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.
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.