Coronary artery bypass grafting - WLTZ 38 | Columbus Georgia Regional News & Community

By Louis Neipris, M.D., Staff Writer, myOptumHealth
Content provided by
 

Heart bypass surgery often offers a new lease on life. For many, before the procedure, climbing stairs or even a walk around the block would bring on angina (chest pain). The problem is that cholesterol plaque builds up in coronary arteries, the blood vessels that keep the heart alive. Partial blockage of coronary arteries causes angina. Complete blockage, such as that caused when a blood clot forms in a narrowed artery, leads to heart attack.

Heart bypass surgery improves blood flow to the heart to relieve angina and reduce the risk of heart attack. For some, the surgery is an emergency life-saving procedure. It is often a chance to start fresh, to form new, healthier habits to lower cholesterol and fat in the diet, to exercise or quit smoking.

What is coronary artery bypass grafting?

Heart bypass surgery is also called CABG, ("cabbage"), which stands for coronary artery bypass grafting. In CABG, the heart surgeon reroutes the flow of blood around the blockage in one or more coronary arteries by using a "graft." A graft is a portion of healthy artery or vein, usually from the chest wall or leg. The graft is sewn on to the coronary artery at two points: before and past the blocked area. Once in place, the blood is redirected through the healthy blood vessel.

Why would I need bypass surgery?

Coronary bypass surgery may be recommended to people who have severe coronary artery disease who:

• Have tried lifestyle modifications or medications unsuccessfully
• Have blockages that can't be treated with angioplasty
• Have heart damage following a heart attack

Bypass surgery may be done as an emergency procedure when someone is having a heart attack.

How is bypass surgery performed?

Cardiac bypass surgery requires general anesthesia - you are temporarily put to sleep. On the morning of surgery, you will have an intravenous line (IV) put in for getting medications and fluids. Once in the operating room, you are connected to a variety of machines that constantly monitor your heart rhythm, blood pressure and oxygen levels.

Coronary bypass surgery can be done in different ways:

• Traditional heart bypass surgery. The heart is stopped temporarily and a special machine (heart-lung machine) takes over the function of the heart and lungs. The surgeon works on the heart while it is stopped. He or she reaches the heart by making a large incision down the middle of the chest and through the breastbone.
  
  
• "Off pump bypass." The heart is kept beating while the bypass graft is sewn into place. Only the portion of your heart with the affected artery is held stable.
  
  
• Minimally invasive surgery. Instead of accessing the heart by opening the chest bone, smaller incisions are made between the ribs.

During the procedure, a piece of the long vein in the leg (called the saphenous vein) may be removed and used for the bypass. Sometimes, the surgeon will use blood vessels from the chest or arm instead of a leg vein. The healthy blood vessel graft is attached both above the area of the blockage and to a point below the blocked section of the coronary artery. When a chest wall artery is used, one end is left in place and the other end is attached past the blockage. A bypass can be done on one or more blocked artery (double, triple, quadruple coronary artery bypass).

What are the risks and complications?

Risks and complications are uncommon. They could include:

• Infection or bleeding
• Problems related to anesthesia
• Stroke
• Heart attack

Temporary problems with memory or concentration may occur, especially in those who are older, have high blood pressure or who drink excessive amounts of alcohol. Risks tend to be higher if heart bypass surgery is done as an emergency procedure or if you have lung or kidney disease.

What can I expect after surgery?

Your recovery starts in the intensive care unit (ICU), where you will be closely monitored as you wake up from the surgery. You'll likely be walking in one or two days, and discharged from the hospital in four to six days. Before being sent home, you'll be given instructions on:

• How to care for surgical incisions
• How to recognize signs of infection
• When to call the doctor

When you return home, at first you'll need to get plenty of rest and follow your doctor's restrictions on physical activity. You may be on new medications for your heart, which you would need to take according to your doctor's instructions.

During your recovery, your doctor will want you to do your best at staying healthy and preventing symptoms from coronary artery disease. You'll get instructions on keeping a low-fat diet and how to exercise safely. If you smoke, you'll receive support for quitting. You may be referred to cardiac rehabilitation, which is a medically supervised program that teaches healthy lifestyles to people with heart disease.

View the original Heart Bypass Surgery: A New Lease on Life article on myOptumHealth.com

SOURCES:

• American Heart Association. Bypass surgery, coronary artery. Accessed: 02/17/2010
• Percutaneous coronary intervention versus coronary artery bypass grafting. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, PA: Saunders; 2007.
• Patel MR, MD, Dehmer GJ, Hirshfeld JW, Smith PK, Spertus JA. Coronary Revascularization Writing Group. Appropriateness criteria for coronary revascularization. Journal of the American College of Cardiology. 2009;53(6);530-553.
• Parmet S, Lynm C, Glass RM. Coronary artery bypass grafting. Journal of the American Medical Association. 2008;299(15):1856.
• National Heart Lung and Blood Institute. Coronary artery bypass grafting (CABG). Accessed: 02/17/2010