Contents:
- Medical Video: Heart Bypass Surgery (CABG)
- Who must undergo coronary artery bypass surgery?
- How is the bypass operation executed?
- What complications might occur?
Medical Video: Heart Bypass Surgery (CABG)
In coronary artery bypass surgery — also called coronary artery bypass grafting (CABG) — surgeons transplant arteries or healthy blood vessels into damaged coronary arteries, outside the area that is blocked by plaque. This procedure makes blood pass through the affected artery, and increases blood flow to the heart muscle.
Who must undergo coronary artery bypass surgery?
Bypass surgery is very effective in restoring angina symptoms if you experience stable angina.
If a part of the main coronary artery is blocked, or to the left of the main coronary artery is blocked (which is the most important coronary artery), or the heart muscle is very weak, bypass surgery can prolong life compared to treatment with angioplasty and stenting, or with medical therapy. Bypass surgery can also be beneficial for people with acute coronary syndrome.
How is the bypass operation executed?
Bypass surgery is carried out under the influence of total anesthesia. The surgeon splits the breast bone to open the chest, then stops the heart with chemicals or coolants (called hypothermia) so the doctor is able to graft with the heart not moving. Blood circulation is maintained, when the heart is stopped, with a cardiopulmonary bypass machine. Once the graft is complete, the heart starts again.
The grafts used during bypass surgery usually originate from the leg veins (saphena veins), or chest wall arteries (internal mammary gland arteries).
Grafts with arteries often last longer than grafts with blood vessels, and arterial grafts rarely cause stenosis, unlike vascular grafts. Thus, arterial grafts of the internal mammary gland should generally be used if possible (as determined by the patient's anatomy). Vascular grafts often cause blockages due to atherosclerosis within 10-12 years of surgery.
In recent years, newer techniques of bypass surgery are being developed, called "minimally invasive bypass surgery". Minimally invasive procedures involve smaller incisions, as well as avoiding the use of bypass machines. Unfortunately, minimally invasive bypass surgery is only suitable for patients whose damaged arteries can be restored in this way.
What complications might occur?
Coronary artery bypass surgery is the main surgical procedure, and patients often do not return "normal" for weeks or even months after surgery. Naturally, the patient loses appetite, weakness, and pain in the incision for several weeks. Depression often occurs in 1-3 patients after surgery, and if depression is not found and treated, the recovery time will be much longer.
Other complications that may arise after bypass surgery include myocardial infarction during or right after surgery (in less than 5% of patients), weakened heart muscle (which is often transient), arrhythmia (especially atrial fibrillation), pleural effusion (fluid buildup between the lungs) lung and chest wall), infection of the incision, and cognitive abnormalities (thinking) called the "pump head" (after cardiopulmonary bypass "pumps" that support circulation during the graft procedure, and which some people assume is responsible for the cause of cognitive change).
Because bypass surgery has several risks, this surgery is usually limited to patients whose lives may be extended by surgery, or whose symptoms of wind do not go away even though they have undergone repeated medical treatment.
