiologists of the world, who routinely perform heart bypass surgery with high rates of success.

Opting for heart bypass surgery can be a life-changing decision, often for the better. As it is a major surgery, exercise caution in selecting the right hospital and right cardiac surgeon abroad.

Resources for CABG:

American Heart Association: The American Heart association is a cardiac surgery information resource for patients, care-givers, healthcare professionals, and researchers.
Cardiological Society of India: The Cardiological Society of India was established in 1948 in Calcutta (now Kolkata), a year ahead of the birth of the American College of Cardiology and the International Society & Federation of Cardiology. It has among its members eminent cardiologists in India. Cardiovascular research established four decades ago in India is being carried forward with technology equal to the best in the world.
The Singapore Cardiac Society: Instituted in 1969, its mission is to advance knowledge and practice of cardiovascular medicine in Singapore and to promote regional and international co-operation in cardiovascular medicine.
Turkish Society of Cardiology: Founded in 1962, the Society’s mission is to prevent the cardiovascular risk of the Turkish population by supporting the professional and public education and research.

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