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Heart bypass surgery is performed to create a new route (termed a "bypass") for the flow of oxygen and blood to the heart. It is performed when coronary artery disease partially or totally blocks the arteries - the small blood vessels which supply the heart with nutrients and oxygen - which lead to the heart. When coronary arteries become blocked the heart cannot obtain sufficient blood, a condition which is termed coronary artery disease, and which can cause severe chest pain (termed angina). Some coronary artery disease can be treated with medicines alone; but severe cases require coronary artery bypass surgery.
Before receiving surgery the patients are given anesthesia, which renders them unconscious and unable to feel the pain. The anesthesia effects last for the entire time of the surgery. Most of the people who have bypass surgery are connected to a bypass pump or a heart-lung bypass machine which does the work of the heart while the heart is stopped during surgery. The machine circulates the blood and adds oxygen to it. Another method of surgery doesn't use the machine but rather allows the bypass to be created while the heart is still beating (termed off pump coronary artery bypass).
Once the patients are unconscious, the surgeon cuts an incision 10 inches long in the center of the chest (in the case of robotic heart surgery, three very tiny incisions are made instead of one large one). Then, the breastbone is separated to permit the surgeon to see the heart and aorta (the principal blood vessel leading out from the heart). The surgeon will take an artery or vein from another part of the patients' bodies and use it to make a graft (a detour) around the artery's blocked area. Frequently the saphenous vein in the leg is used - an incision is made along the inside of the leg between the groin and ankle to cut the vein, which is then sewn to the coronary artery on one end and to an opening in the aorta on the other. Sometimes the internal mammary artery in the chest is used for grafting; this has the advantage that one end of this artery is already connected to the aorta, so only the other end needs to be sewn to the coronary artery. After the graft is done, the patients' breastbone is reconnected with a wire (which remains in the body) and the incision is closed.
In hospitals in Chicago area, the entire surgery takes from four to six hours, after which the patients are taken to the hospitals' intensive care unit. Usually several tubes in the patients' chests drain fluid from the heart area. There may also be a flexible tube called a catheter in the bladder to drain the urine; and intravenous lines for fluid intake. Monitors constantly provide information about the patients' vital signs such as breathing, temperature, and pulse. Usually the patients leave the IC unit within 24 hours, and are moved to a regular care unit to recover their strength. Normally patients spend about a week in the hospital; and it requires four to six weeks for the patients to begin feeling better.
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