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When former President Bill
Clinton undergoes surgery this week, his doctors will stop his heart for
up to three hours to allow them to carry out the bypass.
While it sounds dramatic, Dr. Joseph DeRose, chief of minimally
invasive heart surgery at St. Luke's-Roosevelt Hospital in Manhattan, who regularly performs bypass operations,
said the operation is now routine, and when Clinton's heart is
restarted it is likely to work better than it did before.
Here he explains who will perform the operation and provides a
step-by-step guide about what Clinton
will face in the theater.
THE OPERATION
When Clinton
is anesthetized, a special probe will be inserted through the mouth to
monitor the heart throughout the operation. The surgeon will open the
chest with a saw, dividing the breast bone, to remove the mammary artery,
which will also be used for bypassing the blockage.
At the same time, special instruments will remove a vein from
his leg through a tiny incision by the knee.
After they remove the 1- to 2-mm artery and veins — at this
point about an hour and a half into the operation — doctors will stop Clinton's heart. To
do that, the surgeon will place a large IV into the heart and another
into the aorta, the major artery in the body. The IVs take the blood out
of the patient and into the bypass machine, which will pump blood around
his body to keep him alive.
The heart stops, and the surgeons will start sewing the new
vessels onto the areas of the heart where the blood needs to go around
the blockages. After the bypass grafts are completed, the blood flow to Clinton's heart
will be restored.
Many times, once the heart senses blood, it will restart right
away, but there may be the need for a little shock to get it back into a
regular rhythm. Next, everything will be closed and Clinton will return to the intensive
care unit.
THE TEAM
There will be a large team for the operation, led by a head
heart surgeon, who will perform the bypass, assisted by a second heart
surgeon. An anesthesiologist will tend to Clinton while he is asleep, while a
physician's assistant harvests veins from the President's leg that will
be used to create some of the bypass of the blockages around his heart. A
scrub nurse will help the surgeons, while two or three “perfusionists” will run the bypass machine that
maintains blood flow while the heart is stopped.
RECOVERY
 The patient will be on a
breathing machine for three to six hours, but once Clinton wakes up from anesthesia, the
breathing tube will be removed. He is likely to remain on some
medications to help the heart pump better, but will be weaned off those
within 24 hours.
Clinton would be expected to leave
the intensive care unit the first or second day after surgery to go to a
regular room, and at this point will be able to get out of bed, eat
regular food and perhaps walk a short distance.
By the third or fourth day, he will be on ordinary painkillers,
walking without assistance up and down the hall, and by the fifth day
will probably go home.
REHABILITATION
 Four or five weeks later,
Clinton will start cardiac rehabilitation, which focuses on increasing
the heart rate — working out the heart to help it get used to its new
circulation.
Clinton will have to do aerobic
exercise — walking or biking or treadmill — to increase the heart rate
and the blood pressure. With the newly forceful blood flow, the heart is
able to get stronger and stronger.
Originally published on September 5, 2004
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