Cost of bypass in Sri Lanka
In Sri Lanka a bypass
surgery costs about 500,000. Even patients in richer countries find it
difficult to afford bypass surgery. A safer and more permanent and
successful way to prevent heart attacks in patients at high risk is to
exercise, give up smoking, take 'drugs to get blood pressure under
control and drive cholesterol levels down to prevent blood clotting'.
Longer term, behavioural and medication treatment may be the only way to
avoid vascular related loss of mental function.
Deadly statistics
Today 108 patients die everyday due to heart diseases in Sri Lanka.
Their lives can be saved if the number of by-pass surgeries carried out
on a daily basis is increased by 30 percent. Unfortunately only four to
five surgeries are done per day in Sri Lanka. The main reason for this
is the expenditure and the cost of the surgery.
Initially in 2010 more than 1,000 surgeries were done at the
Karapitiya hospital but after 2010 it has been reduced to 500 and to 250
as of two weeks ago.
Why a bypass surgery
Coronary artery bypass surgery also known as coronary artery bypass
graft (CABG) and colloquially heart bypass or bypass surgery is a
surgical procedure consisting of either diverting the left internal
thoracic artery (left internal mammary artery or "LIMA") to the left
anterior descending (LAD) branch of the left main coronary artery or a
harvested great saphenous vein of the leg, attaching the proximal end to
the aorta or one of its major branches, and the distal end to
immediately beyond a partially obstructed coronary artery (the "target
vessel") usually a 50 to 99 percentage obstruction.
The purpose is to restore normal blood flow to that partially
obstructed coronary artery. It is performed to relieve angina
unsatisfactorily controlled by maximum tolerated anti-ischemic
medication, prevent or relieve left ventricular dysfunction and or
reduce the risk of death. It does not prevent heart attacks.
The surgery is usually performed with the heart stopped,
necessitating the usage of cardiopulmonary bypass. However, two
alternative techniques are also available allowing CABG to be performed
on a beating heart either without using the cardiopulmonary bypass
deemed as 'off-pump' surgery or performing beating surgery using partial
assistance of the cardiopulmonary bypass called as 'on-pump beating'
surgery.
The latter gathers the advantages of the on-pump stopped and off-pump
while minimizing their respective side-effects.
The obstruction being bypassed is due to arteriosclerosis,
atherosclerosis or both. Arteriosclerosis is characterized by
thickening, loss of elasticity, and calcification of the arterial wall,
most often resulting in a generalised narrowing in the affected coronary
artery.
Atherosclerosis is characterized by yellowish plaques of cholesterol,
lipids and cellular debris deposited into the inner layer of the wall of
a large or medium-sized coronary artery, most often resulting in a focal
partial obstruction in the affected artery. Each can limit blood flow if
it causes a cross-sectional narrowing of at least 50%.
-Wikipedia |
