Ten bypass grafts at a go

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In a pathbreaking surgery conducted by Dr Ramakant Panda, a patient from Ludhiana was saved from a fatal heart attack after 10 separate bypass grafts were created for blood to flow smoothly from and into the heart, reports Kounteya Sinha in TOI. The eight-hour-long procedure, conducted at Mumbai’s Asian Heart Institute last week, could be the first such surgery where so many grafts were created to bypass clogged arteries.

Panda and his team took 18 cm of healthy artery from the chest (left and right mammary arteries) of 55-year-old Pawan Agarwal and divided them into 10 different grafts, which were then connected to the blocked coronary artery.  Dr Panda said, “I have done a maximum of eight grafts on a single patient in my entire career. This was the first time that 10 grafts were created. Most patients require just three grafts. But this patient was in seriously bad condition.”

Panda added, “We noticed multiple blockages in not just the three major arteries of the heart but also in its smaller branches. While we used 10 grafts to bypass blocked arteries, one artery was so badly blocked that we couldn’t create a bypass. We, therefore, additionally conducted an arterial cleansing procedure (endarterectomy) to clean up the blockage.”

Number of bypasses

The terms used are single bypass, double bypass, triple bypass, quadruple bypass and quintuple bypass to the number of coronary arteries bypassed in the procedure.

1. Double bypass means two coronary arteries are bypassed

2. Triple bypass means three vessels are bypassed

3. Quadruple bypass means four vessels are bypassed

4. Quintuple means five.

5. Bypass of more than four coronary arteries is uncommon.

A greater number of bypasses does not imply a person is “more sick”, nor does a lesser number imply a person is “healthier.”

A person with a large amount of coronary artery disease (CAD) may receive fewer bypass grafts owing to the lack of suitable “target” vessels. A coronary artery may be unsuitable for bypass grafting if it is small (< 1 mm or < 1.5 mm), heavily calcified  or intramyocardial.

A person with a single stenosis of the left main coronary artery requires only two bypasses to the LAD and the LCX.