Coronary Artery Bypass Surgery (PDF)

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					     Coronary Artery Bypass Surgery

        Coronary artery disease is the leading cause   oxygen and nutrients. Rather, it is the blood
      of death in the United States. Nearly five        vessels on the surface of the heart, called the
      million people have evidence of coronary         coronary arteries, that nourish the heart
      artery disease, and half a million die of it     muscle. Blocked or severely narrowed
      each year. Atherosclerosis, often called         coronary arteries can be bypassed with
      hardening of the arteries, is the most           healthy blood vessels to restore blood flow to
      common type of coronary artery disease. Fat,     the heart muscle. Coronary artery bypass
      cholesterol, and other cellular debris form      grafting is one of the most commonly
      deposits (plaque) along the inner walls of the   performed operations in the United States.
      arteries, which can narrow or completely         The procedure is safe and highly effective
      block blood flow through the arteries to the      when used appropriately.
      heart muscle. The resultant loss of oxygen         Although it requires surgery, the coronary
      causes a heart attack. Heart attacks are not a   artery bypass operation usually offers the best
      consequence of old age: 45% occur in people      long-term results for patients with obstructed
      under 65 and 5% in people under 40.              coronary arteries. Newer non-surgical
       The blood circulating inside the heart does     technologies are very exciting and can be used
      not supply the heart muscle itself with          in many patients. However, the bypass
                                                       operation still remains the most accepted
                                                       form of treatment.
                                                         Bypass surgery may be recommended in
                                Left Main              patients who are suffering from disabling chest
                                Coronary               pain—angina—that cannot be treated with
                                                       medication or angioplasty. These patients
                                                       usually have abnormal electrocardiograms on
                                                       exercise testing and significant obstructions in
                                                       one or more of the coronary arteries. A 50%
 Right                                 Anterior        or greater blockage in the left main artery is a
Coronary                              Descending       specific indication for operation.
                                        Obtuse           Bypass surgery improves heart function,
                                        Marginal       decreases the chances of a heart attack, and
                                                       improves the patient’s quality of life.
                                    Diagonal           Symptoms of angina are relieved in 80%
              Posterior                                of patients.
The Procedure
  To detour blood around the obstructions in
the coronary arteries, either a saphenous vein
taken from the leg or the internal mammary
artery (IMA) beneath the breastbone is used
for the graft. The surgeon decides how many                                        Internal Mammary
bypass grafts will be necessary before the
operation. During the surgery, when the
condition of the arteries can be examined                                            Saphenous
directly, the surgeon may attach more or                                               Vein Grafts
fewer bypasses than planned. (NOTE: The
surgeon should be told before surgery if the
patient has had procedures on the leg veins in
the past, such as vein stripping.)
   If a saphenous vein graft is used for bypass,
it is first attached to the aorta and then to the
coronary artery below the blockage. When
the IMA is used, it remains attached at one         The Future
end to its origin (the subclavian artery), and        Treatment of the blocked arteries is only
the other is then sewn to the coronary artery       the first step in restoring good health. Bypass
below the blockage. When one of these               surgery does not cure the underlying
vessels is relocated to the heart, other veins      condition that caused the problem to
or arteries in the donor area take over to          develop. Further medical evaluation,
circulate blood to the surrounding tissues in       treatment, and changes in lifestyle to reduce
the leg or chest wall.                              risk factors for heart attack are essential.
  Surgery usually takes two to three hours.         These changes may include exercising,
Generally it is more difficult and time             adopting a healthy diet, controlling blood
consuming if the patient has had heart              pressure and weight, lowering cholesterol
surgery in the past.                                levels in the blood, and quitting smoking.
  Patients are hospitalized for 4-5 days
(including one to two days in the intensive
care unit immediately after surgery),
depending on how the body responds to the
surgery and on the healing of the incisions
over the breastbone and the legs, if saphenous
veins were taken for the bypass.

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