New technique makes bypass surgery easier

New technique makes bypass surgery easier
Rajiv Sharma

August 7: Bypass surgery, which earlier used to create fear among patients, has recently undergone a revolution due to the use of a new technique in which the heart does not have to be immobilised. Instead, the entire operation is done on a beating heart with the help of an equipment known as the `octopus'.

The earlier technique involved the stopping of the heart and the taking over of its functions by the heart-lung machine for the duration of the operation. The blood had to be churned through this machine for the purpose of purification and for its circulation throughout the body. But this also had a few disdadvantages. It could result in either clotting disorders or dysfunction of various organs. Another drawback was that a large quantity of blood was lost during operation, and the patient had to be given blood transfusion.

However, bypass surgery has now been revolutionised with the use of `octopus' that is used for stabilising that particular area of the heart which is going to be operated upon, according to Dr Arun Mehra, consultant cariothoracic surgeon at Jaslok Hospital. This means the rest of the heart continues to beat and performs its functions normally, and therefore there is no use for any heart-lung machine, he said. An alternate route, known as a `shunt', is also provided so that blood supply is maintained even to this part of the heart that has been stopped for the operation, he added.

Explaining the function of the `octopus', the consultant said it consists of a clamp that is powered by high pressure vacuum, and it is held in place by attaching it to the sides of the chest wall. The surgery itself involves a lot of skill on the surgeon's part, since the bypass surgery is now done on a beating heart, he pointed out. However, the major advantage is that there is very little loss of blood and also saves on time taken for the operation, he said. It also reduces the operation cost, and a higher number of patients can now afford the operation, he said.

Since the procedure involves lesser trauma, the patient recovers soon after and can be discharged much earlier compared with the earlier method, where the patient took time to recover, Dr Mehra said. ``In fact, this technique is in keeping with the trend of minimally invasive surgery, where a patient undergoes less trauma during the procedure,'' he said. About 60 per cent of the patients are suitable for undergoing the procedure with this technique, and it is only where access to the heart is difficult or where the patient has recently suffered a heart attack that this method is avoided, he said.

Commenting on the `octopus' technique, Dr Ashwin Mehta, director of cardiology, Jaslok Hospital said this has made patients much more open to the idea of bypass surgery, and this number is likely to increase in future, he said. The results of using this technique are also very encouraging and `bypass anxiety' among patients is much less now with an increasing number opting for this technique, he said.