What is coronary artery bypass surgery?

What is coronary artery bypass surgery?

Just as we build bypass roads when a city road is too congested, blood vessels of the heart can by bypassed when they have too many total or partial blocks.

Coronary arteries are blood vessels supplying oxygenated blood to the heart. As age advances and depending on risk factors like heredity, smoking, high blood pressure and diabetes, fat build up occurs in these blood vessels. This can block smooth flow of blood and the person can develop chest pain.

When medications and/or procedures like balloon angioplasty are unable to re-establish good blood flow to the heart, these blood vessels can be bypassed by an operation known as coronary artery bypass grafting or CABG.

Veins or blood vessels returning deoxygenated blood from the legs to the heart were used as bypass grafts initially. Now arteries or blood vessels carrying oxygenated blood within the chest or fore-arm are being used with better long term results. Vein grafts can be used in addition to these if needed. When veins are used, a long piece of vein from the leg is harvested. It is connected from the aorta, the major blood vessel arising from the heart to the blood vessel of the heart beyond the block. Vein grafts are more likely to get blocked in the long run.

The best graft is an artery carrying blood to the chest wall known as internal mammary artery. The lower end is cut, branches are clipped, and lower end connected to the blood vessel of the heart beyond the block. The left sided vessel is used often and is known by the pet short form LIMA. Being a live graft, these function much better in the long term and are preferred to vein graft.

Another artery used for grafting sometimes is the artery of the left fore-arm, known as radial artery. The result is better than vein graft, but not as good as the internal mammary artery.

The surgery was mostly done using a bone splitter to open the breast bone and with heart lung machine to support circulation when the heart is stopped. But now beating heart bypass surgery is commonly done. Many surgeons avoid splitting the breast bone and approach between the ribs for a less invasive surgery.

Bypass surgery certainly provides much better long term results than balloon angioplasty and stent insertion. But the initial worries about an open surgery is definitely there. Even after bypass surgery, good healthy lifestyle has to be followed to prevent recurrence of blocks in the blood vessels. Cardiac rehabilitation programs are also useful in bringing back the person to normal lifestyle. Lifelong medications to prevent recurrence of blocks and regular medical follow up are essential.

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