Heart Disease and Heart Bypass Surgery
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Transcript of Heart Disease and Heart Bypass Surgery
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Heart Disease and Heart Bypass Surgery
Heart bypass surgery can be used to treat heart disease when your coronary arteries are
blocked. Your doctor may treat the problem by giving the blood a new pathway to the heart.
During coronary artery bypass graft surgery (also called CABG, or "cabbage") a blood vesselis removed or redirected from one area of the body and placed around the area or areas of
narrowing to "bypass" the blockages and restore blood flow to the heart muscle. This vessel
is called a graft.
These substitute blood vessels can come from your chest, legs, or arms. They're safe to use
because there are other pathways that take blood to and from those tissues. The surgeon will
decide which graft(s) to use depending on the location of your blockage, the amount of
blockage and the size of your coronary arteries.
Heart bypass surgery is one of the most commonly performed surgeries in the U.S.
Which Blood Vessels Are Used for Grafts in Heart Bypass Surgery?
There are several types of bypass grafts used for heart bypass surgery. The surgeon decides
which graft(s) to use, based on the location of the blockage, the amount of blockage, and the
size of the patient's coronary arteries.
Internal mammary arteries (also called thoracic
arteries). These are the most common bypass grafts
used, as they have been shown to have the best
long-term results. In most cases, these arteries can
be kept intact at their origin since they have their own
oxygen-rich blood supply. During the procedure, the
arteries are sewn to the coronary artery below the
site of blockage. This artery is located in the chest
and can be accessed through the primary incision for
the bypass surgery.
Saphenous veins. These veins are removed from
your leg, and then sewn from youraorta to the
coronary artery below the site of blockage. Minimallyinvasive saphenous vein removal may be performed
and results in less scarring and a faster recovery.
Radial artery. There are two arteries in the lower
part of the arm, the ulnar and radial arteries. Most
people receive adequate blood flow to their arm from
the ulnar artery alone and will not have any side
effects if the radial artery is removed and used as a
graft. Careful preoperative and intraoperative tests
determine if the radial artery can be used. If you have
certain conditions (such as Raynaud's,carpal tunnel
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syndrome, or painful fingers in cold air) you may not
be a candidate for this type of bypass graft. The
radial artery incision is in your forearm, about 2
inches from your elbow and ending about 1 inch from
your wrist. If you have this type of bypass, you willprobably be prescribed a medication called a calcium
channel blockerfor about six months after surgery to
help keep the radial artery open. Some people report
numbness in the wrist after surgery. However, long-
term sensory loss or numbness is uncommon.
The gastroepiploic artery to the stomach and the
inferior epigastric artery to the abdominal wall are
less commonly used for grafting.
It is common for three or four coronary arteries to be bypassed during surgery. A coronary
artery bypass can be performed with traditional surgery (see below) or with minimally invasive
surgery (see below). Your surgeon will review your diagnostic tests prior to your surgery to
see if you are a candidate for minimally invasive bypass surgery.
(continued)
How Is Traditional Heart Bypass Surgery Performed?
During traditional heart bypass surgery, a surgeon makes an incision (about 6 to 8 inches)
down the center of your sternum (breastbone) to get direct access to your heart. You are
connected to a heart-lung bypass machine (called "on-pump" surgery), which allows for
circulation of blood throughout your body during surgery. The heart is stopped and the
surgeon then performs the bypass procedure described above. The heart is generally
stopped for about 30-90 minutes of the 4-5 hour surgery.
After surgery, the surgeon closes the breastbone with special sternal wires and the chest with
special internal or traditional external stitches.
What Is Off-Pump Heart Bypass Surgery?
"Off-pump" or beating heart surgery allows surgeons to perform surgery while the heart is still
beating. The heart-lung machine is not used. The surgeon uses advanced operating
equipment to stabilize (hold) portions of the heart and bypass the blocked artery. Meanwhile,
the rest of the heart keeps pumping and circulating blood to the body.
With present technology, all coronary arteries can be bypassed off-pump. The off-pump
technique may be ideal for certain patients who have an increased risk of complications from
being placed on the heart-lung machine, such as those who have vascular disease, heavy
plaque buildup in the aorta (aortic calcification), carotid artery stenosis (narrowing or blockage
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in the arteries leading to the brain), priorstrokeor transient ischemic attacks (TIAs), or
breathing orkidney function problems.
Not all patients are candidates for off-pump surgery. According to the American Heart
Association, about 20% of heart bypass surgeries are performed off-pump. The decision to
use off-pump surgery is made at the time of surgery when the patient's heart and arteries can
be evaluated more closely.
What Is Minimally Invasive Heart Bypass Surgery?
During minimally invasive bypass surgery, the surgeon performs the surgery through a small
incision (about 3 inches) in the chest. It may be an option for some patients who require a left
internal mammary artery graft to the left anterior descending artery.
Some patients are also candidates for surgery using robotic-assisted techniques, allowing
surgeons to perform bypass surgery in a closed chest, beating-heart environment through
even smaller keyhole incisions.
The benefits of minimally invasive bypass surgery include:
A smaller incision, thus a smaller scar.
A shorter hospital stay. In some cases, only 3 days
are needed (instead of the average 5 to 6 days for
traditional surgery).
Shorter recovery time.
Other benefits may include:
Less bleeding.
Less potential for infection.
Less pain and trauma.
Talk to your doctor to see if minimally invasive heart bypass surgery is right for you.
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