Health Resource Center
Coronary Bypass Surgery
Aug 21st 2008
Coronary artery bypass surgery (CABG) or “open heart
surgery” is a treatment for coronary
artery disease that restores blood flow to the heart muscle by
“bypassing” blockages contained in the blood vessels. There are many techniques
of doing coronary artery bypass surgery, but the basic idea remains the same in
all of these. Essentially, blood is routed around a blockage by using a new
“conduit” (vessel) that is attached to the heart’s blood vessel beyond the
point of blockage.
Many bypasses are performed using the Internal Mammary
Artery from the chest wall. Normally this artery supplies the structures of the
chest. When used in coronary bypass surgery its end is detached from the chest
wall and attached to the heart’s blood vessel beyond the blockage. Blood that
would normally supply the chest wall is now directed to the heart. The chest
wall gets its blood supply from other sources naturally. A second type of
bypass takes a blood vessel from the arm (usually the radial artery) or leg (usually
a vein) as a conduit. In this type of bypass one end is attached to a good
blood supply (usually the aorta which is the first large blood vessel that
exits the heart) and the other end is attached to the heart blood vessel beyond
the blockage. Blood is, therefore, routed around the blockage. Most patients
will have multiple bypasses performed utilizing a combination of conduits.
The procedure is generally performed through a long
incision through the breast bone. Other methods have been utilized including
small incisions made between the ribs and in some centers robots are being
utilized, although this is still not commonly performed and the experience in
robotic cardiac surgery is more limited. In some cases, the heart is “stopped”
to allow the surgeon to perform the surgery. In these cases, circulation to the
body is provided by a pump that takes the place of the heart in both pumping
and providing oxygen to the blood. Bypass surgery can also be performed “off
pump,” during which the heart is allowed to continue to beat but the area of
the heart in which the surgeon is working is held stationary by small devices
to allow the detailed work of bypass surgery to occur. Whether this “off pump”
technique is beneficial for any individual patient depends on many factors and
will be determined by the heart surgeon.
Although
coronary artery bypass surgery is a significant procedure, it is commonly done
and the complication rate is considered very low. The benefits to patients in
whom CABG is felt indicated can be very significant. Bypass surgery has been
shown scientifically to improve the quality of life and lower the rate of heart
attack and death related to cardiac disease in appropriately selected patients.
How long your procedure takes, a very common question,
depends on the number of bypasses necessary and many technical factors that can
only be determined individually and may not be fully known until the surgeon is
actually performing the procedure. In general, the procedure itself may take
several hours but this can vary significantly.
The duration of hospitalization for bypass varies, but in
general approximately four to five days in the hospital should be anticipated.
At discharge, most patients are able to perform the majority of their daily
activities with minimal assistance. Those that work can often expect to return
within a few weeks but this will depend on many factors such as age, possible
complications and how physically demanding their work is. Many will return to
work sooner. Full recovery is usually not anticipated for a few weeks after
that.
The longevity of bypass grafts can vary significantly
from patient to patient. In general, approximately 1/3 of bypass grafts done
with veins are expected to be closed at approximately 10 years, 1/3 will have
significant disease within them by 10 years and 1/3 will remain widely open at
10 years. Bypass grafts utilizing arteries such as the internal mammary artery
have a 95% chance of remaining open at 10 years. Factors that improve the
longevity of bypass grafts are not fully understood, but aggressive management
of all risk factors is strongly recommended. Most importantly, a healthy
lifestyle which includes complete discontinuation of smoking is necessary. In
addition, the patient’s physician may prescribe medication including aspirin.
If necessary, an individual can undergo more than one
coronary artery bypass surgery, although the risks involved with repeat
surgeries does increase.
Click here to learn more about coronary bypass grafting.
Click here to learn more about coronary arteries.